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Bronchoscopy

What is a Bronchoscopy?

This is the endoscopic examination of the airways this includes your throat, voice box, your windpipe then your lungs. The procedure will takes place either in the Endoscopy suite or Theatre in your hospital. You can have either a Rigid Bronchoscopy or more commonly a Flexible Bronchoscopy. If you have a rigid endoscopy this will be done in an operating theatre under a general anaesthetic. If you are having a flexible bronchoscopy this will be done under local anaesthetic possibly with some sedation, this means that you will not be anaesthetised, and will be able to co-operate but will not  really recall much of the procedure.

  • Rigid bronchoscopy: A rigid bronchoscope is a straight, hollow, metal tube. It is usually used when there is a foreign body /something stuck in the throat, or if there is excessive bleeding.

  •  Flexible bronchoscopy: A flexible bronchoscope is a long thin scope that contains small clear fibre optics that transmits light and images as the tube bends. It is able to penetrate much further into the branches of the lungs

The aim of the procedure is to note abnormalities, take biopsies of tissue, or brushings of cells for cytology, or to remove foreign objects. The procedure can usually be done as a day case which means you can go home a few hours after the procedure has finished

Risks:

The risks vary if you are having a rigid or flexible bronchoscopy. With a rigid you have a metal stiff tube being put down your throat, the risks therefore involve the tearing of the mucosal layers in the throat and windpipe and possible damage to the vocal chords. With a flexible these risks are greatly reduced although biopsies taken can lead to bleeding and in only a small minority of cases a pneumothorax (the presence of air in the cavity surrounding the lungs)

Following the guidelines set out by N.I.C.E. National Institute for Health and Clinical
Excellence you doctor will already have sent you for a chest X-ray and a CT scan before you have your bronchoscopy.

The procedure will have been requested because you may be suffering from a one or more of these symptoms:

  • You have had long term trouble breathing
  • Have had chest pain
  • Have been exposed to asbestos
  • Have been coughing up blood
  • Have had a long term cough
  • You have developed a husky horse voice
  • Unexplained weight loss
  • You have had glands up in your neck or above the collar bone
  • You have had an x-ray that indicates a shadow on the lungs

Preparation:

You will have been provided with a leaflet which should explain about the unit you will be attending. You will need to stop eating or drinking at least four hours before the procedure, some doctors will allow you to continue drinking clear fluids up to two hours before they begin.  These fasting times can be different if in doubt please check with staff at the hospital.  You will be given a medicine which will dry up the saliva in your mouth do not be concerned as this is to help with the procedure. You may also be given medicine which will make you feel relaxed and a bit drowsy.

The Procedure:  flexible bronchoscopy

  • You will not be required to change into a gown for this procedure

  • The bronchoscope is very thin less than the width of a biro

  • You will be made comfortable on a examination couch or trolley either in a semi seated position or lying flat with a pillow under your head

  • You will be given a sedative injection in the back of the hand to help you relax further, you will not be anaesthetised, and will be able to co-operate with the surgeon

  • You will also be given local anaesthetic in your throat to prevent you gagging on the fiberoptic instrument as it is passed.

  • You will be attached to various pieces of monitoring equipment like a blood pressure cuff on your arm, a pulse oximeter which goes on your finger and counts your heart beat and analyses the amount of oxygen circulating your body and ECG electrodes which monitor your heart beat.

  • The bronchoscope is usually passed up into the nose where it travels down the back of the throat past the vocal chords, it is important to note that you should not try to talk during the procedure as you may damage your chords if you do so

  • If they are unable to pass the bronchoscope through the nose they will put a mouth guard in between your teeth and go via your mouth

  • Biopsies of tissue, cells, and fluid  in your windpipe or lungs can be taken via the bronchoscope these will be sent to the laboratory for analysis

  • The procedure can be mildly unpleasant as the movement of the scope can make you gag

  • After the procedure you will remain in the unit being monitored by the nursing staff until your gag reflex in your throat has returned, and the sedative has worn off, this usually takes between two and four hours

  • You will have a chest x-ray before leaving to go home to check there is no air in the pleural cavity

  • You may need to remain in hospital if there are any complications with the procedure

After the Procedure:

You will not be able to drive yourself home after this procedure due to the effects of the sedative; you will need someone to stay with you over night to make sure you are okay. You will probably suffer from a soar throat and possible loose your voice for a few days, gargling and sucking throat lozenges can relieve this. When you go home you need to be aware that if you have symptoms of:

  • Sudden sharp chest pain
  • Coughing up large quantities of blood
  • Difficulty with breathing
  • Or a high temperature

You will need to contact the hospital to speak to one of the members of staff in the department, or the doctor.

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