Bronchoscopy
A bronchoscope is a thin flexible tube (fitted with a tiny camera) that is inserted into the windpipe under anaesthesia to allow direct visualization of the bronchial tubes. Samples and biopsies may be taken to plan treatment decisions. The choice of procedure, risks and alternatives will be discussed with your treating doctor prior to the bronchoscopy.
It is important to fast prior to your procedure, as well as follow any instructions regarding the dose and timing of medications, especially diabetic and blood thinning medications (including fish oil, krill oil, ibuprofen etc). Again, details of this will be discussed during your consultation.
Usually, you will be able to go home from your procedure the same day. It is important that a responsible adult can drive you home and stay with you that night. This is because of the sedating medication you are given for the procedure.
When you attend for your bronchoscopy there will be several people in the room. The bronchoscopy team work together to ensure the procedure is safe, successful and efficient.
· Proceduralist (Alex, Lauren or Tom)
· Anaesthetist and anaesthetic nurse
· Airway Nurse
· Scout Nurse
· Radiographer
· Cytology scientist
Standard bronchoscopy
In a standard bronchoscopy, the camera is inserted into the windpipe and the airways are examined sequentially. A standard bronchoscopy is performed investigate a range of problems including haemoptysis (coughing up blood), chronic cough and to obtain samples to allow targeted treatment of infection.
After anaesthesia, a standard bronchoscopy generally takes 10-15 minutes to perform.
Endobronchial ultrasound (EBUS)
EBUS is a major advance in the diagnosis of abnormalities in the chest and allows for highly targeted accurate sampling of the lung and lymph glands. There are two EBUS techniques – EBUS transbronchial needle aspiration (EBUS TBNA) and the EBUS Guide Sheath (EBUS GS).
EBUS TBNA - Using a specialized bronchoscope, the lymph glands adjacent to the large airways can be identified and sampled using a small needle. This test is usually performed to investigate enlarged lymph nodes which is usually due to inflammation, sarcoidosis or cancer.
EBUS GS - Using a small thin flexible ultrasound probe and a standard bronchoscope, small nodules in the periphery of the lung may be identified and biopsied. This procedure is undertaken to characterize lung nodules or masses. During the procedure, a radiographer will use x-rays to ensure the correct placement of the instruments.
After anaesthesia. an EBUS bronchoscopy can take between 20-40 minutes to perform.
Endobronchial cryobiopsy
This investigation is performed to obtain larger pieces of the lung for analysis. Generally, this is performed to understand interstitial lung diseases (inflammatory or scarring lung diseases). The test may be able to provide enough information to avoid a more invasive procedure, for example surgical lung biopsy. A radiographer is present during the procedure to ensure the correct position of the cryoprobe using an x-ray before biopsies are taken.
A cryobiopsy takes approximately 30 minutes to perform.
Pleural disease
The lining of the chest cavity is called the pleural space. Sometimes the space may be filled with fluid (a pleural effusion) or air (pneumothorax), which may impact upon breathing.
Pleural tap
A pleural tap or thoracentesis is a procedure that is performed to obtain a sample of the fluid to send to the laboratory. This is helpful to make a diagnosis and to relieve shortness of breath.
A pleural tap takes about 20 minutes and is done under local anaesthetic using ultrasound.
Intercostal catheter
Sometimes the volume of fluid or air is such that an intercostal tube is required. This is a small tube placed into the pleural space to allow all the fluid or air to drain. Once placed, the tube may be left for several days.
An intercostal catheter is placed under local anaesthetic using ultrasound. The procedure takes around 20 minutes.