This information will help you prepare for your flexible bronchoscopy at Memorial Sloan Kettering Cancer Center (MSK).
A bronchoscopy is a procedure that allows your doctor to look inside your lungs using a flexible tube with a camera. During the bronchoscopy, your doctor may take biopsies (tissue samples) of your bronchi (main passageway into your lungs), lymph nodes, and lungs to see if any cancer cells are present. He or she may also do saline washings to clear your airways or lungs.
During your clinic visit, your doctor will explain the procedure to you and answer your questions. You will be asked to sign a consent form. How you prepare for your flexible bronchoscopy will depend on where you will have it done. Your bronchoscopy will be performed:
- In the operating room
- In the endoscopy suite
If you are having your bronchoscopy done in the operating room, you will need to have a Presurgical Testing (PST) appointment within 30 days of your procedure. Please see the section titled“30 Days Before Your Procedure” below. If you are having your bronchoscopy done in the endoscopy suite, you can skip the PST information and start reading the section titled “10 Days Before Your Procedure.”
30 Days Before Your Procedure
If you are having your bronchoscopy in the operating room, you will need to have a Presurgical Testing (PST) appointment within 30 days of your procedure. During this appointment you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medication to sleep during surgery). Your nurse practitioner will review your medical and surgical history with you, including your medications. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers. Please bring the following to your PST appointment:
- A list of all the medications you are taking, including patches and creams
- Reports of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study
- The name and telephone number of your doctor(s)
10 Days Before Your Procedure
Ask about your medications
You may need to stop taking some of your medications before your procedure. Review the information below carefully so you have time to discuss your medications with your doctor, if necessary.
- If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Some examples of blood thinners are aspirin, warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®).
- If you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve), you will need to stop taking them 7 days before your procedure. For a list of medications in this category and which medications you can take instead, ask for the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). If you take aspirin because you’ve had a problem with your heart, do not stop taking it until you talk with your doctor.
- If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure.
Get a letter from your doctor, if necessary
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
Arrange for someone to take you home
You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.
Partners in Care: (888) 735-8913
Caring People: (877) 227-4649
Prime Care: (212) 944-0244
3 Days Before Your Procedure
If you are having your bronchoscopy in the endoscopy suite, an endoscopy nurse will call you 3 days before your procedure. He or she will confirm the type of procedure(s) you are having and review the instructions listed in this resource with you. The nurse will also ask you questions about your medical history and all medications you are taking.
1 Day Before Your Procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call (212) 639-5014.
If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.
The Day of Your Procedure
Things to remember
- Do not eat or drink anything the morning of your procedure. This includes water, gum, and hard candy.
- Take only the medications your doctor told you to take the morning of your procedure. Take them with a sip of water.
- Do not put on any lotion, cream, powder, deodorant, make-up, or perfume.
- Remove any jewelry, including body piercings.
- Leave all valuables, such as credit cards and jewelry, at home.
- If you wear contact lenses, wear your glasses instead.
What to bring with you
- A list of the medications you take at home, including patches and creams
- Your rescue inhaler (such as albuterol for asthma), if you have one
- A case for your glasses
- Your Health Care Proxy form, if you have completed one
Where to park
Parking at MSK is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block toward First Avenue, on the right (north) side of the street. A tunnel connects the garage to the hospital. There are also nearby commercial garages: four on East 69th Street between First and Second Avenues and three on East 65th Street between First and Second Avenues. For questions about pricing, call (212) 639-2338.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having procedures on the same day.
After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first, you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleep during your procedure). When it’s time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart rate, breathing, and blood pressure. You will also receive oxygen through your nose.
You may be asked to gargle with a solution that will numb the back of your throat and stop your gag reflex during the procedure. Your doctor may spray some medication into the back of your mouth to numb your throat.
You will receive anesthesia through your IV. Once you are asleep, your doctor will insert a bronchoscope (a tube-like instrument with a small camera) into your nose or mouth. He or she will gently move it down the back of your throat and through the large and small airways leading into your lungs (see the pathway in Figure 1). If your doctor needs to take any biopsies, he or she may use fluoroscopy (live x-ray) or ultrasound (also known as endobronchial ultrasound,) for guidance as needed.
The bronchoscopy usually takes 45 minutes to 1 hour.
After Your Procedure
In the recovery room
You will wake up in Post-Anesthesia Care Unit (PACU). Your nurse will continue to monitor your heart rate, breathing, and blood pressure. If you had a lung biopsy, you may have a chest x-ray to make sure your lung was not punctured. This type of injury is uncommon.
Once you are fully awake, your nurse may give you a drink and will remove your IV. Your doctor will talk with you and the person taking you home after your procedure. If you were told to stop taking any medications before your procedure, ask your doctor when you can start taking them again. Your nurse will explain your discharge instructions to both you and the person taking you home before you leave.
- You may want to have someone stay with you the day of your procedure because you may still feel sleepy from the anesthesia.
- You may have a sore throat, a low grade fever (below 101° F or 38.3° C), and cough up a small amount of blood after your procedure. These side effects should go away within 3 days. Eating soft foods and sucking on ice chips or throat lozenges may help. Avoid eating spicy foods and smoking.
- A nurse will contact you the next day to ask how you are doing.
- If you had any tests done during the bronchoscopy, call your doctor’s office in a few days to get the results.
Call Your Doctor or Nurse If You:
- Have a temperature of 101° F (38.3° C) or higher
- Have difficulty breathing or shortness of breath
- Have chest pain or a feeling of pressure in your chest
- Cough up more than 1 teaspoon of blood or cough up any amount of blood for longer than 3 days