This information will help you prepare for your rigid bronchoscopy procedure at Memorial Sloan Kettering Cancer Center (MSK).
A rigid bronchoscopy allows your doctor to see the inside of the airways that lead to your lungs. During the procedure, your doctor can control bleeding, reduce the size of a tumor, place a stent, remove foreign objects, and take biopsies (tissue samples), as necessary.
A rigid bronchoscopy usually takes 60 to 90 minutes, although you will be in the hospital for most of the day because you will have had general anesthesia (medication that makes you sleep). In most cases, you will be able to go home the same day.
If you have any head or neck problems, such as stiffness, dental issues, surgery or radiation to the head or neck, or if you have rheumatoid arthritis, be sure to tell your doctor before your procedure.
Before Your Procedure
Within 30 days of your procedure, you will have an appointment for presurgical testing (PST). Your doctor's office will schedule this for you.
During your 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). He or she 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.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you take
- Reports of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study
- The name and telephone number of your doctor(s)
During your PST appointment, your nurse practitioner will tell you which medications you should take the morning of your procedure. Use the space below to write them down.
10 days before your procedure
You will need to stop taking some medications 10 days before your procedure. Your nurse will give you a resource called Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), which contains important information about these medications, and what you can take instead.
There are some medications that you may need to talk with your doctor about before your procedure. For example:
- If you take medication to thin your blood, ask the doctor who prescribes it for you if you should stop taking it. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, aspirin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), fondaparinux (Arixtra®), dabigatran (Pradaxa®), cilostazol (Pletal®), and rivaroxaban (Xarelto®), and there are many more. Do not stop taking these medications without speaking to your doctor first.
- If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes this medication for you what you should do the day before and the morning of 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.
In New York:
Partners in Care: (888) 735-8913
Prime Care: (212) 944-0244
In New York or New Jersey:
Caring People: (877) 227-4649
Note the time of your appointment
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 you are scheduled for your procedure 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.
Do not eat or drink anything after midnight the night before your surgery.
This includes water, gum, and hard candy.
The Day of Your Procedure
Things to remember
- Do not eat or drink anything the morning of your surgery. This includes water, gum, and hard candy.
- Take only the medications your doctor told you to take the morning of your procedure. You may have written them down on the first page of this guide. Take them with a few sips 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 contacts, wear your glasses instead.
What to bring with you
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), chest pain, or both
- 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 York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. For questions about prices, call (212) 639-2338.
There are also garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Where to go
Please arrive at the Presurgical Center at 1275 York Avenue (between East 67th and East 68th Streets). This is the main building of MSK. Take the B elevator to the 6th floor.
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.
You'll be asked to change into a hospital gown, and remove dentures, prosthesis, and eyeglasses, if you have any.
Your doctor will review the procedure with you, and your anesthesiologist will talk with you about your health history and place an intravenous (IV) catheter into a vein, usually in your hand or arm. Your nurse will check your heart rate, blood pressure, breathing, and temperature. Your healthcare team is available to answer any questions you have. When it's time for your procedure, you will be brought into the operating room.
During Your Procedure
Once you're in the operating room, you will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose or mouth. You will receive medication to make you sleepy through your IV.
Figure 1. Inserting the bronchoscope
Once you're asleep, your doctor will insert a bronchoscope (a tube-like instrument with a small camera) into your 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 figure). Your doctor may use a laser, electrocautery or cryotherapy to heat, burn, or freeze the tumor or sites of bleeding inside your airways. Your doctor may also place a stent (a hollow tube) inside your airways to keep them open (see the resource Tracheal or Bronchial Stent Placement). Your doctor may use fluoroscopy, a type of x-ray, during your procedure.
After Your Procedure
In the recovery room
You will wake up in the recovery room. Your nurse will continue to monitor your heart, breathing, and blood pressure. You may feel numbness in your throat. This is from medication used to make you more comfortable and reduce coughing, and it will go away shortly after you wake up. You may have a chest x-ray. This is to make sure your lung was not punctured during the procedure. This type of injury is rare.
Once you are fully awake, your nurse will give you a drink and a light snack and remove your IV. Your doctor may talk with you and the person taking you home after your procedure. If you stopped 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 of you before you leave. If your doctor placed a stent, you will receive instructions on how to take care of it.
- You may have a sore throat for 1 or 2 days. Throat lozenges, ice chips, and eating soft foods can help. You should avoid spicy foods and smoking.
- You may cough up streaks of blood. This is expected. However, call your doctor's office if you cough up more than 1 teaspoon of blood.
- You may resume your usual activities after your procedure.
- A nurse will contact you the next day to ask how you are doing.
- If tests were done during your bronchoscopy, call your doctor's office in a few days to get the results.
- If you need any additional equipment, such as nebulizer, it will be ordered through your doctor's office.
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
- Have severe pain, or pain for longer than 2 days