This information will help you prepare for your flexible bronchoscopy at Memorial Sloan Kettering (MSK).
A bronchoscopy is a procedure that allows your doctor to look inside your lung airways using a bronchoscope (a flexible tube with a camera). The bronchoscope is placed in your mouth or nose and moved down your throat and trachea (windpipe), into your airways. During your flexible bronchoscopy, your doctor may take biopsies (tissue samples) from your airway, your lymph nodes outside your airway, or your lungs. They may also perform washings to clear your airways or lungs.
You may have other procedures done at the same time as your flexible bronchoscopy, such as an ultrasound, medical lasering, or placement of a stent (hollow tube that helps keep your airway open). If you may need a stent, ask your nurse for the resource Tracheal or Bronchial Stent Placement.
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 may be performed either:
- In the operating room at 1275 York Avenue, B elevator to 6th floor or
- In the endoscopy suite at 1275 York Avenue, M elevator to 2nd floor
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. See the section titled “Presurgical testing.” If you are having your bronchoscopy done in the endoscopy suite, you can skip the PST information and start reading the section titled “Ask about your medications.”
Before Your Procedure
If you are having your bronchoscopy in the operating room on the 6th floor, 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 done, 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).
If you are having your bronchoscopy in the endoscopy suite on the 2nd floor, an endoscopy nurse will call you before your procedure. They will confirm the type of procedure(s) you are having and review the instructions listed in this resource with you. Your nurse will also ask you questions about your medical history and all medications you are taking. You may have tests done, 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 may also recommend you see other healthcare providers.
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 that affects the way your blood clots, ask your doctor when to stop taking it. Some examples of these medications are listed in the table below.
|Examples of Blood Thinners|
|apixaban (Eliquis®)||dalteparin (Fragmin®)||meloxicam (Mobic®)||ticagrelor (Brilinta®)|
|aspirin||dipyridamole (Persantine®)||nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) or naproxen (Aleve®)||tinzaparin (Innohep®)|
|celecoxib (Celebrex®)||edoxaban (Savaysa®)||pentoxifylline (Trental®)||warfarin (Coumadin®)|
|cilostazol (Pletal®)||enoxaparin (Lovenox®)||prasugrel (Effient®)|
|clopidogrel (Plavix®)||Fondaparinux (Arixtra®)||rivaroxaban (Xarelto®)|
|dabigatran (Pradaxa®)||heparin (shot under your skin)||sulfasalazine (Azulfidine®, Sulfazine®)|
Whether they recommend you stop taking it will depend on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.
- If you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®) or naproxen (Aleve®), you may 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 insulin or other medications for diabetes, you may need to change the dose before your procedure. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure.
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
You must have someone 18 years or older take you home after your procedure. If you don’t have someone to do this, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.
|Agencies in New York||Agencies in New Jersey|
|Partners in Care: 888-735-8913||Caring People: 877-227-4649|
|Caring People: 877-227-4649|
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The Day Before Your Procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. They 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.
- Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
The Day of Your Procedure
- Take the medications you were instructed to take the morning of your procedure 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 contact lenses, wear your glasses instead.
- 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
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto 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 to the hospital. If you have questions about prices, call 212-639-2338.
There are also other 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.
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. People 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. You will meet your nurse. They 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’re asleep, your doctor will insert the bronchoscope your nose or mouth. They will gently move it down the back of your throat and through the large and small airways leading into your lungs (see Figure 1). If your doctor needs to take any biopsies, they may use fluoroscopy (live x-ray) or ultrasound (also known as endobronchial ultrasound), for guidance as needed.
The flexible bronchoscopy usually takes 45 minutes to 1 hour.Back to top
After Your Procedure
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 rare.
Once you are fully awake, your nurse may give you a drink and will 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 you and the person taking you home 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, 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.
- 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 you had any tests done during your flexible 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