About Your Flexible Bronchoscopy

This information will help you get ready for your flexible bronchoscopy at Memorial Sloan Kettering (MSK).

A bronchoscopy is a procedure that lets 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 wash your airways with a saline solution 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 to get rid of tissue, or placement of a stent (hollow tube that helps keep your airway open). If you need a stent, read 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 get ready 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, take the B elevator to the 6th floor 
  • In the endoscopy suite at 1275 York Avenue, take the M elevator to the 2nd floor
 

If you’re having your bronchoscopy done in the operating room read the “Presurgical testing” section for more information.

If you’re having your bronchoscopy done in the endoscopy suite, read the section “Talk with your endoscopy nurse” and skip the “Presurgical testing” section.

Before Your Procedure

Presurgical testing

If you’re 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 your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your procedure). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your procedure.

It’s very helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Talk with your endoscopy nurse

If you’re 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’re having and review the instructions listed in this resource with you. Your nurse will also ask you questions about your medical history and all the medications you’re taking.

Getting ready for your procedure

You and your healthcare team will work together to get ready for your procedure.

Help us keep you safe during your procedure by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications prescribed by a healthcare provider), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia (medication to make you sleep during procedure) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.
 

About drinking alcohol

The amount of alcohol you drink can affect you during and after your procedure. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your procedure. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your procedure to keep from having problems:

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your procedure is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask your healthcare provider questions about drinking and procedure. As always, all of your medical information will be kept confidential.

About smoking

If you smoke, you can have breathing problems when you have procedure. Stopping even for a few days before procedure can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program by calling212-610-0507.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after procedure.

 

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP machine) for sleep apnea, bring it with you the day of your procedure.

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner (medication that affects the way your blood clots), ask the doctor performing your procedure what to do. Their contact information is listed at the end of this resource. Whether they recommend you stop taking the medication depends on the reason you’re taking it.

Do not stop taking your blood thinner medication without talking with your doctor.

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®)  

If you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®) or naproxen (Aleve®), you may need to stop taking them 2 days before your procedure.

 

Read our resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). It has important information about medications you’ll need to avoid before your procedure and what medications you can take instead

Medications for diabetes

If you take insulin or other medications for diabetes, ask the doctor who prescribes the medication what you should do the morning of your procedure. You may need to change the dose before your procedure.

Diuretics (water pills)

If you take any diuretics (medications that make you urinate more often), ask the doctor performing your procedure what to do. You may need to stop taking them the day of your procedure. Diuretics are sometimes called water pills. Some examples are furosemide (Lasix®) and hydrochlorothiazide.

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 (a letter that says you can the procedure) from your cardiologist (heart doctor) before your procedure.

Arrange for someone to take you home

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

Note the time of your procedure

A staff member from the Admitting Office will call you after 2:00 pm the day before your procedure. If you’re scheduled for a procedure on a Monday, you will be called on the Friday before.

The staff member will tell you what time you should arrive at the hospital for your procedure. They will also tell you where to go on the day of your procedure. If you don’t receive a call by 7:00 pm, please call212-639-5014.

If you need to cancel your procedure for any reason, call the doctor who scheduled it for you.

Instructions for eating and drinking before your procedure

12 ounces of water
  • 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.
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The Day of Your Procedure

Things to remember

  • Take the medications you were instructed to take the morning of your procedure with a few sips of water.
  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during a procedure can damage your eyes.
  • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
  • Remove any jewelry, including body piercings.
  • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
  • Before you’re taken into the procedure room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.

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, or any other medications for breathing.
  • Your cell phone and charger.
  • Only the money you may want for small purchases (such as a newspaper).
  • A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
  • Your Health Care Proxy form and other advance directives if you have completed them.

Where to Park

MSK's parking garage

MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

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’s a tunnel that you can walk through that connects the garage to the hospital.

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.

What to expect

You will be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having a procedure 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 with your nurse before your procedure. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse will place an intravenous (IV) line into one of your veins, usually in your arm or hand. 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).

Meet with your anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your procedure.
  • Talk with you about the kind of anesthesia you will have.
  • Answer your questions about your anesthesia.
Figure 1. The path of the bronchoscope during your bronchoscopy

Figure 1. The path of the bronchoscope during your bronchoscopy

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 into 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), to see the tissue better.

The flexible bronchoscopy usually takes about 45 minutes to 1 hour.

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After Your Procedure

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your procedure, you will be in the Post-Anesthesia Care Unit (PACU).

A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. If you had a lung biopsy, you may have a chest x-ray to make sure your lung wasn’t damaged. This type of injury is rare.

Once you are fully awake, your nurse may give you a drink and will take out your IV. Your doctor will talk with you and the person taking you home after your procedure to discuss how it went. 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 you had a stent placed in your lung, you will get instructions on how to take care of it.

At home

  • You may have a sore throat, a low-grade fever (below 101° F or 38.3° C), cough up a small amount of blood, or all 3 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 your sore throat. Avoid eating spicy foods and smoking.
  • You may cough up streaks of blood. This is normal after having this procedure. However, call your doctor’s office if you cough up more than 1 teaspoon of blood.
  • You can resume your usual activities after your procedure.
  • A nurse will contact you the day after your procedure to ask how you’re doing.
  • If you had any tests done during your flexible bronchoscopy, call your doctor’s office in a few days to get the results.
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Call Your Doctor or Nurse if You:

  • Have a fever of 101° F (38.3° C) or higher
  • Have trouble 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 more than 3 days after your procedure
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