Respiratory - Bronchoscopy with EBUS (Endobronchial ultrasound)

What is a Bronchoscopy with EBUS (Endobronchial ultrasound)?

Bronchoscopy with EBUS is a test which enables the doctor to examine the air passages with a special cameral. In the EBUS test, an additional special telescope is used, which has a small ultrasound probe at its tip, to enable the doctor to see the lymph glands in chest and take small samples from them using a needle.

The EBUS test is done with sedation. This means that you will need to arrange for someone to pick you up from the day case unit and stay with you overnight. If there are any problems with this, please contact the respiratory secretaries. You should not drive, drink alcohol, sign any legal documents or operate machinery for 24 hours afterwards.

Do I take my tablets on the day of the test?

If you are on any blood thinning tablets or injections (Warfarin, Synthrone, Clopidogrel, Ticagrelor, Prasugrel, Rivaroxaban, Apixaban, Dabigatran, Edoxaban or Dalteparin) then these will need to have been stopped prior to the procedure and you may need to be issued with alternative medicine. The doctor in clinic should have checked your medicines with you.

If you are taking any of these medicines and you have not been advised when to stop them or are unsure, please can you contact the lung nurses or respiratory secretaries to be advised when to stop these prior to the procedure.

You should take all other tablets as normal.

Allergies

It is important that you tell us if you are allergic to latex (rubber compounds). We use a small rubber balloon on the tip of the EBUS telescope and if you have an allergy to it, we will not be able to use the balloon.

We also use lignocaine, midazolam and fentanyl.

What happens on the day of the test?

You will be seen by a nurse on the admitting ward who will ask some basic questions about your health. You will be seen by a doctor who will explain the procedure and ask you to sign the consent form.

A small needle will be placed in your arm through which we will administer a sedative. A probe will be placed on your finger to measure the oxygen level in your blood. Extra oxygen will be given to you through a fine tube placed at the entrance to your nose and your mouth will be sprayed with a local anaesthetic.

The standard bronchoscope will be passed through your mouth into your lungs. Local anaesthetic will be sprayed onto your voice box and airways to make them numb which may make you cough. The procedure is not painful and does not restrict your breathing. Samples may be taken using the standard bronchoscope. You will then lie down flat and the EBUS camera will be passed through your mouth and specimens taken from the lymph glands with a needle.

The procedure will take about 30-45 minutes.

After the procedure you will be taken to the recovery area to wait until the sedation and local anaesthetic have worn off. The recovery time will be about 1 hour.

Are there any risks?

Bronchoscopy with EBUS is extremely safe. During the test you will be closely monitored by experienced staff. Minor side effects can include mild sore throat for a few days and mild fever which settles with paracetamol. If you start to cough up green phlegm or feel especially “chesty” in the few days following the test, this may be a sign of a chest infection. Your GP can advise you about the need for antibiotics.

Coughing up a small amount of blood after the test is to be expected and should settle in a day or two. More serious side effects are very rare but could include:

Bleeding – with all biopsy procedures there is a small risk of bleeding. However, this is rare as the ultrasound shows where the main blood vessels are so that puncturing them with the needle can be avoided.

Puncture of the lung (pneumothorax) – very rarely the needle can puncture and collapse the lung. This is called a pneumothorax and can be easily treated once recognised, either by simply observing you overnight in hospital or, very occasionally, by putting a small tube into the lung to allow the air to escape and the lung to re-expand.

Respiratory depression – the drugs we give to sedate you can slow your breathing down. For this reason, your oxygen levels are monitored throughout the test. If the doctor performing the test thinks your breathing is too slow, they can give you drugs to reverse the sedation.

There is a tiny risk of death of less than 1 in 3000.

What are the benefits?

The purpose of this test is to take samples from lymph glands inside the lungs in a safe and effective manner. By doing an EBUS, we may be able to avoid the need for a more complicated surgical procedure called a mediastinoscopy which is performed under general anaesthetic to sample the lymph nodes in the chest.

When will I get the results?

Most patients will be given an appointment to come to the clinic one week after the test. If the test has been arranged by another team or another hospital, your follow up will be arranged by them.

Who do I contact if I have a problem?

In the event of an emergency please dial 999 or contact the Emergency Department.

In the event of other queries prior to or following the procedure, please contact the lung specialist nurses, the respiratory secretaries or the lung pathway navigators. If you have a particular anxiety about this procedure before it is done, please let us know and we will do our best to reassure you.

Contact Numbers

Respiratory Secretaries:

Lisa Oliver (Oldham) 0161 627 8523
Victoria Mellor (Oldham) 0161 627 8524
Suzanne Toyne (Bury) 0161 778 2479
Louisa Barker (Bury) 0161 778 2636

Lung Specialist Nurses:

Oldham
Amanda Dand 0161 627 8527 (Weds-Thurs)
Chrissie Charlesworth 0161 627 8527
Angela Findlow 0161 656 1943
Natalie Howarth 0161 778 5481
Zoe Nichol 0161 656 1943

Bury
Lesley Valentine 0161 918 8583
Yasmin Hamdan 0161 778 3789
Paula Hall 0161 778 2693

Lung Pathway Navigators:

Dominique Stretch 07813 994614
Lucy Dixon 07814 829574

Please note: an answerphone service is available - please leave your full name and contact number when leaving a message and someone will return your call as soon as possible.

Your Bronchoscopy with EBUS has been arranged for:

Date and Time ………………………………………………………

Location ……………………………………………………………..

On the day of the test:

You may have something to eat or drink up to 4 hours before the test.

Please do not have anything to eat or drink after: ………………………………………………………………………….

You can take meds with a sip of water apart from ones that may have been stopped for the procedure e.g. blood thinning medication.

Please note that the timing of your procedure is not precise and there may be a delay due to several different factors such as the number and type of cases to be performed.