Diagnostic Bronchoscopy

You are required to fast for at least six hours prior to admission.  You will be discharged a few hours after the test is complete and will need to be collected to go home.  You are not allowed to drive yourself home.  Although a light anaesthetic is used, some general precautions still apply.  You should rest for the remainder of the day and avoid any activities that rely on memory, such as complicated banking or making investments!

The anaesthetist inserts an intravenous drip through which sedative medication and then a light anaesthetic is given.  You will have no awareness during the test and often people are surprised when they wake up thinking that they haven’t had the test at all!  Once you are anaesthetised, we lubricate the bronchoscope with anaesthetic jelly and ease it down the nose and the back of the throat, and then using anaesthetic spray, ease our way down past the voice box and into the windpipe, and thereafter into all of the branches and openings that we can reach.  The procedure is usually complete within 15 minutes, but if there is something complicated such as clearing phlegm or taking biopsies, it may take longer.  We try to take photographs to show you at a later date, particularly where there is something interesting.

During the procedure we routinely use salty water to irrigate and then suck it back into a container, before sending it off to the laboratory for microbiology and cell analysis.  This is called bronchial washings.  In addition, we use a microscopic brush to get cellular material (called bronchial brushings).  We often use microscopic forceps which pass through the bronchoscope and take biopsies of the airways for analysis under the microscope.  This is the standard bronchoscopy procedure for which we ask you to consent.  It is common to have some minor irritation in the throat following the procedure and not unusual to cough up some specs of blood over the succeeding 24 hours or experience a slight fever the next day.  These affects usually settle within 48 hours.

We may occasionally push the biopsy forceps further and take a small section of lung tissue.  This is called a transbronchial biopsy.  In this instance, we generally aim to get at least two but usually four and sometimes six pieces of lung tissue.  It is not uncommon to have some bleeding and occasionally this may be very major.  We therefore ask for your added consent for transbronchial biopsies.  There may be a minor leakage of air called a pneumothorax as a result and we may ask for a chest x-ray to check on this as a matter of routine.  Transbronchial biopsies are usually performed with x-ray equipment helping us to guide the biopsy forceps into their intended location.  Very rarely is there a critical situation with bleeding or air leakage which may prolong your hospitalisation.

Most results are available within five days, but often the washings are left to incubate for a number of weeks in case there are slow growing organisms present.  A full report may therefore not be available for up to eight weeks in certain situations.

After the test, you will be moved to recovery and fairly quickly come to your senses, usually within the hour and eat a sandwich within two hours.  Most people are out the door after two hours.  We will try to speak with you after the test, particularly if there is something that needs to be organised as a result of what was found.  Unless we specifically instruct you otherwise, we would expect to see you two weeks after the bronchoscopy procedure to discuss the results in detail.