Endobronchial ultrasound (EBUS)

Why do I need an EBUS?

Your doctor will explain to you why you need this procedure however a common reason is to investigate the cause of enlarged lymph nodes found in the centre of the chest.

Are there any alternatives?

Other imaging, such as x-rays, may give us some information about your lungs and lymph nodes, but there are only two ways of getting samples from the lymph nodes in the centre of your chest - either a surgical procedure (called a mediastinoscopy) or an EBUS procedure.

The surgical procedure is performed under general anaesthetic, would usually involve you being admitted to hospital and is performed through an incision at the top of the chest. EBUS is generally much more comfortable, does not involve any surgical incisions and does not require you to be admitted to hospital overnight. EBUS is performed under local anaesthetic and sedation and normally takes around 45-60 minutes. EBUS is just as good as the surgical procedure at getting the correct diagnosis

What happens on the day?

An EBUS is normally a day-case procedure which means that you can come in and go home on the same day.

Please arrive at the appointment time stated on your letter. Your procedure will be carried out as near as possible to this time, however in order to ensure safe running of the list due to individual circumstances and emergency cases, there may be delays so please be patient with us.

• Please do not bring any valuables with you.
• Please do not wear any nail varnish, lipstick or jewellery (tongue and nose studs must be removed).
• Please bring a contact number of a friend or relative.

A nurse will check your details including medications with you. They will also perform some baseline observations.

A doctor will go over the procedure with you and answer any questions you may have. You will be asked to sign a consent form at this time.

In the procedure room

A cannula (a small needle) will be inserted into the back of your hand to allow us to give you some sedation.

You will be asked to lie down on an examination couch.

A clip will be attached to your finger to allow us to monitor your oxygen levels and heart rate. We also administer a small amount of oxygen via a tube placed in your nose.

The doctor will spray the back of your throat with an anaesthetic spray to make it numb, as well as giving you some sedation. A mouth guard will then be placed between your teeth to prevent you biting on the scope. The doctor will then pass the scope through your mouth and will spray more anaesthetic to your airways. This may make you cough, which is normal.

Samples will then be taken from the lymph nodes in the middle of your chest via the scope.

This will not be painful.

The whole procedure will take approximately 45 - 60 minutes.

After the procedure

You will be taken to the recovery area to rest and be monitored by nurses.

You will remain on oxygen for about one hour or until your oxygen levels have returned to normal.

You will not be able to eat and drink for about two hours after the test to allow the anaesthetic to wear off. After this you can eat and drink normally.

You will normally be allowed to go home approximately two hours after the test has finished. After sedation it is essential that a responsible adult comes to pick you up and accompany you home via car or taxi. Public transport is not suitable. Please note the unit closes at 18:00. Your relative/friend should arrive no later than 17:30.

Sedation can impair your reflexes and judgement for the next 24 hours. We therefore advise you rest quietly with someone to look after you for the next 24 hours.

For 24 hours after your procedure you must not:

• drive a car
• drink alcohol
• take sleeping tablets
• operate any machinery or electrical items – even a kettle
• sign any legally binding documents
• work at heights (including climbing ladders or onto chairs)

When will I know the results of the test?

When people have sedation it can impair their memory therefore we tend not to discuss the findings of the test on the day. Any samples that were taken normally take at least one week (sometimes longer) to be analysed. The doctor who organised your test will receive the results of your test and will contact you as required.

Are there any risks to having an EBUS?

EBUS is generally considered a safe and well tolerated procedure; however as with any procedure there are some side effects/risks involved.

Common but less serious risks

• Streaks of blood in sputum – this is normal for a few days after the test
• Sore throat
• Fever

Minor complications which occur less commonly

• Breathlessness can occur after the procedure but usually settles before you go home
• Spasm of vocal cords
• Air leakage outside the lung, which can be left to settle or sometimes requires tube drainage
• Inflammation of the area sampled

Major complications which occur rarely

• Major bleeding – if you cough up a large amount of blood (e.g. an egg cup full) then you should contact your doctor straight away
• Stopping breathing
• Unusual heart rhythms (arrhythmias)
• Chest infection (pneumonia)
• Fluid on the lung

Information for people who are on blood thinning medications

• Aspirin – Can continue as normal
• Clopidogrel/ticagrelor/Dipyridamole – must be stopped seven days before procedure
• Warfarin – must be stopped 5 days before procedure. We will arrange for you to have your INR checked beforehand to ensure it is back into normal range
• pixaban/rivaroxaban/edoxaban – must be stopped 48 hours before procedure

Occasionally if you have a more complex condition (for example a metallic heart valve) your doctor will advise you on what to do with your blood thinning medications.