Having an Endobronchial Ultrasound (EBUS)

Important information

You must phone us immediately if:

• you are taking any blood thinning medication such as aspirin, clopidogrel, warfarin, rivaroxaban, apixaban or others (please ask your doctor if you are unsure about any of your tablets
• you have had a heart attack within the last six weeks
• you need oxygen at least 16 hours a day
• you have recently had or been exposed to tuberculosis you are diabetic and have concerns.

You must organise for someone to accompany you home from hospital and stay with you overnight after the procedure because you will have had a sedative.

You cannot drive yourself home or travel unaccompanied.

A responsible adult must be available to stay overnight with you. Otherwise you may need to be admitted to hospital overnight after your procedure. You must let us know if this is an issue on the telephone number at the end of this leaflet as soon as possible in order for us to make arrangements.

You must not eat within four hours of your appointment time.

You must not drink, including water, within four hours of your appointment time.

The procedure usually takes about 40 minutes and you are likely to be in hospital for a total of four hours. There is no need to bring overnight clothes as this a day case procedure. Please try to leave valuables at home.

What is an EBUS?

It is a procedure that allows us to look into your lungs and to take samples of cells from the glands or abnormal lumps in the centre of your chest with the aid of ultrasound scanning (using sound waves). The ultrasound allows us to take samples from areas of the chest that could otherwise be difficult to reach, such as next to a blood vessel.

Why do I need an EBUS?

Some of the common reasons why an EBUS may be carried out include:

• To investigate large glands in the middle of the chest
• To identify and diagnose conditions such as tuberculosis or sarcoidosis
• To diagnose lung cancers that lie outside the main airways within the lung
• To determine if an individual cancer has spread to the glands in the middle of the chest (this alters the type of treatment that may be offered).

The doctor who referred you for an EBUS will explain why you need this test.

Is there an alternative test that I can have?

The alternative to an EBUS is usually an operation called a mediastinoscopy, which involves a cut (surgical incision) in the neck, a general anaesthetic and an overnight stay in hospital. The EBUS procedure can be done under a sedative as a day case with a shorter recovery time.

How do I prepare for my EBUS?

You will need to provide an up-to-date list of all your medication, allergies and any medical conditions. It is vital you let both us, and the doctor who referred you, know if you are taking any blood thinning medication (such as warfarin, aspirin, clopidogrel or rivaroxaban, apixaban or similar) or if you are diabetic. We can be contacted on the number provided. You should take all of your usual morning medications unless advised otherwise by your doctor or ourselves.

You must not eat or drink anything (including water) for four hours before the procedure.

What will happen before the EBUS?

You will be met by a nurse who may ask you to change into a hospital gown and will carry out a series of pre-procedure checks (glasses and/or false teeth will be removed before the procedure). The doctor will talk you through what will happen and you will have the opportunity to ask any questions before signing a consent form. A loose clip (finger probe) will be attached to your finger or ear so that we can monitor the oxygen levels in your blood and your heart rate during the procedure. A tiny plastic tube (cannula) will be inserted so that we can give you medication to relax you. You will also be given some oxygen into your nose or mouth.

What happens after the procedure?

You will be looked after by a nurse until you are awake enough to leave. Your breathing rate, pulse and blood pressure will be checked. You may have a chest x-ray. You may cough up small amounts of blood – please inform the nurse if you cough up more than a tablespoon of blood, have chest pains or difficulty breathing. When you have come round from the sedation sufficiently, you will be offered a drink and a small bite to eat. If you tolerate these well, you will be allowed to go home.

Can anything go wrong?

An EBUS is a safe procedure with little risk, and complications are relatively rare. There is a small chance of infection and bleeding associated with the procedure, but every effort is made to prevent this from happening. Air can also sometimes leak into the space surrounding your lung during the procedure, but this is not usually a problem and the air can be taken out with a needle and syringe or, in some instances, a drain (little plastic tube) needs to be inserted and left inside for a couple of hours to drain the air out. Occasionally patients take a longer time to recover after the procedure and may need to be admitted to hospital for observation.

Are there any adverse effects?

Most patients have very few after effects.

However, you are likely to feel sleepy for the rest of the day and into the next morning. Your throat may be numb for an hour or two and you may have a mild sore throat for a couple of days. There may be discomfort in the chest or the throat, but this is temporary for a day or so. You may also experience a feeling of congestion in the chest, and there is a one in 10 chance of a mild fever that should settle by itself. These can all be treated with paracetamol or ibuprofen if required. Due to the sedative you may not remember much about the test.

It is likely you will cough up a small amount of blood due to the biopsy procedure and the telescope. This should subside within a day or so. If it doesn’t, or if a large amount of blood comes up either all at once or over a period of time, you should contact us on the numbers below or attend your local emergency department. If you develop discomfort in the chest or increased difficulty breathing, you should attend your local emergency department immediately.

Like all tests, EBUS does not offer a 100% chance of finding all the answers, although the success rate for this procedure is good. There is a chance that you may need other procedures as well as the EBUS to help in your diagnosis/treatment plans.

Going home

You must be accompanied home by a relative, friend or carer and have someone stay with you overnight because you have had a sedative. You must not go home alone or use public transport. If no-one is available please let us know so that we can arrange for you to be admitted to hospital.
You must not drive, drink alcohol or operate machinery for 24 hours, or sign legal documents for 48 hours following the procedure.

Results

The results will be sent to the doctor who requested the procedure and they will contact you when they have received them. If you have not heard within a week, please contact them for an appointment. Results cannot be given on the day, as it takes time for the samples to be reviewed.

Contact numbers

We hope that you have found this information useful. If you have any questions or are worried about anything, please speak to the following Dorset County Hospital staff:

Endoscopy booking office: 01305 255225
Respiratory secretaries: 01305 255259

About this leaflet

Authors: Endoscopy team
Written: September 2020
Approved: September 2020
Review date: September 2023
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk