What is EBUS-TBNA?
EBUS-TBNA (EndoBronchial UltraSound-guided Transbronchial Needle Aspiration) is a safe and effective technique that allows the doctor to investigate your lungs and take samples of the lymph glands located in the chest. Lymph glands (sometimes called lymph nodes) are an important part of the immune system and are joined together by lymph channels; they are normally pea sized.
A thin flexible telescope (bronchoscope) is passed down the windpipe through the mouth. The bronchoscope is combined with high frequency sound waves, transmitted from the ultrasound probe at the tip of the bronchoscope. This allows a scanning of the surrounding lymph glands. These glands are located outside the breathing tubes and a fine needle is used to take samples.
This is day case procedure and done under conscious sedation and local anaesthesia.
An EBUS-TBNA is usually suggested if there are abnormal appearing lymph nodes identified on radiological scans. Sampling these lymph nodes may help your doctor to get the diagnosis and determine most appropriate route of treatment.
- EBUS is generally a very safe procedure with risk of serious complication being 1 in 1000
- Minor complications include cough, sore throat, hoarse voice, soreness in the chest and lung collapse.
- Occasionally you may cough up small streaks of blood; this usually settles without requiring further treatment. Occasionally you may develop a chest infection after the procedure. Please see your GP if you start to become more poorly.
- Occasionally your oxygen levels may drop during the procedure, and you may require extra oxygen for some time afterwards. If you are an outpatient, there is a small chance that you may need to be admitted to the hospital. This is more likely to happen if your oxygen levels are not normal before the procedure.
- Sometimes the airways constrict during or after the procedure (bronchospasm). This is usually relieved with a nebuliser.
- Very rarely this procedure has been known to cause death (fewer than 4 in 10,000 people). This risk is higher if your general health is poor, and lower if you are otherwise healthy.
Preparation prior to the procedure
- You will be asked to sign the consent at the time of booking for the procedure or on the day of the procedure.
- Please do not eat or drink anything for at least four hours before coming to hospital.
- Please do not wear jewellery, nail varnish or make up.
- Bring all your medications with you.
- Please come to reception at Gastro-enterology at the time you have been given.
- If you have allergies to any medications, please inform us.
For Patients taking blood thinning medications (anticoagulants and antiplatelets):
Please inform us at the time of booking for the procedure if you take Warfarin, Clopidogrel, Direct oral anti-coagulants (Rivaroxaban, Apixaban, edoxaban, dabigatran) Prasugrel, Dipyridamole or other blood thinning treatments including injections (eg. Low molecular weight heparins: Dalteparin) as these may need to be temporarily stopped before the bronchoscopy with a view to reduce the risk of bleeding during or after the procedure.
Risk and benefit of withholding or stopping the above treatment will be discussed prior to procedure.
For Patients who take insulin for diabetes:
- Your medication may need to be altered therefore, please contact your diabetic nurse 3 days before the procedure for advice.
- When you arrived at Endoscopy unit, a member of staff will take your name and a few details. A small needle will be placed in your arm to enable us to give you the sedative drug.
- Sedation
- We recommend you have sedation, but you will not be “put to sleep”.
- This will help you relax and make you more comfortable; you may not remember anything about the procedure afterwards.
- If you have been given sedation, you must not drive for 24 hours. Have a friend or relative to escort you from the unit to your home and someone need to stay with you overnight. You are also advised not to operate machinery, drink alcohol or sign any legally binding documents for 24 hours after the procedure.
- When your procedure is due to start you will be taken to bronchoscopy room. The back of your throat will be numbed with local anaesthetic. This taste bitter and has the side effect of making it difficult to swallow.
- A small plastic tube may be placed in your nose to give you extra oxygen. A small sensor is placed on one of your fingers to measure oxygen level in the blood.
- The doctor will then gently pass the EBUS bronchoscope to look inside the airways and take samples as required; you may be offered more anaesthetic or sedation to help address any discomfort you may feel during the procedure.
- If necessary, the doctor may take a ‘photograph’ of any abnormalities seen within the airways.
- The procedure usually lasts 30-40 minutes.
- The procedure will not hurt you and you will be able to breathe normally.
- It may make you cough as the bronchoscope goes into your airways.
You will be taken from the treatment room to the recovery area where you will rest on the trolley. You will be monitored until most effects of any medication given have worn off. After 1-2 hours you will be taken to the discharge area. You will be advised on when to start eating and drinking. If you require an outpatient appointment this will be sent by post. Please follow the written instructions you will be given on leaving the ward.
- If samples have been taken, the results may take up to a week.
- The details of the results and necessary treatment will be discussed with you by the referring doctor.
Additional Information
Please be aware on the day of your bronchoscopy you may be in the unit for up to four hours.
