Navigational bronchoscopy: patient information

What is navigational bronchoscopy?

Navigational bronchoscopy is a medical procedure where a small camera is used to look inside the lungs and take a sample of tissue. It is usually used to check nodules (lumps) within the lungs to find out whether they might be cancerous.

The steps below provide a short overview of how a navigational bronchoscopy is carried out.

Step 1: Pre-operative assessment and CT scan

Your doctor may refer you for a navigational bronchoscopy if a nodule is found either through a chest x-ray or CT scan.  

A few days before the navigational bronchoscopy, you will need to attend a pre-operative assessment. This will include: 

• Blood tests; 

• A recording of the activity of your heart, called an electrocardiogram (ECG); 

• Tests (skin swabs) for an infection called MRSA; 

• Blood pressure, height, and weight recording; 

• Seeing a specialist nurse or doctor take to your health history, examine you before the procedure, and answer any questions or concerns regarding the procedure. 

You may also undergo another CT scan. 

Step 2: The day of the procedure

In some cases, you will be admitted to hospital the day before the procedure. However, most people will be told to attend a Surgical Admissions Lounge (SAL) on the day of the navigational bronchoscopy. The hospital will let you know what time you’ll need to arrive for the procedure. 

Usually, you will be able to leave the hospital a few hours after your navigational bronchoscopy. However, in some cases you might be kept in overnight. You should bring a small bag with essentials such as nightclothes or medicines in case you do need to stay overnight. 

Once you’ve been admitted to SAL or the ward, a member of the nursing staff will help prepare you. This preparation will include: 

1. Filling out necessary paperwork; 

2. Checking you are fit to undergo the procedure;  

3. Providing you with any surgical garments you may need to wear. There will be a room to change your clothes and place your property in a property bag; 

4. Answering any questions you might have about the procedure; 

5. Signing a consent form which says that you understand the procedure and agree for it to take place. 

If you are a female under the age of 55 you will also need to take a pregnancy test. 

Once the surgical team are ready for you, a member of the team will come and collect you from the SAL or ward. Waiting times on the day differ depending on a number of factors. After the pre-operative checks, you’ll then be taken to the anaesthetic rooms where you’ll meet the anaesthetist.

Step 3: The procedure

When the theatre staff are ready for you, you will be moved to a room where the anaesthetist will explain the procedure and answer any questions. Once in the theatre, you will be given pure oxygen with a plastic mask to breathe it through. 

The anaesthetist will inject the anaesthetic medicines through a thin plastic tube into a vein in your back of your hand or arm. This will help numb your body and you will become unconscious within a minute or so. The anaesthetist will continue to monitor you and give you medicine to keep you unconscious throughout the procedure. 

While you are asleep, a small device with a camera (called a bronchoscope) will be passed through your mouth and into the airways. Using information from your CT scan, the bronchoscope is guided to the nodules which need to be looked at. Once the bronchoscope has reached the right area, images and a small sample (called a biopsy) of the nodules can be taken. 

The procedure usually takes 30-40 minutes to complete. 

Step 4: After the procedure

After the procedure is complete, you'll be transferred to the recovery unit. Here, you will gradually wake up from the anaesthetic. Nurses will check your blood pressure, pulse, oxygen levels, heart rate, breathing rate, and temperature. They will also check your blood sugar levels if you are diabetic. A chest x-ray will be taken to ensure your lung is fully expanded. 

After these tests, usually you will be released from the surgical day unit. However, you may be taken to the ward to continue recovering from the procedure (or anaesthetic) if needed. In some cases, you will be kept in overnight for monitoring. 

Most people are able to move around and eat and drink normally soon after the procedure. In the first 48 hours after your procedure, the effects of the anaesthetic mean you should avoid exercising, driving, or signing any legal documents. You should also have someone stay with you for the first 24 hours after the procedure.

How long does navigational bronchoscopy take?

The procedure itself is relatively quick, only taking 30–40 minutes. However, you should bear in mind that there will be some pre-operative assessments that will need to be completed before the procedure, as well as some post-operative checks to ensure you are fit to leave hospital.  

In most cases, including these checks, you will be in hospital for a full day. Some people will need to be in hospital for a night before or after the procedure. 

What are the side effects of navigational bronchoscopy?

While navigational bronchoscopy is a relatively safe procedure, it still does come with some risks. 

You are likely to experience some minor symptoms, which might include: 

• A sore throat, which will last for a couple of days to a few weeks.  

• Small amounts of blood coming out whenever you cough, which may last a few days. 

• Feeling light-headed due to low blood pressure. 

• Bronchospasm (tightening of the airways) which may cause a temporary cough or wheeze. 

• Damage to the lips or teeth. 

• Side effects of the anaesthetic such as sleepiness or nausea. 

There is also an increased risk of chest infections, but we will minimise these risks by helping you to sit up and be active as soon as possible following the procedure. 

A collapsed lung (pneumothorax) is a rare but serious complication of the procedure. If this happens, it will usually be identified while you are waking up in recovery. In some cases, a chest drain may need to be inserted to remove air from around your lung. If this happens, we will discuss proper wound care and advise you on when you can return to your usual activities after discharge from the hospital. 

Additionally, there is a risk that the procedure is non-diagnostic, meaning the results of the procedure do not give us a clear indication of whether you have a cancer in your lungs. In this case, you may need to have more tests scheduled.