# Diagnostic flexible bronchoscopy and EBUS: preparation, sedation and aftercare

Source: https://onco.cc/protocols/diagnostic-bronchoscopy-and-ebus-preparation/  
OnCo record `diagnostic-bronchoscopy-and-ebus-preparation` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A bronchoscopy passes a thin flexible camera into the airways to look and take samples; EBUS adds an ultrasound probe to sample lymph nodes in the chest, often to diagnose or stage lung cancer. You usually stop eating 4 hours before and clear fluids 2 hours before, have a numbing spray and usually sedation, and must not drive for 24 hours. Tell the team about blood thinners.

## Summary

BTS 2013 (graded A to D, with good practice points) remains the most recent national guideline for diagnostic flexible bronchoscopy in the UK. Before: verbal and written information (Grade C); a staging chest CT before bronchoscopy for suspected lung cancer (Grade D); no food for 4 hours and clear fluids until 2 hours (Grade D); coagulation tests only when there are clinical risk factors (Grade D); clopidogrel stopped 7 days before endobronchial or transbronchial biopsy while low-dose aspirin continues (Grade C), anticoagulants per published guidance; asthma and COPD optimised; ideally a 4-week wait after myocardial infarction. Anticholinergic premedication is not used (Grade A), and antibiotic prophylaxis is not warranted (Grade B).

During: intravenous sedation is offered unless contraindicated (Grade B), titrated so verbal contact is possible at all times, with midazolam the preferred drug (Grade B), no more than 5 mg drawn up initially under 70 years and 2 mg over 70, and only 1 mg/ml midazolam stocked; a short-acting opioid such as fentanyl may be added, given first (Grade B for combination). Topical lidocaine (Grade A), at the lowest effective dose with the total recorded. Continuous pulse oximetry (Grade C), oxygen for significant prolonged desaturation (Grade D), intravenous access until discharge, and a safety checklist for every procedure (BTS Quality Standard 2b).

After: written information on post-bronchoscopy fever (Grade C) and, after transbronchial biopsy, on delayed complications such as pneumothorax (Grade D), with a chest X-ray if symptoms suggest one; no driving, legal documents or machinery for 24 hours after sedation. For EBUS, BTS quality standards set a staging sensitivity of at least 88% and complications below 1%.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: bronchoscopy; flexible bronchoscopy; EBUS; EBUS-TBNA; endobronchial ultrasound; camera test into the lungs; bronchoscopy sedation; bronchoscopy fasting; transbronchial biopsy

## Connected records

- protocols: [Anticoagulants and antiplatelet drugs around elective endoscopy and endoscopic biopsy](https://onco.cc/protocols/anticoagulants-and-antiplatelets-before-endoscopy/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/)
- technologies: [Robotic and navigational bronchoscopy](https://onco.cc/technologies/robotic-bronchoscopy/)
- terms: [Bronchoscopy (EBUS, robotic navigation)](https://onco.cc/terms/bronchoscopy/), [Endobronchial ultrasound (EBUS-TBNA)](https://onco.cc/terms/ebus-tbna/)

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