Biopsy Instructions

Bronchoscopy Instructions
Thoracoscopy Instructions: Pre-operative instructions "Preparing for Lung Surgery"
Thoracoscopy Instructions: Post-operative instructions "Do's and Don'ts After Surgery"
CT-Guided Fine-Needle Aspiration (Biopsy)

Bronchoscopy Instructions

You have been scheduled to have a bronchoscopy on ______________________ at __________ AM / PM.
Please check with your insurance company to see if prior authorization is needed and notify us if it is required.

Please read the following instructions carefully:

  • You MUST arrange to have someone (not a taxi) drive you home after the bronchoscopy. This requirement is for your safety. Although you will be observed for several hours after the procedure, you will still be affected by medications you will receive. If you do not have a responsible driver, the procedure will be cancelled. 
  • DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT the night before the bronchoscopy. If you take over-the-counter medication or any blood thinners including aspirin, please alert the physician. You may be asked to refrain from taking these medications before the procedure.
  • You should plan to arrive at University Medical Center 1 hour before the time of your procedure. Stop at Central Registration in the main lobby. Then report to the Endoscopy Suite on the 14th floor, north tower, of the hospital.
  • The nurse in the holding area will start an IV line (intra-venous; into a vein), give you the necessary medication, and perform a brief medical evaluation.

You should plan to be in the recovery area for about 2 hours after the procedure is over.
If you have any questions before the bronchoscopy, do not hesitate to call us at (631) 444-2981 during the day, or speak with the pulmonary physician on call at night or during the weekend at (631) 689-8333 (operator).

Thoracoscopy Instructions

Pre-operative instructions "Preparing for Lung Surgery"

Once the surgeon has reviewed your medical information and discussed with you what your options are, preparations can begin for your surgery. A date can be picked that takes into consideration both your time schedule and your surgeon's schedule. Once that date is chosen, you will also be given a date about 1-2 weeks ahead of your surgery day to come to the Cancer Center for pre-admission testing.

Pre-Admission Testing
All patients who need surgery require routine blood tests, a urine test, and an electrocardiogram (also known as ECG or EKG; a simple test that provides information about your heart health). This pre-admission testing will be done about 1-2 weeks ahead of your surgery day. Also at that visit you will meet with the nurse practitioner who will review your past medical history and complete a physical exam. It is very important that you tell us about all medications you take, and if you have any allergies.

Please make a list of all your medications including the dosages and how often you take them, and bring this list with you to that appointment. The nurse practitioner will discuss with you what medications you will continue and what should be stopped. In general, medications such as aspirin, clopidogrel (Plavix), and warfarin (Coumadin) will be stopped about a week before surgery to decrease the risk of bleeding at the time of surgery.

Other medications such as a multivitamin that contains vitamin E should also be stopped. If you are a diabetic, special instructions will be given to you about your oral medications and/or your insulin. The nurse practitioner will also ask you to sign a consent form giving your permission for surgery and anesthesia.

At this visit you will also meet with an anesthesiologist. This doctor will explain to you how you will be put to sleep for the procedure, and the different methods of controlling pain after surgery. Very often a catheter (thin tube), placed in your back prior to surgery, is used to help you manage pain after surgery. This special catheter is called an epidural catheter, and liquid pain medication is given to you through it.

An incentive spirometer will also be given to you. This is a device that helps you exercise your lungs after surgery, by taking deep breaths. It is normal for you to want to take shallow breaths after the surgery because of the pain; this device encourages you to take deep breaths.

To deep breathe with the incentive spirometer, do the following:

  • Exhale (breathe out) slowly until you cannot push out any more air;
  • Place the mouthpiece of the incentive spirometer between your lips, grasp it with your teeth, and close your lips over the mouthpiece;
  • Take a slow deep breath through your mouth only;
  • Hold your breath for 3 to 5 seconds;
  • Remove the mouthpiece; 
  • Exhale.
  • Repeat this exercise 5 to 10 times during every hour when you are awake.

After Surgery
When your surgery is completed, you will be taken to the recovery room, or post-anesthesia ICU (intensive care unit). The nurses there will monitor you until you are ready to be moved to the intermediate care unit of the hospital (16 South). Some patients, because of their other medical conditions, may require to be more closely monitored in an ICU overnight or a few days.

When you wake up you will notice that you are attached to a heart monitor, an IV line (intra-venous; into a vein), and a Foley catheter (thin tube in your bladder to drain urine). You will also notice that you have drainage tubes coming from the side of your chest where the surgery was performed; these tubes are called chest tubes and will drain fluid and air from around your lungs.

In general, patients have two chest tubes. These tubes will remain in for several days; usually, once they are all removed, you are ready to go home.

Exercises at Home
Some exercises increase the movement in your arm if they are done several times a day. These exercises help to prevent a condition called frozen shoulder (also known as adhesive capsulitis) that is characterized by stiffness, pain, and limited motion in the shoulder joint:

Raise your hand to touch your ear on the affected side. Try to walk your fingers over your head to reach your opposite ear.
Stand 1-2 feet away from a wall. With your affected arm extended toward the wall, walk your fingers up the wall as high as you can. With each attempt, try to walk your fingers higher on the wall.

Follow-up Care
About 2-3 weeks after your discharge from the hospital, you will return to the clinic to see your surgeon. We will ask you to have a chest x-ray prior to that visit. At this visit, the surgeon will look at your incision, review the x-ray, and discuss further with you the results from your surgery.

Thoracoscopy Instructions
Post-operative instructions "Do's and Don'ts After Surgery"

The following instructions consist of do's and don'ts to help you recovery after your surgery. These guidelines are not meant as rigid rules, but as suggestions coming from our experience with patients whom we have discharged from the hospital over the years. As a general rule, common sense is a good guideline. For example, there is no reason why you cannot walk up and down stairs, even if you have to take a rest in the middle.

The basic rule is: do what feels good and comfortable. This particularly holds true for the amount of daily walking, which is strongly suggested. Everybody is different and comes to surgery with a different set of lung functions. This will dictate how much a person can walk after surgery.

Do's

  • Shower daily and wash incision and drain sites. Use Ivory soap. Let the water stream run over the incision and drain sites. Leave the incisions uncovered. Where the chest tubes used to be, the drain sites may drain for several days, and therefore may need a Band-Aid.
  • Wear comfortable, clean clothing. Particularly suitable is cotton clothing, especially if drainage is still an issue.
  • Walk as much as you feel able to. Stop when you are short of breath, rest, and then continue. You may not see a daily increase, but over a week's time you should see an increase in the distance that you are able to walk. Fatigue and tiredness are expected. It is entirely normal that you may have to take a nap in the morning or in the afternoon. Avoid spending prolonged periods of time lying down during the daytime hours.
  • Eat foods you find appealing. You may find that your appetite is not nearly as good as it was before you had your surgery. This is entirely normal. You may eat smaller portions and you may increase the frequency of your meals. We suggest that you weigh yourself twice a week and that you keep a record of your weight. If you notice that you gain 2-3 pounds over a 24- to 48-hour period, call us because you may be retaining water. It is normal to lose up to 10% of your weight after surgery. Patients often notice that their appetite has changed, as well as their taste buds. This is also normal.
  • As long as you are taking pain medication, particularly narcotics, you should consider taking a stool softener or laxative. These medications have a tendency to render one constipated, which may lead to a vicious cycle where one feels constipated and nauseated with an increase in pain.
  • Do take your pain medications as needed. In the beginning, you should take your medications on a regular basis as they were prescribed. Often, you receive two types of pain medication, one of which should be taken constantly to produce a steady level of analgesia (pain relief). The other medication is given for "breakthrough" pain or the peaks, which you take as needed depending on your daily activities.
  • Remember, a good night's sleep is worth a lot and makes the next day much easier. Therefore, taking a pain medication at the time one goes to bed is a reasonable approach.

Don'ts

  • If you were a smoker, do not restart. If your environment-your apartment or house-still contains curtains, linens, and furniture full of smoke and tobacco odor that can give you the urge to smoke again, please have them cleaned. The overwhelming majority of people who develop lung cancer in the United States do so because of smoking. If you have difficulty stopping your smoking habit, or if you live with family members or house-partners who smoke, please call us and we can help you through a smoking cessation program.
  • Do not lift anything heavier than 10 pounds for about 4-6 weeks. Remember that your recovery overall takes about 10-12 weeks.
  • Do not drive until your surgeon says that you can. Generally, at about 3 weeks you will be allowed to drive locally.

If you have any concerns or questions, call us at (631) 444-2981. If, by chance, none of the people that you met during your hospital stay answer, and you are connected with HealthConnect, they will be able to direct your call to one of the team members and they will get back to you shortly.

If further referrals to other specialists are needed, these referrals will be addressed at this appointment. The LCEC team will also discuss with you the long-term follow-up care you require.

CT-Guided Fine-Needle Aspiration (Biopsy)

You MUST have a driver with you on the day of your biopsy or THE BIOPSY WILL NOT BE DONE. You cannot take a taxi or bus.

  • Do not eat or drink anything after midnight the night before the biopsy.
  • Do not take aspirin, ibuprofen (Advil, Genpril, Haltran, IBU, Menadol, Midol, Motrin), or vitamin E for 3-7 days prior to the biopsy. If you are taking any anti-coagulant (anti-clotting medication, also called blood thinner)—clopidogrel (Plavix), warfarin (Coumadin), enoxaparin (Lovenox-heparin)—PLEASE bring this to our attention IMMEDIATELY as it may require being stopped for a longer period of time and approval from a physician.
  • If you see a hematologist for any blood-related medical condition, please let us know.
  • If you are diabetic, please let us know so we can instruct you on when to stop (temporarily) taking your diabetic medication.
  • Take the main elevator down to 4th floor. Report to CT SCAN-Special Procedures to check in. Expect to be there for a total of about 3-4 hours.

If your CT scan was done at another facility other than here at Stony Brook University Hospital, we will have to scan your films onto our system.
Biopsy date: __________________

Medication to stop taking: ____________________________________________________
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Special instructions: _________________________________________________________
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