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Instructions for Procedures

Flexible Bronchoscopy

Flexible bronchoscopy is a procedure that enables your physician to examine the major passage ways of your lungs. This allows your physician to evaluate your lungs and take tissue samples if needed. The procedure is performed in the outpatient clinic or at the outpatient center at the hospital. You will have mild sedation and your nose or mouth will be numbed. Your doctor will then insert a bronchoscope – a flexible narrow tube about the width of a pencil – through your nose or mouth into your lung.

Why should I have a bronchoscopy?

Common reasons to have a bronchoscopy are: abnormal chest x-rays or Cat Scans of the chest or coughing up blood. Tissue samples are sent to a laboratory for testing and can assist your physician in making a diagnosis.

How do I prepare for a bronchoscopy?

Your physician and nurses will go over specific instructions with you prior to the procedure. Blood tests are sometimes needed prior to the procedure.

What happens after the procedure?

When the procedure is complete you will be observed until you are awake enough to leave. Your vital signs will be monitored. You will be given instructions to call the doctor’s office with any chest pain or difficulty breathing. It is normal to cough up a small amount of blood for 1-2 days after the procedure but you will be directed to call if it is greater than a small amount. You will have a follow up in the office to discuss all results of the test.

A health care professional will call you in 5 to 7 working days to check on you. If you have any questions or problems after your bronchoscopy, please call (215) 955-6591.


Water or fluid around the lung (pleural fluid) is abnormal and may represent a disease in the chest or other parts of the body. A chest x-ray or CT scan of the chest usually establishes the presence of abnormal fluid in the chest. Thoracentesis is a procedure performed by a doctor to sample and/or remove fluid from around the lung. This is frequently performed at the doctor's office. your consent or permission is required for us to perform this procedure.

Thoracentesis is done to:

  • Relieve shortness of breath from fluid build-up around the lung
  • Testing is performed on the fluid build-up around the lung

Moderate to large amounts of fluid around the lung can decrease the lung's ability to function and expand. This can cause shortness of breath during physical activity or while lying down. Removing the fluid from around the lung may allow the lung to re-expand and function better.

During the procedure:

  • The staff will position you for this procedure that will typically require 15-30 minutes. Be sure to inform the staff if you are taking blood thinning medications such as coumadin, aspirin, etc; you should be free from these drugs for at least 5-7 days.
  • The doctor will inject a small amount of local anesthetic under the skin to numb the area. You may feel a slight stinging when the medication is injected.
  • the doctor will place a small, thin needle into your chest to remove the fluid.
  • As the lung re-expands toward the end of the procedure, you may experience mild tightness in the chest or coughing. Your vital signs will be measured and monitored during the procedure.
  • Your doctor may recommend that you have a chest x-ray after the thoracentesis procedure at Thomas Jefferson University Hospital. if so, you will need to wait at the hospital until after the chest x-ray reviewed. This x-ray will show any possible lung collapse that may have resulted from the procedure (pneumothorax).

Report the following to our office:

  • Sudden or increasing shortness of breath
  • Fever greater than 101F
  • Excessive drainage or bleeding from puncture site
  • Increased pain in your chest when you try to take a deep breath

For questions or problems please call us at (215) 955-6591.

Interventional Pulmonary Procedures

Many patients with lung cancer, or other cancers metastatic to the lung, will have involvement of their airways (breathing tubes).  This can lead to shortness of breath, cough, coughing up blood, as well as lung collapse and pneumonia.  We have multiple therapies available which can relieve these symptoms.  These therapies include freezing of tumor (cryotherapy), burning of tumor (APC/Electrocautery), balloon dilatation, and placement of stents (rigid devices designed to open an airway).  Your doctor will determine which therapy, or combination of therapies, is best for you after reviewing your labs, x-rays, as well as images from prior bronchoscopies.  Sometimes, a bronchoscopy will need to be done in order to evaluate and help plan for your treatment.

These therapies can all be performed during flexible bronchoscopy (see flexible bronchoscopy above for details). You will be given medications to keep you moderately sedated, and most patients do not have any recall of the procedures.  If a particular patient has a severe obstruction, this may require hospitalization for a few days in order to assure maximal safety.

If you are interested, please make an appointment.  You will need to bring all x-rays and CT scans of your lungs, as well as any records from your referring doctor.  You will see a doctor in clinic who will discuss the procedures with you. 

Additional Pleural Procedures

Some patients who have a collection of fluid around the outside of the lung (a pleural effusion) will keep getting new effusions despite drainage from a thoracentesis. There are several conditions which can cause this. With the recurrence of the effusion, symptoms such as shortness of breath and cough may return. If this is the case, doctors here can perform procedures to help alleviate your symptoms.

A catheter can be placed into your pleural space. It will have a part outside of the skin on your chest. This outside part can be connected to a suction device, and the fluid around your lung will be drained. The catheter is placed under local anesthesia (no OR). You can then go home and drain your effusion daily from the comfort of your own home. Most patients tolerate this very well, with little or no discomfort. You should call if you have pain, redness, or swelling at the site of the catheter.

We can also perform a thoracoscopy. A small incision is made into your chest, and a tube with a camera is inserted into the space around your lung. The entire area can be viewed, and biopsies can be performed if necessary. Medications can be administered into this area which will help to stop the formation of the fluid. A small tube is left in place, and will remain until the fluid has stopped draining. This procedure is done under moderate sedation, with most patients not remembering the procedure. You will need to stay in the hospital while the tube remains in your chest, which can take from 24 hours to a few days. Most patients tolerate this well. Sometimes pain medications may be helpful in relieving discomfort. 

If you are interested in these procedures, please call for an appointment.  Your doctor will explain which procedure may be best for you, as well as the specific instructions about preparing for the procedure.

Related Tests & Treatments

Arterial Blood Gas. (ABG)   If you are having severe breathing problems or your symptoms may be the cause of a lung disease such as asthma, cystic fibrosis or chronic obstructive pulmonary disease (COPD), an arterial blood gas (ABG) test may be performed to reach an accurate diagnosis.

Bronchoscopy.   A pulmonologist performs a test called bronchoscopy to diagnose several lung diseases, cancers, infections or blockage by a tumor. At Jefferson, our expert pulmonologists will look at your vocal chords, lungs, windpipe or trachea to diagnose your condition using this method.

Mediastinoscopy.   If you are diagnosed with lung cancer, you will find the latest and most progressive treatment programs at Jefferson, aided by an outstanding cancer team and state-of-the-art technology and equipment.

Peak Flow Measurement.   Jefferson's Asthma Program offers comprehensive services related to asthma diagnosis, treatment and patient education, and we enjoy a national reputation in asthma research and in the management of difficult asthmatic conditions.

Photodynamic Therapy.   Over the last few years, there have been great strides made in the use of a novel approach to cancer treatment called photodynamic therapy (PDT), available at the Jefferson Digestive Disease Institute.

Pulmonary Function Tests.   Certified pulmonary function technicians in Jefferson's Division of Pulmonary and Critical Care Medicine will perform your pulmonary function tests (PFTs).

Spirometry.   Spirometry is a type of pulmonary function test that is used in the evaluation of lung function. For expert diagnosis of asthma, chronic obstructive pulmonary disease or other lung condition, turn to Jefferson.

Thoracentesis.   If you are suspected of having lung cancer or other lung diseases, Jefferson physicians may perform a thoracentesis in which fluid removed from the sac surrounding the lungs is examined for cancer cells.