Procedures
Procedural Experience
- Dr Herath is an interventional bronchoscopist with formal international training and a post specialist fellowship in interventional bronchoscopy in thoracic malignancy, completed at McGill University Montreal Canada in 2013.
- She is one of the very few interventional bronchoscopists who have completed formal training in a North American Centre.
- Dr Herath started up new services for minimally invasive Radial EBUS and Cryobiopsy in Middlemore Hospital Auckland and New Zealand as well as Westmead Hospital, Sydney Australia.
- She has completed over 1500 bronchoscopies with over a 1000 EBUS procedures with excellent published success rates.
- Dr Herath frequently performs the following procedures
EBUS
What is EBUS? (Endobronchial Ultrasound Guided Biopsy)
- EBUS is a minimally invasive advanced bronchoscopy procedure and the success of this procedure heavily relies on the training and expertise of the proceduralist.
- Dr Herath has completed an international fellowship in interventional bronchoscopy and EBUS in McGill University in Canada in 2013 and has completed over a 1000 EBUS procedures with excellent success rates.
- The procedure involves a small flexible camera that also has an USS (ultrasound scan) at the end of the bronchoscope.
- Therefore, EBUS is an internal scan of your windpipes and identifies abnormal masses and glands around your windpipes. These glands are situated near large blood vessels in the chest.
- Once an abnormal area is identified a needle is inserted under direct vision to the abnormal area to take a sample.
- There are two types of EBUS – Linear EBUS and Radial EBUS
- Linear EBUS is used to diagnose glands and abnormal masses around large windpipes and Radial EBUS is used to diagnose lung nodules around the smaller windpipes which are usually more peripherally located.
What conditions is Linear EBUS used for?
- This procedure is used mainly to diagnose and decide the spread of lung cancer.
- It can also be used to diagnose infections and other diseases causing enlarged chest lymph nodes like sarcoidosis and tuberculosis.
- EBUS is less invasive than the conventional surgical treatment to remove lymph node samples (mediastinoscopy) and is most often used to biopsy lymph nodes in patients with lung cancer.
- EBUS can also be used to assist in staging a range of other conditions from sarcoidosis and blood disorders like lymphomas that start in the lymphatic system.
- Linear EBUS using a “core biopsy” or larger biopsy needle is sometimes required to obtain repeat samples of tumours during treatment to test for various immunomarkers.
Am I asleep for the procedure? Where can I have it done?
- This depends on whether you are privately insured or not.
- For privately insured patients this procedure is performed under general anaesthetic; therefore, you will not be aware of the procedure.
- The procedure can be booked at Macquarie University Hospital, Sydney Adventist Hospital or Westmead Private Hospital as per your preference.
- Procedures are held on Thursdays and Fridays each week and urgent procedures can be booked at very short notice.
- If you do not have private health insurance the procedure will be booked at Westmead Public Hospital and the procedure will be done under conscious sedation.
- Dr Herath is a staff specialist at Westmead Public Hospital with admission rights and a bronchoscopy list every Wednesday. Unfortunately, Westmead Public Hospital has only 2 anaesthetist supported lists per month for many patients which are reserved for very unwell patients and has long wait times.
- The procedure performed under sedation is not painful but of course not as comfortable as having it under anaesthesia.
What is the wait period to get a Linear EBUS?
- Dr Herath is a an advanced bronchoscopist and thereby has her own lists in both public and private sector
- The procedure will be done as urgently as possible as per the medical condition of the patient.
- You do not need to be referred to another doctor to do your procedure which reduced the wait times and cost to you as the patient markedly.
- If you were referred by another Respiratory Physician for Linear EBUS and your Respiratory physician has already discussed the procedure with you and had taken your consent, you will be given a booking immediately.
- Dr Herath will discuss this procedure with you on the day of the procedure.
- However, if you are anxious about the procedure, we will organise a clinic appointment with Dr Herath to discuss your concerns and meet Dr Herath beforehand.
How long does it take? How long will I stay in Hospital?
- A Linear EBUS takes 30-45 minutes for the procedure.
- This is a day procedure and you can go home 1-2 hours after the procedure.
- You will be monitored for two hours after your procedure.
- You will be given a sip of water in 1 hour after the procedure called a “sip test”.
- This is to check that the local anaesthetic effect on your mouth has worn off and you can swallow without a risk of aspiration. If you pass the test you will be given a light snack and discharged home.
What is the item number for this procedure?
- The MBS item number for your health fund for this procedure is 30710
What should I do in preparation for Linear EBUS?
- Fasting for 6 hours prior to the procedure for both food and fluid
- If you are undergoing a biopsy stop blood-thinning tablet agents for 5 days pre procedure.
- Dr Herath will discuss this with you. These include but not limited to Xeralto, Eliquis, Warfarin, Clopidogrel, Ticaglore
- You may continue aspirin even if you have a biopsy.
- Dr Herath will contact your cardiologist or your referring respiratory physician to discuss if it is OK for you to stop blood thinners or if you require a “bridging agent” called Clexane or Heparin leading up to the procedure.
- You should not take diabetic medication the morning of the procedure.
- You should take all other medications with a sip of clear water.
- You need someone to drive you home and stay with you for one night.
- If this is not possible, we can organise for you to stay overnight in the hospital.
- If you are a current smoker, stopping smoking for a period will help immensely in reducing airway discomfort and irritation. This will make the cough much better post procedure
What are the side effects of a Linear EBUS?
- Linear EBUS is a non-complicated, advanced but safe procedure.
- We do these procedures on daily basis and are prepared for types of adverse events during procedure and equipped to handle emergencies. Most side effects occur whilst you are in hospital and will be attended to with monitoring.
- The rare side effects that may occur after discharge are listed so that you can watch out for them and take immediate action.
- The success of the procedure relies heavily on the training and expertise of the proceduralist.
| Common side effects during or immediately after the procedure | What to Do | Rare side effects Once you leave the hospital | What to Do |
| Cough post procedure Coughing blood mixed with sputum |
Self-resolve over 24h | Infection and fever post procedure | Occurs 2-4 hours post procedure in 3% patients If you have fever >38.5 or feel unwell, you will need IV antibiotics and fluids. Please return to emergency department of the nearest hospital. |
| Tiredness | Self-resolve in 24h | Shortness of breath/chest pain after going home | Shortness of breath is also a sign of pneumothorax or air leak outside the lung. If this occurs, please report to the nearest hospital emergency department. |
| Sore throat | Difflam lozenges or throat spray for 48h | Coughing up frank blood more than a tablespoon | However, coughing up frank blood more than a tablespoon is not normal. This is a sign of a larger bleed inside the lung. Please report to the nearest emergency department. |
| Feeling as if you have flu (30% of patients after a wash/lavage) | Take paracetamol Take your temperature This should be below 38.5 C |
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| Bleeding during procedure | We are prepared for a bleed specially during a biopsy. | ||
| Air leak outside the lung | If we anticipate an air leak, we will perform an USS or a Chest X ray to find out if this had occurred prior to discharge |
| Common side effects during or immediately after the procedure | What to Do |
| Rare side effects Once you leave the hospital | What to Do |
| Cough post procedure Coughing blood mixed with sputum |
Self-resolve over 24h |
| Infection and fever post procedure | Occurs 2-4 hours post procedure in 3% patients If you have fever >38.5 or feel unwell, you will need IV antibiotics and fluids. Please return to emergency department of the nearest hospital. |
| Tiredness | Self-resolve in 24h |
| Shortness of breath/chest pain after going home | Shortness of breath is also a sign of pneumothorax or air leak outside the lung. If this occurs, please report to the nearest hospital emergency department. |
| Sore throat | Difflam lozenges or throat spray for 48h |
| Coughing up frank blood more than a tablespoon | However, coughing up frank blood more than a tablespoon is not normal. This is a sign of a larger bleed inside the lung. Please report to the nearest emergency department. |
| Feeling as if you have flu (30% of patients after a wash/lavage) | Take paracetamol Take your temperature This should be below 38.5 C |
| Bleeding during procedure | We are prepared for a bleed specially during a biopsy. |
| Air leak outside the lung | If we anticipate an air leak, we will perform an USS or a Chest X ray to find out if this had occurred prior to discharge |
- Although not mentioned above in the chart due to extreme rarity, adverse events due to anaesthesia, drug allergies, heart attacks, asthma exacerbations and even death can occur post procedures.
- The more medical issues you have the higher the chance of an adverse events the above chart is a general guide only.
- If you have multiple medical issues Dr Herath will discuss your individual risk and you will be referred to the pre-admission clinic for an anaesthetist to view your medical history and decide on the best level of anaesthesia for you.
- We will take extra precautions like booking an Intensive Care bed post procedure if you have underlying medical issues.
When can you return to work?
You can return to work and start all your normal medications including blood thinners the next day.
When will the results be available?
- Preliminary results will be available as soon as the procedure is completed on the same day.
- There is a cytologist working with Dr Herath during the procedure who will look at the samples as they are being taken to give a diagnosis and feedback to see if more tissue is required. You will have a preliminary result at the end of the procedure.
- Please book an appointment with Dr Herath one week after your procedure to discuss management and obtain referrals.
- On some occasions when the diagnosis is an aggressive tumour you may be sent to the oncologist on the same day.
- If you were referred to Dr Herath by your respiratory physician or other specialist, please make an appointment with your specialist only. The results will be copied to the referring specialist.