Author: Avi Cohen
GLP-1 agonists Aspiration Precautions
Patients who are on GLP1 agonist must adhere to a 24 hour clear liquid diet: Examples of clear liquids include water, fruit juice without pulp, carbonated beverages, clear tea and black coffee WITHOUT Creamer.
GLP1 agonist include:
- Exenatide (Byetta, Bydureon)
- Pramlintide (Symlin)
- liraglutide (Victoza)
- albiglutide (Tanzeum)
- lixisenatide (Adlyxin)
- dulaglutide (Trulicity)
- semaglutide (Ozempic, Wegovy)
Robotic Bronchoscopy – Uptraining Protocol
Studies have shown that competency as to related to yields improves after 35 cases.
- 5 cases – observing live cases. during downtime, performing >50 repetitions on simulator
- 5 cases – Registration + Planning
- 10 cases – Localization with utilization of rEBUS and CBCT
- 5 cases – assisting with biopsies
- 5 full cases – performed while you are observed
- 5 full cases performed alone – with dedicated staff on backup in the bronch suite
Anticoagulation and Bronchoscopic Biopsies
| LAST DOSE BEFORE BRONCHOSCOPY | TIME TO RESTART MEDICATIONS AFTER BRONCHOSCOPY WITH BIOPSIES | |
| Heparin SubQ | No Need to stop | Not applicable |
| Enoxaparin 1mg/Kg SubQ BID | Omit the evening dose prior to procedure day (last dose 24 hours prior to procedure) | > 12 hours |
| Enoxaparin 1.5mg/Kg SubQ QD | > 24 hours | > 12 hours |
| Warfarin (Coumadin) | 5 days (confirm INR < 1.5) | immediately |
| Heparin IV | > 4 hours (check PTT) | > 4 hours (no bolus) |
| Fondaparinux (Arixtra) | 4 days | > 12 hours |
| Rivaroxaban (Xarelto) | 3 days | > 24 hours |
| Apixaban (Eliquis) | 3 days | > 12 hours |
| Edoxaban (Syvasa) | 3 days | |
| Streptokinase (Local) | No Need to stop | |
| Alteplase (Local) | No Need to stop | |
| Alteplase (Systemic) | 10 days | 10 days |
| Streptokinase (Systemic) | 10 days | 10 days |
| Urokinase (Systemic) | 10 days | 10 days |
| Aspirin | No Need to stop | |
| NSAID | No Need to stop | |
| ASA/Dipyridamole (Aggrenox) | > 24 hours | immediately |
| Abciximab (Reopro) | > 48 hours (check platelet/PTT) | > 4 hours |
| Cilostazol (Pletal) | 3 days | > 6 hours |
| Clopidogrel (Plavix) | 5 days | > 6 |
| Eptifibatide (Integrilin) | 8 hours (check Platelet/PTT) | > 4 hours |
| Tirofiban (Aggrastat) | 8 hours (check Platelet/PTT) | > 4 hours |
| Ticagrelor (Brilinta) | 5 days | > 6 hours |
| Cangrelor (Kangreal) | > 4 hours | > 2 hours |
| Ticlopidine (Ticlid) | 5 days | immediately |
| Prasugrel (Effient) | 7 days | > 8 hours |
| Argatroban (Acova) | > 4 hours (check PTT) | > 2 hours |
| Dagitraban (Pradaxa) | 5 days | > 6 hours |
| Bevalirudin (Angiomax) | > 10 hours | > 4 hours |
| Desirudin (Revasc) | > 10 hours | > 4 hours |
| Lepirudin (Refludan) | > 10 hours | > 4 hours |
| Time to resume anticoagulants COULD BE CHANGED by physician |
Regional Anesthesia and Antithrombotic Agents.: Recommendations of the European Society of Anesthesiology. European Journal of Anaesthesiology 2010; 27: 999-1015
Thopaz
the Thopaz+ and its associated disposables are located in the pleural room (isolation room #1). They are on the top shelf of the cabinet located directly over the sink. Please make sure that it is documented on the equipment sign-out sheet if it is taken outside of the Bronch Suite. Also please disinfect with a purple wipe before returning to the cabinet.
Thopaz+ Express In-Service Video – YouTube
Medela-Thopaz+-training-for-physicians – YouTube
How to check therapy progress (air) with Thopaz+ (youtube.com)