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

	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

Category: Guides