Bronchoscopy Overview and Techniques

Bronchoscopy Overview

• Bronchoscopy is a procedure used for several purposes, including inspecting the airway, removing foreign objects, collecting samples, and placing medical devices.

Learning Objectives

• Understand the purposes of bronchoscopy (airway inspection, sample collection, device placement).
• Differentiate between rigid tube and flexible fiberoptic bronchoscopy techniques.
• Identify the advantages and disadvantages of each bronchoscopy technique.
• Recognize indications and contraindications for bronchoscopy.
• Understand potential complications and hazards of bronchoscopy.
• Recognize the importance of equipment and airway preparation prior to bronchoscopy.
• Describe the role of a respiratory therapist in assisting with bronchoscopy procedures.
• Explore monitoring requirements for bronchoscopy patients.
• Gain knowledge of equipment needed for bronchoscopy beyond bronchoscopes and patient monitoring devices.
• Understand the goals of premedication before bronchoscopy and the use of vasoconstrictors in airway preparation.

Types of Bronchoscopy

Rigid Tube Bronchoscopy

• A sturdy metal tube.
• Primarily used by otorhinolaryngologists and thoracic surgeons.
• Inserted through the mouth into the trachea and bronchi.
• Useful for specific tasks but has drawbacks like patient discomfort and limited access to small airways.
• The head can be adapted to different sizes needed for the procedure.
• Used with ancillary tools and ventilation connection.

Flexible Fiberoptic Bronchoscopy

• More versatile and can access smaller airways.
• Primarily used by pulmonologists, often with respiratory therapist assistance.

Indications for Bronchoscopy

• Checking chest lesions.
• Evaluating recurrent pneumonia, atelectasis, or lung infiltrates.
• Investigating symptoms like hemoptysis, cough, wheezing, or stridor.
• Collecting samples for analysis.
• Assessing injuries from toxic inhalation or aspiration.
• Managing airway tube issues.
• Removing foreign objects.
• Performing therapeutic procedures.

Contraindications and Precautions

• Absolute contraindications: Lack of patient consent, experience, or facilities for emergencies.
• Relative contraindications: Increased risks like recent heart issues or tracheal obstructions.

Hazards and Complications

• Medication-related effects.
• Hypoxemia (low oxygen levels).
• Bronchospasm (airway narrowing).
• Mechanical issues.
• Infection risk.

Equipment Needed

• Instruments for the Bronchoscopist and Assistant: Masks, goggles, sterile gloves, gowns, appropriate-sized bronchoscopes.
• Bronchoscopic Devices: Bronchoscopic light source, adapter for endotracheal tubes, cytology brushes, flexible forceps, trans-bronchial aspiration needles, retrieval baskets, syringes for medication delivery, normal saline lavage, needle aspiration.
• Specimen Collection Devices and Fixatives: Specimen collection devices, fixatives.
• Other Supplies: Bite blocks, sterile gauze pads, water-soluble lubricant, venous access equipment (if intubation is required), appropriate documentation.

Premedication and Airway Preparation

• Premedication: Essential to reduce patient anxiety, enhance cooperation, and alleviate pain/anxiety (medications like codeine, midazolam, morphine, diazepam, fentanyl used).
• Airway Preparation: Creating an ideal environment for procedure by drying the airway. This improves anesthetic deposition, visibility, and shortens procedure time.
• Vasoconstrictors: Pseudoephedrine or dilute epinephrine (usually 1:10,000) are occasionally used to prevent or treat bleeding.
• Anesthesia: Achieved through topical anesthetics (like lidocaine) via atomizers, mouthwash, or nebulizers.

Monitoring During Bronchoscopy

• Pulse Oximetry: Assess oxygen saturation (SpO2).
• Respiratory Rate: Observe patient's breathing pattern.
• ECG: Track heart's electrical activity.
• Blood Pressure: Check for any fluctuations.

Role of the Respiratory Therapist (RT)

• Monitors patient condition constantly.
• Adjusts oxygen therapy as needed.
• Ensures optimal oxygen levels.
• Responds to any changes in the patient's respiratory status.
• Monitors ventilator parameters (like tidal volume, peak inspiratory pressure, and inspiratory flow) if patient is mechanically ventilated.
• Assists with the procedure by supplying medications (anesthetics, vasoconstrictors, mucolytic agents, lavage solutions) and handling instruments.
• Collects samples (sputum, tissue) for analysis.

Recovery and Post-Bronchoscopy Care

• Ensure patient recovers well.
• Maintain oxygen therapy for up to 4 hours and confirm adequate oxygenation via pulse oximetry.
• Monitor for signs of stridor or wheezing and provide aerosol therapy if necessary.