Bronchoscopy Overview and Techniques

Study Notes

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

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.

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.

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

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: 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.

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.

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.