Bronchoscopy: A Comprehensive Guide PDF

# Bronchoscopy ## Learning Objectives - Understand the purposes of bronchoscopy, including inspection of the airway, sample collection, and device placement. - Differentiate between rigid tube bronchoscopy and flexible fiberoptic bronchoscopy techniques. - Identify the advantages and disadvantages...

# Bronchoscopy ## Learning Objectives - Understand the purposes of bronchoscopy, including inspection of the airway, sample collection, and device placement. - Differentiate between rigid tube bronchoscopy and flexible fiberoptic bronchoscopy techniques. - Identify the advantages and disadvantages of each bronchoscopy technique. - Recognize the indications and contraindications for performing bronchoscopy. - Learn about the potential complications and hazards associated with bronchoscopy. - Understand the importance of equipment preparation and airway preparation before bronchoscopy. - Describe the role of the respiratory therapist in assisting with bronchoscopy procedures. - Explore the monitoring requirements for patients undergoing bronchoscopy. - Gain knowledge of the 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. ## Definition and Purpose What is bronchoscopy? It is a procedure used for several purposes: - Inspecting the airway - Removing foreign objects from the airway - Collecting samples from the airway - Placing medical devices into the airway ## Types of Bronchoscopic Techniques There are two main types of bronchoscopy: ### Rigid Tube Bronchoscopy - A sturdy metal tube. - Used mainly by otorhinolaryngologists and thoracic surgeons. - Inserted through the mouth down into the trachea and bronchi. - Useful for certain tasks but can be uncomfortable for the patient and has limited access to small airways. ### Flexible Fiberoptic Bronchoscopy - More versatile and can access even the tiniest airways. - Primarily used by pulmonologists, often with the assistance of respiratory therapists. ## Indications for Bronchoscopy - Checking chest lesions - Evaluating recurrent pneumonia, atelectasis, or lung infiltrates - Investigating symptoms like hemoptysis (coughing up blood), cough, wheezing, or stridor (noisy breathing) - Collecting samples for further analysis - Assessing injuries from toxic inhalation or aspiration - Managing issues with airway tubes - Removing foreign objects - Performing various 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 Complications may include: - Medication-related effects - Hypoxemia (low oxygen levels) - Bronchospasm (narrowing of airways) - Mechanical issues - Infection risk ## Equipment Needed ### Instruments for the Bronchoscopist and Assistant: - Masks - Goggles - Gloves (Sterile For Bronchoscopists) - Gowns - Appropriate-sized Bronchoscopes. ### Bronchoscopic Devices: - A bronchoscopic light source - An adapter for endotracheal tubes (ETT's) - 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 for cleaning the bronchoscope tip - Water-soluble lubricant - Venous access equipment (in case intubation is required) - Appropriate documentation paperwork. ## Premedication and Airway Preparation ### Premedication - Essential to reduce patient anxiety and enhance cooperation. - Medications such as codeine, midazolam, morphine, diazepam, and fentanyl are used. - Help alleviate pain and anxiety. - Benzodiazepine antagonists like flumazenil and narcotic antagonists like naloxone are on hand in case of adverse reactions. ### Airway Preparation - To create an ideal environment for the procedure, the patient's airway needs to be dry. - Promotes better anesthetic deposition, improves visibility, and can reduce the duration of the procedure. - Vasoconstrictors like pseudoephedrine or dilute epinephrine (usually 1:10,000) may be used to prevent or treat bleeding. - Anesthesia is achieved through topical anesthetics like lidocaine (in various concentrations) administered via atomizers, mouthwash, or nebulizers. - The RT often administers lidocaine via nebulizer, which can make the procedure less uncomfortable for the patient. - Special nerve blocks may also be used to provide anesthesia in specific areas of the airway. ## Monitoring During Bronchoscopy ### Continuous Monitoring - **Pulse Oximetry**: To assess oxygen saturation (SpO2) - **Respiratory Rate**: To observe the patient's breathing pattern - **ECG**: To track the heart's electrical activity - **Blood Pressure**: To check for any fluctuations ## Role of the RT - Respiratory therapists play a crucial role in monitoring the patient's condition. - They are responsible for adjusting oxygen therapy as needed, ensuring the patient's oxygen levels are optimal, and responding to any changes in the patient's respiratory status. - If the patient is mechanically ventilated, the RT also monitors ventilator parameters like tidal volume, peak inspiratory pressure, and inspiratory flow. ## Assisting With the Procedure ### Supplying Medications and Solutions: - During bronchoscopy, the RT assists by supplying medications such as: - Anesthetics - Vasoconstrictors - Mucolytic agents - Lavage solutions ### Handling Instruments: - The RT may be responsible for handling instruments like forceps or brushes that are inserted into the bronchoscope by the bronchoscopist. - These instruments are used to perform specific tasks like collecting samples or removing foreign objects. ### Sample Collection - The RT may collect sputum or tissue samples obtained by the bronchoscopist and prepare them for laboratory analysis. - This is a crucial part of the procedure, as these samples can provide valuable diagnostic information. ## Recovery and Post-Bronchoscopy Care - After the procedure, we need to ensure the patient recovers well. - Oxygen therapy continues for up to 4 hours, and we confirm adequate oxygenation using pulse oximetry. - Also watch for any signs of stridor or wheezing, and if necessary, we provide aerosol therapy. ## Reference Chapter 36 basic therapeutics page 784 Egan's fundamental of respiratory care 12 edition.