Bronchoscopy
• A technique for assessing and examining
the bronchi by means of a bronchoscope,
which is used for both therapeutic and
diagnostic purposes
Rigid Bronchoscope
• Consists of a hollow
metal tube with a light on
its distal end.
• Tube is inserted orally,
then passed between the
vocal cords into the
trachea.
• Is useful for removing
aspirated foreign bodies
and thick secretions from
the lungs.
Flexible Fiberoptic Bronchoscope
• Consists of a collection of
thin, threadlike glass
strands called fiberoptic
filaments with a light
source projected to its
distal end for
visualization.
• Is better tolerated by
patients than the rigid
bronchoscope because of
its more flexible nature; it
is therefore more
commonly used.
Flexible Fiberoptic Bronchoscope
Indications
• Removal of foreign bodies
• Removal of mucus plugs and thick secretions
– Is normally performed when secretions cannot be removed by routine
suctioning techniques
• Atelectasis that affects a lobe or an entire lung
• Pulmonary hemorrhage
– To locate the area of bleeding
– To control bleeding by instillation of epinephrine or iced saline lavage at
the bleeding site
• When tracheal intubation is difficult as a result of upper airway
trauma, obesity, tumors, or spinal deformity
– The ET tube is slipped over the fiberoptic bronchoscope; the scope
should protrude well past the end of the ET tube.
– The vocal cords are visualized, and the scope is advanced through the
cords to the midtracheal level, where the ET tube is then advanced over
the scope to the proper position. The scope is then withdrawn.
• Biopsy of suspected tumors
• When sputum is needed for culture and sensitivity studies
Complications
•
Hypoxemia
–
–
•
–
•
–
•
Results from irritation of the airway.
Bronchodilator should be readily
available.
Arrhythmias
–
–
Result from vagal stimulation.
Monitor ECG and remove
bronchoscope until cardiac status is
stabilized.
Results from sedatives given before
the procedure.
Monitor respiratory status closely.
Hypotension
–
–
•
May occur during insertion.
May occur after biopsy.
Respiratory depression
–
Bronchospasm
–
–
•
Makes advancing the tube more
difficult.
Bronchodilator should be readily
available.
Hemorrhage
–
–
Laryngospasm
–
•
Monitor oxygen saturation during
procedure.
Increase oxygen percentage during
procedure.
•
Results from vagal nerve stimulation.
May result from sedatives given before
the procedure.
Pneumothorax
–
–
Results from inadvertent puncture of
the lung.
Monitor respiratory status closely.
Preparation
• A mild sedative should be administered to the patient 1 to 2 h before
the procedure.
– Diazepam (Valium) or midazolam (Versed)
– conscious sedation: just enough to allow the patient to follow
commands yet still be comfortable.
• The airway must be dry during the procedure to aid in visualization
– Atropine 1 to 2 h before the procedure.
– Atropine may also decrease vagal tone, resulting in a decreased
potential for bradycardia and hypotension, which can occur during the
procedure.
• The bronchoscope should be lubricated with a water-soluble jelly for
nasal insertion.
– Lidocaine (Xylocaine) jelly is used both as a lubricant and for its
anesthetic effects.
– In some cases, the RCP administers aerosolized lidocaine before the
procedure.
RT Role During Bronchoscopy
• Prepare the patient and explain the procedure.
• Administer aerosolized local anesthetic to the patient's
upper airway.
• Conduct patient monitoring throughout the procedure.
–
–
–
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Pulse and blood pressure
Respiratory rate
ECG
Oxygen saturation
Level of consciousness
• Collect sputum and tissue samples that the physician
has obtained and prepare them for laboratory analysis.
• Clean the bronchoscope properly after the procedure.
The Centers for Disease Control and Prevention
recommends that bronchoscopes be sterilized by
immersion in glutaraldehyde (Cidex) for 3 to 10 h.
»
• (Persing, Gary. Respiratory Care Exam
Review: Review for the Entry Level and
Advanced Exams, 3rd Edition. Elsevier
Health Sciences, 112009. 5.2).