Download special procedure bronchoscopy

Special Procedures
Bronchoscopy
Dr. Abdul-Monim Batiha
Definition and Terminology
• Endoscopy
– Use of instrument to look into various parts of
the body to diagnose various diseases or
explain certain conditions
• Bronchoscopy
– Procedure that allows visualization of the
airways below the larynx
Equipment
• A bronchoscope is an instrument about 3ft long
and 0.5 ins or smaller in diameter that combines
four narrow chambers into one tube
– One lumen contains a fiber-optic light source so that
structures can be viewed effectively
– 2nd chamber lumen is attached to a suction device &
airway secretions can be removed
– 3rd chamber has tiny metallic alligator forceps that can
be extended past the proximal end for tissue biopsies
– 4th chamber lumen allows passage of a small wire brush
that can be passed vigorously over airway structures for
collection of tissue cells for microscopic evaluation
Equipment
• Flexible or Rigid
• Adult sizes
– 5.0 mm OD to 6.0 mm OD
• Pediatric sizes
– Most manufacturers provide scopes in sizes 3.5
mm OD or less appropriate for children. No
channel outlet may exist for suctioning
because of its small size
Indications
• Diagnostic
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Suspected foreign body
Suspected malignancy
Bronchial washings
Hemoptysis
Persistent problems
• Therapeutic
– Foreign-body
obstruction
– Secretion removal
– Bronchial lavage
– Stenosis
– atelectasis
Procedure
• Topical anesthetic (lidocaine) is administered to
control gag/cough reflex and prevent
bronchospasm
– 5 – 10 cc 4% lidocaine aerosolized to upper airway
delivered by a mask nebulizer
– Benzocaine nasal sprays
– 2% lidocaine instilled into the hypopharynx in 2 cc
incements
• Intubation preferred but not required. Intubation
will not allow visualization of the vocal cords
• Scope is inserted and the airways viewed
• O2 needs to be provided to patient via mask or
by removing one prong of the nasal cannula from
the nose to allow for insertion of the scope
Procedure
• Diagnostic and/or therapeutic procedures are
performed
• Intubated patients on vents need special
adapters for advancement of the scope. Adapter
should allow for:
– No loss of ventilating pressures
– No loss of PEEP
• Continuous monitoring of EKG and O2 saturation
by pulse oximeter is recommended
• Equipment is cleaned by decontamination with
alkaline glutaraldehyde
Adapter for intubated patients
Rigid bronchoscopy
• Diagnostic use
– Biopsy of tumors within the main airway
• Therapeutic use
– Treatment of massive hemoptysis by cold-saline lavage
or placement of Fogarty catheter to occlude the airway
– Removal of foreign bodies in infants and small children
– Aspiration of inspissated secretions
• Limitations
– observing or treating beyond the right or left mainstem
bronchus
– Dz or trauma of cervical spine who cannot hyperextend
neck
– Dz or trauma of jaw who cannot open their mouth wide
RCP responsibilities
• Inform patient of procedure and obtain consent
form. Prepare patient and explain procedure
• Nebulize a topical/local anesthetic
• Check fiberoptic unit for proper functioning
• Set up and monitor patient’s ECG and SpO2
• Administer O2 and monitor vital signs
• Collect suctioned or other specimens for C&S
• Perform biopsies and brushings for cytology
• Operate any photographic equipment
• Tend to patient comfort
• Disinfect the equipment between patients
Hazards and complications
• Most common complication is mild epistaxis
• Bronchospasm or laryngospasm
– From irritation of the airway
• Bleeding
• Hypoxemia
• Arrhythmias
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– From vagal stimulation. Monitor ECG and remove scope
until cardiac status is stabilized
Seizures
Aspiration
Pneumothorax
Respiratory depression
Contraindications
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Refractive hypoxemia
Bleeding disorders
Cardiovascular instability
Status asthmaticus
Marked hypercpanea