Special Procedures Bronchoscopy



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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

    • Suspected foreign body
    • Suspected malignancy
    • Bronchial washings
    • Hemoptysis
    • Persistent problems








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:

  • 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

  • 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

  • Seizures

  • Aspiration

  • Pneumothorax

  • Respiratory depression









Contraindications

  • Refractive hypoxemia

  • Bleeding disorders

  • Cardiovascular instability

  • Status asthmaticus

  • Marked hypercpanea







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