Bronchoscope (mod8) Flashcards
Purpose of Bronchoscope
Used to view airways and check for abnormalities
- Know if its diagnostic and therapeutic and what the difference is and what you would do differently ***
- Visualization
- Collect samples (washout, biopsies)
Rigid tube bronchoscopies?
Used for removal of foreign bodies
- need anesthesiogist present
- Target SpO2 <90%
Is sedation needed for bronchscopies?
On spontaneously breathing (like a conscious sedation w/LOTS of numbing) or on fully sedated patient
Indications for Bronchoscopy?
- Diagnostics
- Therapeutics – trying to fix issues with pt (FBA, A/w dilation
– for stenosis, instill for thick secretions, bronchial toiletting, another method to intubate pt – for v difficult a/w – keep awake as long as possible, numb as much as possible and then intubate while awake)
- Fiberoptic intubation – Thread the ett, go down nose or mouth with bronch, visual vocal cords, push bronch through the vocal cords, and then thread the ett through
Microbiology – through washout
Therapeutic indications for bronchoscopy
- could include intubation, but this cards not focused on that.
- Airway dilation
- Atelectasis
- Endotracheal intubation
- Foreign body aspiration
- Instillation of med
- Laser therapy
Diagnostic Bronchoscopy indications
For diagnostic purposes, persistent or recurrent respiratory symptoms are the most common indication for flexible bronchoscopy.
- These symptoms may include stridor, an abnormal voice, wheeze, cough, and recurrent or persistent abnormalities on chest radiography.
Contraindications for Bronchoscopy
Absolute contraindications include the following; relative in image
- Cardiovascular instability
- Inability to oxygenate
- uncontrolled coagulopathy or bleeding
- when risks outweigh benefits
Why could bronchoscopy patients be difficult to bag?
Hard to bag bc of increase of resistance from the tub.
- bronch can also cause bleeding and cause vasoconstriction if patient has uncontrolled disorders like asthma.
What should be done if patient is inadequately oxygenated and they start desatting?
Take off vent and bag while going down bronch.
- Huge amount of resistance
Bronchoscopy considerations
Bronchoscopy can cause hypoxemia due to occlusion, hypoventilation, and sedation.
- monitor SpO2 and Cardiac status during the procedure
- provide assisted O2 therapy
- Prepare to assist with ventilatory support by bag and mask, followed by intubation
- Bronch may have to be removed to bag. terminate if it happens too often
Equipment needed for bronchoscopy
- Bronchscope
- Light source/processor/monitor
- sterile water soluble lube
- 4cm by 4cm gauze pad (for the lube to be used and gripped by main operator)
- sterile basin/container
- non-bacteriostatic normal saline
- swivel connector
- 2x60 ml syringe
- suction connective tubing/source
- specimen transport bags (and pen)
- patient labels
- waterproof tape
Patient monitoring needed for bronchoscopy
- Pulse ox
- O2 and related delivery equipment
- Sphygmomanometer
- suction and supplies
- resuscitation equipment
- PPE
- 1x80 ml specimen trap if BAL
Is bronchoscopy a clean or sterile procedure?
Bronch always maintain sterility (Sealed and keep sterile as possible until procedure done)
- Assembly and operation – depends on facility
- Alligator clamps to take piece of a/w to biopsy
- Needles to stab into things like lymph node to take sample
Medications for Bronchoscopy?
What does tachycardia and hypertension indicate during a bronchoscopy?
Patient is stressed, might need more sedation
Patient prepration? *
Where would numbing of lidocaine be injected for a bronchoscopy?
Start with 3 (1% or 2% lidocaine instillations): apply syringe at nasal cavity, posterior pharynx, vocal cords and tracheobronchial tree (titrate to affect)
- same thing at the carina
- Numbing at oropharynx, glottis, carina
Patient requirements during procedure for bronchoscopy
Patients require moderate sedation (IV offten required: Midazolam, fentanyl, morphine combos)
- Sedation may caused resp depression
- Bronchospasm could occur
- Pediatric pts may need emotional support and comfort
Bronchospasm during bronchoscopy?
Prepare with Ventolin (salbutamol) nebulizer treatment
Patient monitoring vitals
SpO2 > 95% and HR
- observe for adequate respirations (depth and rate), cyanosis, and peripheral perfusion
Bleeding control for bronchoscopies?
Epinephrine, if bleeding doesn’t stop use cold saline (60ml syringe).
- cool the area = vasoconstriction locally.
Bronchoalveolar Lavage (BAL)
Bronch is wedged into position of selected segmental or subsegmental bronchi
- saline is instilled (20-60 mls)
- ideally no suction of pt prior to sampling; captured in sterile trap
- Sample is then sent to the labs for analysis of colonizing organisms so that specific antibiotics can be used for Rx.
- saline sent into segment is the sample gathered and tested
How are Bronchoalveolar Lavage (BAL) samples collected?
Sterile trap
What is Bronchial washing used for
- Cytologic screen (cancer)
- mycobacterial
- fungus
What is Bronchial washing
Byproduct of general bronchoscopy procedures
- fluid from suctioning is captured in a sterile container
- still putting in 60mls of saline and suctioning back
Bronchial bronchoscopy samples
aside from washing; there is
- brushing
- tissue biopsy (use of forceps)
- needle aspiration
Bronchial Brushings:
Objective is to obtain a sample of a suspected lesion in the lungs
- Assistant RT prepares brush for insertion
- Operator brushes the lesion 5 – 10 times
Bronchial Biopsy
Used to obtain tissue samples from lesions
- Histologic examinations for neoplasms for suspected carcinoma
- Complication of bleeding or pneumothorax
- Instillation of ice-cold saline or epinephrine may help to stop bleeding
- uses alligator clamps
Bronchoscopy Needle Aspiration
Allows subsurface tissue samples
- Often guided with ultrasound
- used If you want to get sample from lymph node for testing
Rigid bronchoscopy
Rigid bronchoscopy used to remove large masses in the lungs
- Laser or balloon dilation
Post procedure guidelines for bronchoscopy
- Monitor patient for stridor or wheezing
- make sure they fully awake
- Prevent aspiration; oral fluids withheld until the patient is fully awake and topical anesthesia has worn off for about 1 hour
Complications with flexible bronchoscopy tubes?
Blood pressure tends to increase
Rigid tube bronchoscope
Used mainly by surgeons for removal or foreign bodies
Disadvantages of rigid tube bronchoscopes?
Can not access smaller airways and have Limited maneuverability
- Very uncomfortable if patient is conscious
- Requires assistance of anesthetist and or Pass through distal end so they can see what they’re grabbing…Cannot access smaller airways
Flexible fiberoptic bronchoscope
Can access smaller airways, used by respirologist.
- Mostly disposable
- Can pass fluids, instruments, and can suction back through them to clean airways
