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Interventions 3 > Bronchoscope (mod8) > Flashcards

Bronchoscope (mod8) Flashcards

1
Q

Purpose of Bronchoscope

A

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)
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2
Q

Rigid tube bronchoscopies?

A

Used for removal of foreign bodies

  • need anesthesiogist present
  • Target SpO2 <90%
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3
Q

Is sedation needed for bronchscopies?

A

On spontaneously breathing (like a conscious sedation w/LOTS of numbing) or on fully sedated patient

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4
Q

Indications for Bronchoscopy?

A
  • 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

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5
Q

Therapeutic indications for bronchoscopy

  • could include intubation, but this cards not focused on that.
A
  • Airway dilation
  • Atelectasis
  • Endotracheal intubation
  • Foreign body aspiration
  • Instillation of med
  • Laser therapy
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6
Q

Diagnostic Bronchoscopy indications

A

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.
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7
Q

Contraindications for Bronchoscopy

A

Absolute contraindications include the following; relative in image

  • Cardiovascular instability
  • Inability to oxygenate
  • uncontrolled coagulopathy or bleeding
  • when risks outweigh benefits
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8
Q

Why could bronchoscopy patients be difficult to bag?

A

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.
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9
Q

What should be done if patient is inadequately oxygenated and they start desatting?

A

Take off vent and bag while going down bronch.

  • Huge amount of resistance
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10
Q

Bronchoscopy considerations

A

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
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11
Q

Equipment needed for bronchoscopy

A
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12
Q

Patient monitoring needed for bronchoscopy

A
  • Pulse ox
  • O2 and related delivery equipment
  • Sphygmomanometer
  • suction and supplies
  • resuscitation equipment
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13
Q

Is bronchoscopy a clean or sterile procedure?

A

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
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13
Q

Medications for Bronchoscopy?

A
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14
Q

What does tachycardia and hypertension indicate during a bronchoscopy?

A

Patient is stressed, might need more sedation

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15
Q

Patient prepration? *

A
16
Q

Where would numbing of lidocaine be injected for a bronchoscopy?

A

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
17
Q

Patient requirements during procedure for bronchoscopy

A

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
18
Q

Bronchospasm during bronchoscopy?

A

Prepare with Ventolin (salbutamol) nebulizer treatment

19
Q

Patient monitoring vitals

A

SpO2 > 95% and HR

  • observe for adequate respirations (depth and rate), cyanosis, and peripheral perfusion
20
Q

Bleeding control for bronchoscopies?

A

Epinephrine, if bleeding doesn’t stop use cold saline (60ml syringe).

  • cool the area = vasoconstriction locally.
21
Q

Bronchoalveolar Lavage (BAL)

A

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
22
Q

How are Bronchoalveolar Lavage (BAL) samples collected?

A

Sterile trap

23
Q

What is Bronchial washing used for

A
  • Cytologic screen (cancer)
  • mycobacterial
  • fungus
24
Q

What is Bronchial washing

A

Byproduct of general bronchoscopy procedures

  • fluid from suctioning is captured in a sterile container
  • still putting in 60mls of saline and suctioning back
25
Q

Bronchial bronchoscopy samples

A

aside from washing; there is

  • brushing
  • tissue biopsy (use of forceps)
  • needle aspiration
26
Q

Bronchial Brushings:

A

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
27
Q

Bronchial Biopsy

A

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
28
Q

Bronchoscopy Needle Aspiration

A

Allows subsurface tissue samples

  • Often guided with ultrasound
  • used If you want to get sample from lymph node for testing
29
Q

Rigid bronchoscopy

A

Rigid bronchoscopy used to remove large masses in the lungs

  • Laser or balloon dilation
30
Q

Post procedure guidelines for bronchoscopy

A
  • 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
31
Q

Complications with flexible bronchoscopy tubes?

A

Blood pressure tends to increase

32
Q

Rigid tube bronchoscope

A

Used mainly by surgeons for removal or foreign bodies

33
Q

Disadvantages of rigid tube bronchoscopes?

A

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
34
Q

Flexible fiberoptic bronchoscope

A

Can access smaller airways, used by respirologist.

  • Mostly disposable
  • Can pass fluids, instruments, and can suction back through them to clean airways
35
Q
A

Interventions 3 (19 decks)

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