Bronchoscopy

Question 1

What are indications of a bronch?

Answer 1

Therapeutic indications for bronchoscopy include removal of secretions, mucous plugs, obstructing tissues, or foreign bodies.

Intubation

Assess abnormalities in airway damage (burns and hemorrhage)

collect samples

Question 2

What are contraindication for Bronch?

Answer 2

Absence of concent unless emergent

Coagulopathy or uncontrolled bleeding
Severe obstructive airway disease (bronchospasm)
Severe refractory hypoxemia
Unstable hemodynamic status including dysrhythmias

Question 3

What are complication to doing a bronch?

Answer 3

Adverse response to medication given

Bleeding
Epinephrine 1:10,000 can be used to vasoconstrict

Hypoxemia / hypercarbia / bronchospasm

Pneumothorax / hemoptysis

Question 4

What is the connector that we use in bronchs that allow is to hold PEEP and keep the patient on the vent?

Answer 4

Bodai adapter

Question 5

When would you perform a Transbronchial needle aspiration?

Answer 5

Staging of mediastinal lymph nodes, diagnosis of submucosal infiltrate

Question 6

When would you perform a Transbroncheal biopsy?

Answer 6

Used to obtain parenchymal tissue (example = for interstitial disease)
For peripheral parenchymal masses

Question 7

What is a protected brush in bronchs?

Answer 7

One catheter inside the other – internal catheter protected by biodegradable plug

When you want to make sure you have lower airway pathogen only

Question 8

How would you prep the patient for a bronch?

if they are not intubated and sedated?

Answer 8

Lidocaine / NS / albuterol mixture aerosolized 20 minutes prior
Lidocaine: total max dose= ~300mg (serum conc can be 50% of topical administration)

ATROPINE

Anti-anxiety and Narcotic analgesic may be given…Have NARCAN ready, watch for respiratory depression

Question 9

What are some equipment needed for bronch?

Answer 9

Appropriate size bronchoscope
Bronchoscopic light source
Bronchoscope adapter for endotracheal tube

Cytology brushes, flexible forceps, transbronchial aspiration needles, retrieval baskets
Syringes for medication delivery, normal saline lavage, and needle aspiration

Sterile normal saline

Specimen collection devices and fixatives
Biteblock
Sterile gauze pads for cleaning
Watersoluble lubricant
Venous access equipment

Endotracheal tubes

Question 10

Considerations for Et tube size during bronchs?

Answer 10

should be 1.5F bigger than the bronch

Question 11

What should you monitor during a bronch?

Answer 11

Continuous Oxygen saturation
Continuous ECG
Respiratory rate and depth (look for over sedation)

Periodic BP

Continuous EtCO2

Question 12

How should you take care of the patient Post bronch?

Answer 12

Closely monitor patient the next 2-4 hours

If a transbroncheal / tracheal procedure was done, check CXR one hour post procedure

Question 13

How far does the bronch go down?

Answer 13

Fifth bronchi