RCP 204 unit 1

Question 1

What is a Bronchoscopy

Answer 1

-A well-established diagnostic and therapeutic tool used in ICU’s special procedure rooms, and outpatient settings

-It may be rigid or flexible

-It may be diagnostic or therapeutic

-Rigid bronchoscopy is used to manage obstruction of the trachea or proximal bronchus, and insert airway stents, due to its large size.

Question 2

Flexible Bronchoscope

Answer 2

-Fiberoptic, flexible bronchoscope allows direct visualization of the upper airways (nose, Oral cavity, and pharynx) larynx, vocal cords, subglottic area, trachea, bronchi, lobar bronchi, and segmental bronchi down to the third or fourth generation.

-became a standard procedure because of its diagnostic value, safety, and ease of performance

-Can be used under local anesthesia or moderate ( Conscious sedation)

-Can investigate tumors or obstructions in the airways and lungs, provide lavage and suction, and obtain specimens using lavage fluid, cytology brushes, transbronchial needle aspiration, or biopsy forceps

Question 3

Bronchoscopy Delivery

Answer 3

-Can be performed on spontaneously breathing patients via oral or nasal route

-Recommended for intubation with suspected neck fracture

-Can be performed on PTs with an ET tube or trach

Question 4

Bronchoscopy sedation

Answer 4

-Most procedures are performed under moderate (conscious) sedation

	-the goal of sedation is to improve the PTs comfort during the procedure and facilitate the procedure by minimizing pts movement and other potential interruptions

	-At this level of sedation the pts can respond to verbal stimuli and demonstrate preserved protective airway reflexes

Question 5

Bronchoscopy sedation IV forms

Answer 5

-Several IV forms of benzodiazepine and opioids are commonly used.

-The combination of benzodiazepine and opioid has been shown to be safe and effective for sedation

Question 6

-Bronchoscopy Indications

• Diagnostic

Answer 6

-Suspected foreign body

	- Suspected malignancy

	-Bronchial washings

	-hemoptysis

	-Persistent problems

	-Inflammation or infection

	-Evaluation of tumor

	-Vocal cord paralysis

Question 7

-Bronchoscopy Indications

-Therapeutic

Answer 7

-Foreign body obstruction/ removal

	-secretions removal

	-Bronchial lavage

	-Stenosis

	-Atelectasis

	-Placement of airway stent

	-Placement of ET tube / trach tube

Question 8

Bronchoscopy Contraindications

Answer 8

Absolute- unstable hemodynamic status persistent life threatening arrhythmias, refractory hypoxemia before or after procedure, acute ventilatory failure with hypercapnia during spontaneous breathing, coagulopathy or bleeding condition, increased ICP, and tracheal obstruction

Question 9

Bronchoscopy Procedures

Answer 9

-Topical anesthetic (lidocaine) is administered to control the gag/ cough reflex and prevent laryngospasm

-Intubation is preferred but not required. Intubation will not allow visualization of the tru vocal cords.

-The scope in inserted and the airways are viewed

-O2 needs to be provided to the pt via a mask or or by removing one prong ot the nasal cannula from the nose to allow for insertion of the scope

-Diagnostic/ therapeutic procedures are performed

Question 10

Bronchoscopy Procedures

Bodai

Answer 10

-Pt receiving mechanical ventilation will need a special adapter for advancement of the scope (Bodai)

	-This adapter should allow a fit tight enough that:

		-No loss of ventilation pressure

		-No loss of PEEP

		-No volume is lost

	-Further precautions should be taken for pts on mechanical vent that included:

	-A topical anesthetic should be administered down the ET tube or trach tube prior to insertion of bronchoscope

	-Increase the FI02 to 100%

-Tissue specimens are obtained using specialized instruments such as as bronchial brushes and forceps

Question 11

Bronchoscopy For pts receiving mechanical ventilation

Answer 11

-For pts receiving mechanical ventilation

	-Minimum ET tube size for flexible bronchoscopy if 8.0 mm ID

	-Obtain a Bodia adaptor, which allows the pt to continue receiving positive pressure ventilation during the procedure

	-Administer topical anesthetic through the ET tube

	-Increase FI02 to 100%

	-Increase the high pressure alarm setting

Question 12

Bronchoscopy Hazards and Complications

Answer 12

-The most common complication is mild epistaxis (nasal bleeding)

-Internal Hemorrhage is not uncommon. Most cases can be controlled with saline lavage and time

-If major bleed occurs, then one or more of the following steps should be taken:

	-Instill Epinephrine (1m of 1:1000)

	-Compress the site with the scope

	-INsert a Fogarty catheter

Question 13

Bronchoscopy Hazards and Complications pt 2

Answer 13

Hazards and com contin

-Bronchospasm/ Laryngospasm are possible and are prevented/ Treated with bronchodilators and anesthetics

-Hypoxemia would be a serious harvard and is monitored by pulse ox amd ECG and prevented/ treated with oxygen

-Pneumothorax is possible when taking tissues samples

-Cleaning and Care of equipment

-INsertion tube or portion of bronchoscope that makes contact with mucosal membranes or infectious diseases (TB ot HIV) must be sterilized

-Glutaraldehyde (Cydex)

Question 14

Specialized Bronchoscopy

Answer 14

-Endobronchial Ultrasound (EBUS), combines traditional bronchoscope technology with ultrasound to permit high resolution imaging of lesions that would otherwise be hard to visualize

-Electromagnetic Navigational Bronchoscopy (ENB) uses low frequency electromagnetic waves transmitted from a magnetic board placed below the PTs chest to allow a lesion to be visulized in three dimensions and in real time

-Both EBUS ans ENB can also be combined to further increase the diagnostic value of such systems