This document discusses bronchoscopy, including its purposes, types of techniques, equipment needed, and the roles of healthcare professionals. Bronchoscopy is used to inspect airways, collect samples, and place devices. There are two main techniques - rigid tube bronchoscopy used by ENTs and thoracic surgeons, and flexible fiberoptic bronchoscopy used by pulmonologists with RT assistance. Premedication and airway preparation are important steps. During the procedure, the RT monitors the patient and assists the bronchoscopist by supplying medications/solutions and handling instruments. Afterward, the RT ensures proper recovery and post-procedure care.

1. BRONCHOSCOPY
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2. Learning Objectives:
 Understand the purposes of bronchoscopy, including inspection of the airway, sample collection, and
device placement.
 Differentiate between rigid tube bronchoscopy and flexible fiberoptic bronchoscopy techniques.
 Identify the advantages and disadvantages of each bronchoscopy technique.
 Recognize the indications and contraindications for performing bronchoscopy.
 Learn about the potential complications and hazards associated with bronchoscopy.
 Understand the importance of equipment preparation and airway preparation before bronchoscopy.
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3. Learning Objectives:
 Describe the role of the respiratory therapist in assisting with bronchoscopy procedures.
 Explore the monitoring requirements for patients undergoing bronchoscopy.
 Gain knowledge of the equipment needed for bronchoscopy beyond bronchoscopes and patient
monitoring devices.
 Understand the goals of premedication before bronchoscopy and the use of vasoconstrictors in airway
preparation.
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4. Definition and Purpose
 So, what exactly is bronchoscopy?
 It's a procedure used for several purposes:
 Inspecting the airway
 Removing foreign objects from the airway
 Collecting samples from the airway
 Placing medical devices into the airway
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5. Types of Bronchoscopic Techniques
 There are two main types of bronchoscopy:
 Rigid Tube Bronchoscopy:
 Think of this as a sturdy metal tube.
 It's used mainly by otorhinolaryngologists and thoracic surgeons.
 They insert it through the mouth down into the trachea and bronchi.
 It's useful for certain tasks but has some drawbacks, like patient discomfort
and limited access to small airways.
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6. Rigid Tube Bronchoscopy
The head of the rigid bronchoscope can be adapted
to the desired tube, according to the different needs
Rigid bronchoscope with ancillary tools and
connection for ventilation
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7. Types of Bronchoscopic Techniques
 Flexible Fiberoptic Bronchoscopy:
 This one is more versatile and can access even the tiniest airways.
 Pulmonologists, often with the assistance of respiratory therapists, primarily
use this method.
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8. Flexible Fiberoptic Bronchoscope
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9. Indications for Bronchoscopy
 Checking chest lesions
 Evaluating recurrent pneumonia, atelectasis, or lung infiltrates
 Investigating symptoms like hemoptysis (coughing up blood), cough,
wheezing, or stridor (noisy breathing)
 Collecting samples for further analysis
 Assessing injuries from toxic inhalation or aspiration
 Managing issues with airway tubes
 Removing foreign objects
 Performing various therapeutic procedures
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10. Contraindications and Precautions
 Absolute contraindications include cases where we lack patient consent,
experience, or facilities for emergencies.
 Relative contraindications come into play when there are increased
risks, like recent heart issues or tracheal obstructions.
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11. Hazards and Complications
Complications may include
 Medication-related effects
 Hypoxemia (low oxygen levels)
 Bronchospasm (narrowing of airways)
 Mechanical issues
 Infection risk
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12. Equipment Needed
 Instruments for the Bronchoscopist and Assistant:
 Masks
 Goggles
 Gloves (Sterile For Bronchoscopists)
 Gowns
 Appropriate-sized Bronchoscopes.
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13. Equipment Needed
 Bronchoscopic Devices:
 A bronchoscopic light source,
 An adapter for endotracheal tubes (ETT’s)
 Cytology brushes,
 Flexible forceps,
 Trans bronchial aspiration needles,
 Retrieval baskets
 Syringes for medication delivery,
 Normal saline lavage
 Needle aspiration.
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14. Equipment Needed
A bronchoscopic
light source
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15. Equipment Needed
 Specimen Collection Devices and Fixatives:
 Specimen collection devices
 Fixatives.
 Other Supplies:
 Bite blocks,
 Sterile gauze pads for cleaning the bronchoscope tip,
 Water-soluble lubricant,
 Venous access equipment (in case intubation is required)
 Appropriate documentation paperwork.
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16. Equipment Needed
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17. Premedication and Airway Preparation
 Premedication:
 This step is essential to reduce patient anxiety and enhance cooperation.
 Medications such as codeine, midazolam, morphine, diazepam, and
fentanyl are used.
 These medications can help alleviate pain and anxiety.
 We also have benzodiazepine antagonists like flumazenil and narcotic
antagonists like naloxone on hand in case of adverse reactions.
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18. Premedication and Airway Preparation
Airway Preparation:
 To create an ideal environment for the procedure, we need to dry the patient's
airway.
 This promotes better anesthetic deposition, improves visibility, and can reduce
the duration of the procedure.
 Vasoconstrictors like pseudoephedrine or dilute epinephrine (usually 1:10,000)
may be used to prevent or treat bleeding.
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19. Airway Preparation
 Anesthesia is achieved through topical anesthetics like lidocaine (in various
concentrations) administered via atomizers, mouthwash, or nebulizers.
 The RT often administers lidocaine via nebulizer, which can make the procedure less
uncomfortable for the patient.
 Special nerve blocks may also be used to provide anesthesia in specific areas of the
airway.
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20. Monitoring During Bronchoscopy
Continuous Monitoring
This includes:
 Pulse Oximetry: To assess oxygen saturation (SpO2)
 Respiratory Rate: To observe the patient's breathing pattern
 ECG: To track the heart's electrical activity
 Blood Pressure: To check for any fluctuations
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21. Role of the RT
 The respiratory therapist plays a crucial role in monitoring the patient's condition.
 They are responsible for adjusting oxygen therapy as needed, ensuring the patient's
oxygen levels are optimal, and responding to any changes in the patient's respiratory
status.
 If the patient is mechanically ventilated, the RT also monitors ventilator parameters like
tidal volume, peak inspiratory pressure, and inspiratory flow.
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22. Assisting With the Procedure
Supplying Medications and Solutions:
 During bronchoscopy, the RT assists by supplying medications such as
 Anesthetics
 Vasoconstrictors
 Mucolytic agents
 Lavage solutions
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23. Assisting With the Procedure
Handling Instruments:
 The RT may be responsible for handling instruments like forceps or
brushes that are inserted into the bronchoscope by the bronchoscopist.
 These instruments are used to perform specific tasks like collecting
samples or removing foreign objects.
Sample Collection:
 Additionally, the RT may collect sputum or tissue samples obtained by
the bronchoscopist and prepare them for laboratory analysis.
 This is a crucial part of the procedure, as these samples can provide
valuable diagnostic information.
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24. Recovery and Post-Bronchoscopy
Care
 After the procedure, we need to ensure the patient recovers well.
 Oxygen therapy continues for up to 4 hours, and we confirm adequate
oxygenation using pulse oximetry.
 Also watch for any signs of stridor or wheezing, and if necessary, we
provide aerosol therapy.
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25. Reference
 Chapter 36 basic therapeutics page 784 Egan's fundamental of respiratory care
12 edition.
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