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.
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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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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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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