Norm of Bronchoscopy
Normal larynx, trachea, and bronchi.
Usage of Bronchoscopy
Used to examine the bronchi for abscesses, aspiration pneumonia, hemoptysis, unresolved pneumonias, strictures, and tumors; for removal of foreign objects; and to obtain deep sputum specimens and tissue biopsy specimens.
Description of Bronchoscopy
Direct visual examination of the larynx, trachea, and bronchi with a rigid bronchoscope or a flexible fiberoptic bronchoscope.
Professional Considerations of Bronchoscopy
Consent form IS required.
Bleeding, bronchospasm, cardiopulmonary arrest, dysrhythmias, hypotension, hypoxia, pneumothorax.
Pregnancy; clients with severe shortness of breath who cannot tolerate interruption of high-flow oxygen. Such clients may be intubated for the procedure to ensure optimal oxygenation. Sedatives are contraindicated in clients with central nervous system depression.
- Obtain vital signs, activated partial thromboplastin time, platelet count, and prothrombin time.
- Remove any dentures or eyeglasses.
- Sedation may be prescribed. Sedation includes benzodiazepines in 63% of cases, opioid in 14%, and both in 12% of cases (Smyth & Stead, 2002).
- Prepare suctioning equipment.
- Have emergency resuscitation equipment readily available.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The nasopharynx and oropharynx are anesthetized with a local anesthetic.
- The client is placed in a sitting or supine position.
- After the tube is passed through the mouth or nose into the larynx, more local anesthetic is sprayed into the trachea to inhibit the cough reflex.
- If the client has a large endotracheal tube in place, the flexible bronchoscope can be inserted through it.
- The trachea and bronchi are visually examined for abnormal color, structure, or lesions.
- Mucus is then suctioned until clear, bronchial washings are performed and the specimens are collected, and biopsy specimens are obtained if the flexible tube is used.
- The rigid bronchoscope is used to retrieve foreign bodies and excise lesions.
- The client is observed for impaired respirations or laryngospasms throughout the procedure.
- No food or fluids are given until the gag reflex has returned, about 2 hours after the procedure.
- The client should not attempt to swallow saliva until the gag reflex has returned. Saliva should be expectorated into an emesis basin. Observe the client's sputum for blood if a biopsy was performed. If a tumor is suspected, collect post bronchoscopy sputum specimens for cytologic examination.
- Observe postanesthesia precautions if a sedative was given. If deep sedation was used, follow institutional protocol for post sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds appropriately to commands spoken in a normal tone.
- Observe closely for postprocedure complications, including bronchospasm, bacteremia, bronchial perforation (indicated by facial or neck crepitus), cardiac dysrhythmias, fever, hemorrhage from the biopsy site, hypoxemia, laryngospasm, pneumonia, and pneumothorax.
Client and Family Teaching
- Fast after midnight the day of the procedure. Your diet will be restarted a few hours after the procedure.
- Arrange for transportation home after the procedure because you will not be permitted to drive for 24 hours after receiving sedation.
- Notify the physician if you are experiencing fever or difficulty in breathing during the next 48–72 hours.
- You can begin drinking or eating approximately 2 hours after the procedure.
Factors That Affect Results
- The procedure should be stopped if the client becomes uncooperative or if impaired respiratory function is noted.
- Intermittent negative-pressure ventilation is safe during interventional rigid bronchoscopy.
- Virtual bronchoscopy (use of computed tomography) has shown promise for assessing complications of lung transplantation.