BRONCHOSCOPY

BRONCHOSCOPY – Definition, Purpose, Principle, General Instruction, Preliminary Assessment, Preparation of the Patient Unit, Articles Needed, After Care, Findings and Complications

Bronchoscopy is a endoscopic diagnostic procedure involving the inspection and observation of the trachea, larynx, and bronchi. Bronchoscopy is ordered when clients have unexplained pulmonary signs and symptoms or when nonspecific radiological abnormalities exist

DEFINITION

• Bronchoscope is an endoscopic diagnostic procedure involving the inspection and observation of the trachea, larynx and bronchi. Bronchoscopy is ordered when clients have unexplained pulmonary signs and symptoms or when nonspecific radiological abnormalities exist

PURPOSE

Diagnostic Purpose

• To visualize tumors, obstructions secretions, bleeding sites and foreign objects in the tracheobronchial system
• Collection of secretions for cytological and bacteriologic study
• Assessing tumors for potential resection
• Tissue for lung biopsy may be obtained

Therapeutic Purpose

• To remove secretions that obstructing the air passages
• To fulgurate (electrodesiccate) and excise lesions

PRINCIPLE

• The knowledge of the anatomy and physiology of the body is essential for the safe administration of the injection
• Microorganism are present everywhere so strict aseptic technique should be practiced
• Any unfamiliar situation produces anxiety
• Organization and planning results in the economy of time material and effort

GENERAL INSTRUCTION

• Proper explanation about the procedure should be given to the patient
• Sedation should be given 30-60 minutes before the procedure
• Procedure is done in a darkened room
• Instruction should be given to the patient to keep his mouth clean
• Nothing should be given to the patient 6-8 hours before the procedure
• Loose teeth and artificial dentures should be removed
• The patient should be positioned on his back with neck hyperextended
• The patient should be informed that his eyes will be covered during the procedure to reduce anxiety
• The patient should be told that the doctor and his assistants will be masked and gloved

PRELIMINARY ASSESSMENT

• Identify the patient with name, bed no: etc
• Check the physician’s order
• Check the general condition of the patient
• Assess the abilities and limitations of the patient
• Check the article available in the patient’s unit

PREPARATION OF THE PATIENT UNIT

• Ensure that a signed consent form has been obtained
• Obtain a medication history to determine whether the patient is receiving anticoagulation therapy or aspirin preparations
• Explain the purpose and procedure of the test. Warn the patient that the local anesthetic may taste bitter
• Record baseline vital signs
• Check for articles available in the unit
• The client should be NPO for 6 to 8 hours before the test
• Oral hygiene should be given the night before the test and in the morning
• Postural drainage is performed for 3 days before the test

ARTICLES NEEDED

Bronchoscope (flexible fiberoptic bronchoscope)

A sterile tray containing

• Gown
• Gloves
• Mask

An unsterile tray containing: Normal saline

Procedure

• A sedative and atropine are usually given 1 hour before the test. The sedative/tranquilizer is to promote relaxation; atropine is to reduce secretions during the test
• A topical anesthetic is sprayed into the pharynx and trachea
• A rigid or flexible fiber optic bronchoscope may be used
• The bronchoscope is inserted through the nose (most common) or through the mouth
• The tube is inserted as the physician observes the condition of the upper airways through the eyepiece and guides the tube to the area of the lung to be evaluated

Parts of flexible fiberoptic bronchoscope:

• Eyepiece
• Open channel
• Fiberoptic tube connected to cold light source
• Section tubing
• In-line sputum trap

AFTER CARE

• If bronchoscope is done under general anesthesia, position the patient in a head low position, flat with head turned to one side
• If not under general anesthesia semi-Fowler’s position
• Save all the sputum for laboratory studies
• Observe the patient for impaired respiration laryngeal spasm and laryngeal edema
• Laryngeal strider, dyspnea and shortness of breath should be notified to the doctor
• Provide emergency resuscitation as necessary
• Give treatment as prescribed
• Give nothing by mouth until his gag reflex returns
• Give warm, soothing, soft fluids
• Observe the patient for toxicity of anesthetic drugs
• Treat the sore throat
• An ice collar may; be used to minimize edema and soreness
• Lozenges and smooth gargles are given to the patient
• Instruct the patient not to clear his throat, cough or talk

FINDINGS

• Atelectasis
• Bleeding
• Bronchial adenomas
• Foreign bodies
• Infection
• Lung cancer
• Sarcoidosis
• Secretions
• Tuberculosis
• Tumors

COMPLICATIONS

• Bleeding
• Drug reactions
• Hypotension
• Laryngospasm
• Bronchospasm
• Hypoxia
• Dysrhythmia
• Cardiopulmonary arrest