Special Procedures Bronchoscopy Dr AbdulMonim Batiha Definition and

Special Procedures Bronchoscopy Dr. Abdul-Monim Batiha

Definition and Terminology • Endoscopy – Use of instrument to look into various parts of the body to diagnose various diseases or explain certain conditions • Bronchoscopy – Procedure that allows visualization of the airways below the larynx

Equipment • A bronchoscope is an instrument about 3 ft long and 0. 5 ins or smaller in diameter that combines four narrow chambers into one tube – One lumen contains a fiber-optic light source so that structures can be viewed effectively – 2 nd chamber lumen is attached to a suction device & airway secretions can be removed – 3 rd chamber has tiny metallic alligator forceps that can be extended past the proximal end for tissue biopsies – 4 th chamber lumen allows passage of a small wire brush that can be passed vigorously over airway structures for collection of tissue cells for microscopic evaluation

Equipment • Flexible or Rigid • Adult sizes – 5. 0 mm OD to 6. 0 mm OD • Pediatric sizes – Most manufacturers provide scopes in sizes 3. 5 mm OD or less appropriate for children. No channel outlet may exist for suctioning because of its small size

Indications • Diagnostic – – – Suspected foreign body Suspected malignancy Bronchial washings Hemoptysis Persistent problems • Therapeutic – Foreign-body obstruction – Secretion removal – Bronchial lavage – Stenosis – atelectasis

Procedure • Topical anesthetic (lidocaine) is administered to control gag/cough reflex and prevent bronchospasm – 5 – 10 cc 4% lidocaine aerosolized to upper airway delivered by a mask nebulizer – Benzocaine nasal sprays – 2% lidocaine instilled into the hypopharynx in 2 cc incements • Intubation preferred but not required. Intubation will not allow visualization of the vocal cords • Scope is inserted and the airways viewed • O 2 needs to be provided to patient via mask or by removing one prong of the nasal cannula from the nose to allow for insertion of the scope

Procedure • Diagnostic and/or therapeutic procedures are performed • Intubated patients on vents need special adapters for advancement of the scope. Adapter should allow for: – No loss of ventilating pressures – No loss of PEEP • Continuous monitoring of EKG and O 2 saturation by pulse oximeter is recommended • Equipment is cleaned by decontamination with alkaline glutaraldehyde

Adapter for intubated patients

Rigid bronchoscopy • Diagnostic use – Biopsy of tumors within the main airway • Therapeutic use – Treatment of massive hemoptysis by cold-saline lavage or placement of Fogarty catheter to occlude the airway – Removal of foreign bodies in infants and small children – Aspiration of inspissated secretions • Limitations – observing or treating beyond the right or left mainstem bronchus – Dz or trauma of cervical spine who cannot hyperextend neck – Dz or trauma of jaw who cannot open their mouth wide

RCP responsibilities • Inform patient of procedure and obtain consent form. Prepare patient and explain procedure • Nebulize a topical/local anesthetic • Check fiberoptic unit for proper functioning • Set up and monitor patient’s ECG and Sp. O 2 • Administer O 2 and monitor vital signs • Collect suctioned or other specimens for C&S • Perform biopsies and brushings for cytology • Operate any photographic equipment • Tend to patient comfort • Disinfect the equipment between patients

Hazards and complications • Most common complication is mild epistaxis • Bronchospasm or laryngospasm – From irritation of the airway • Bleeding • Hypoxemia • Arrhythmias • • – From vagal stimulation. Monitor ECG and remove scope until cardiac status is stabilized Seizures Aspiration Pneumothorax Respiratory depression

Contraindications • • • Refractive hypoxemia Bleeding disorders Cardiovascular instability Status asthmaticus Marked hypercpanea