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Bronchoscopy

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by

Richard Stephenson

on 28 March 2014

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Transcript of Bronchoscopy

Medications Administered
Bronchoscopy: definition
Indications for a Bronchoscopy
Evidence of a lung tumor
Medications Administered
Video
Bronchoscopy
Visual examination of the bronchials
In many healthcare facilities, RT's assist the physician during a bronchoscopy
RT's may also be responsible for cleaning, sterilizing, and maintaining the equipment
Rigid Bronchoscope
Flexible Bronchoscope
Pneumonia
Hemoptysis
Atelectasis (intractable)
Unexplained cough, stridor, wheezes
Abnormal sputum culture
AARC
To obtain sputum speciman
Indications...
To intubate or assess patency of an artificial airway
To remove a foreign body
Pulmonary toilet with VAP
To place airway stents
Intubate one main stem bronchus
This is the most common
The flexible bronchoscopy tube contains:
1. a light
2. Open channel for suctiioning
3. A viewing lense
AARC
Contraindications per the AARC
Absence of patient consent
Lack of facilities to perform bronchocopy
Absence of qualified person to perform procedure
Inability to provide O2
Refractory hypoxemia
Unstable hemodynamics
Bleeding disorder
Hazards/Complications
hypoxemia
hypercarbia
bronchospasm
hypotension
laryngospasm, vaso-vagal response
epitaxis,pneumothorax, hemoptysis
increased airway resistance
cross-contamination
To anesthetize the throat:
2 % lidocaine (xylocaine)
benzocaine (cetacaine)spray
The RT may administer the 2% lidocaine via SVN prior to the bronchoscopy
For sedation:
Lorazepam (Ativan)
Diazepam (Valium)
Midazolam (Versed)
For pain:
Fentanyl
Medications Administered
For secretion management:
Atropine
Epinephrine
Let's Review
First there must be a consent form
Secondly the patient must be prepared:
Anesthetize the nose and pharynx
Administer sedation and pain medications to the patient
Why these drugs?
They dry out the airways
Flexible fiberoptic bronchoscopy tube

With bronchoscopy, we’re able to:
- Visually inspect the airway
- Biopsy samples from the airway either by brushings, forceps, needle aspiration
- Aspirate mucous plugs from the airway
- Obtain sputum samples
- Remove foreign objects
- Intubate



Intractable asthma
Additional Medications
Acetylcysteine

Beta 2 agonist

Racemic epinephrine

Pseudophedrine
Equipment Preparation
Bronchoscope with light source

Brushes, forceps, transbronchial aspiration needles

Syringes for lavaging, medication administration, needle aspiration

Normal saline

Slides, collection jars, fixation liquid

Equipment preparation
Water based lubricant

IV set-up equipment

Gauzes for cleaning

Crash cart

Pulse oximeter

ECG monitor

RT responsibilities
Drawing up the lidocaine, normal saline, and acetylcysteine

Preparing the suction equipment

Preparing the sputum sample cups and specimen traps

Forceps, brushes, needles (for the bronchoscope)

Administering O2
RT responsibilities
Monitor vital signs:
- heart rate
- ECG
- respirations: rate and depth
- SpO2
Monitor lavage volumes

Medications

Level consciousness

Cleaning the bronchoscope

What is always the first step before disinfection or sterilization?

Ans: cleaning

Clean the bronchoscope with detergent and water

Disinfect by immersion for 20 minutes in a high-level liquid disinfectant agent

Rinse all channels with sterile water

Place the bronchoscope in a forced air dryer
When drying, hang the scope in a vertical position

Post-bronchoscopy
Make sure patient is awake, alert, orientated

Patient shouldn’t eat or drink for several hours; why?

No driving

Vital signs are stable

Absence of bleeding

Prepare all specimens for transport to the lab

Homework
Read chapter 17 in Wilkins' book "Clinical Assessment in Respiratory Care"
Read pages 779-784 in chapter 33 "Egan's Fundamentals of Respiratory Care"
On Blackboard there is an assignment and a discussion board question to completed by Sunday night March 30th;
quiz this weekend!
Used mainly by surgeons
Large diameter tube is good for suctioning
Uncomfortable and requires sedation
Cannot visualize the small airways
Physician can obtain tissue samples
- brushings, needle aspiration, suction, swabbing
Morphine
Prepare the bronchoscope
Preparation
Set-up syringes with:
- lidocaine
- 0.9% NaCl
slides for the cultures
gauzes for cleaning off lubricant from the bronchoscope
collection jars with fixation solution
Epinephrine (for bleeding)
To sum it all up:
Full transcript