BRONCOSCOPY

Bronchoscopy is the direct inspection of the larynx, trachea, and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope. The fiberoptic scope is used more frequently in current practice.

PURPOSE
The purposes of diagnostic bronchoscopy are: 1. To examine tissues or collect secreations. 2. To determine the location and extent of the pathologic process and to obtain a tissue sample for diagnosis (by biting or cutting forceps, curettage, or brush biopsy). 3. To determine whether a tumor can be resected surgically. 4. To diagnose bleeding sites (source of hemoptysis).

Therapeutic bronchoscopy is used to:

1. Remove foreign bodies from the tracheobronchial tree. 2. Remove secretions obstructing the tracheobronchial tree when the patientcannot clear them. 3. Treat postoperative atelectasis. 4. Destroy and excise lesions. It has also been used to insert stents to relieve airway obstruction that is caused by tumors or miscellaneous benign conditions or that occurs as a complication of lung transplantation.

Fiberoptic bronchoscope is a thin, flexible bronchoscope that

can be directed into the segmental bronchi. Because of its small size, its flexibility, and its excellent optical system, it allows increased visualization of the peripheral airway and is ideal for diagnosing pulmonary lesions. Fiberoptic bronchoscopy allows biopsy of previously inaccessible tumors and can be performed at the bedside. It also can be performed without surgical interventions.

Rigid bronchoscope is a hollow metal tube with a light and its

end. It is used mainly for removing foreign substances, investigating the source of massive hemoptysis, or performing endobronchial surgical procedures. Rigid bronchoscopy is performed in the operating room, not at the bedside.

NORMAL VALUES:
No organisms are seen on the culture. Normal cells and secretions are found. No foreign substances or blockage are seen.

WHAT DO ABNORMAL RESULT MEAN:

Abnormal culture results usually indicate a respiratory infection. The infection may be caused by bacteria, viruses or fungi. The result of the culture will help determine the best treatment.

NURSING INTERVENTIONS and RESPONSIBILITIES: BEFORE THE PROCEDURE:

1. A signed consent form is obtained from the patient. 2. Food and fluid are withheld for 6 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. 3. A nurse explains the procedure to the patient to reduce fear and decrease anxiety and administers preoperative medications (usually atropine and sedative or opioid) as prescribed to inhibit vagal stimulations (thereby guarding against bradycardia, dysrhymias and hypotension), suppress the cough reflex, sedate the patient, and relieve anxiety.

NURSING ALERT!!!
Sedation given to the patients with respiratory insufficiency may precipitate respiratory arrest. Patient must remove dentures and other oral prostheses. The examination is usually performed under local anesthesia or moderate sedation, but generally anesthesia may be used for rigid bronchoscopy. A Topical Anesthesia such as Lidocaine (Xylocaine) may be sprayed on the pharynx or dropped on the epiglottis and vocal cords and into the trachea to suppress the cough reflex and minimize discomfort. Sedatives or opioids are administered intravenously as prescribed to provide moderate sedation.

AFTER THE PROCEDURE:

1. It is important that the patient takes nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protection of laryngeal reflex and swallowing for several hours. 2. Once the patient demonstrate a cough reflex, the nurse may offer ice chips and eventually fluids. 3. In the elderly patient, the nurse assesses for confusion and lethargy, which may be due to the large doses of lidocaine administered during the procedure.

CONTINUATION:
4. The nurse must monitors the patients respiratory status and observe for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea. 5. Any abnormality is reported promptly. 6. The patient is not discharged from the recovery area until adequate cough reflex and respiratory status are present. 7.The nurse instructs the patient and family caregivers to report any shortness of breath or bleeding immediately.

PROCEDURE:
Bronchoscopy (bron-KOS-ko-pee) is a procedure that allows your doctor to look inside your lungs' airways, called the bronchi (BRONG-ki) and bronchioles (BRONGke-ols). The airways carry air from the trachea (TRA-keah), or windpipe, to the lungs. During the procedure, your doctor inserts a thin, flexible tube called a bronchoscope into your nose or mouth. The tube is passed down your throat into your airways. If you have a breathing tube, the bronchoscope can be passed through the tube to your airways. Youll be given medicine to make you relaxed and sleepy during the procedure.

The bronchoscope has a light and small camera that allow your doctor to see your windpipe and airways and take pictures. If you have a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. The rigid tube, which is passed through the mouth, is wider. This allows your doctor to see inside it more easily, treat bleeding, and remove stuck objects. A rigid bronchoscopy usually is done in a hospital operating room using general anesthesia (AN-es-THEze-ah). The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.

RATIONALE FOR ACTIONS:

1. To visualize the tracheobronchial tree for diagnostic purpose. 2. To obtain a tissue tissue specimen. 3. To remove foreign body. 4. To assist the physician by promoting maximum efficiency and minimal time expenditure.