Bronchoscopy (ADULTS)

Bronchoscopy procedure explanation

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2. BRONCHOSCOPY PREPARED BY: RN Arpana Bhusal BNS 7/24/2022 2

3. Definition Bronchoscopy is the direct inspection and examination of the larynx, trachea and bronchi through an instrument called bronchoscope. 7/24/2022 3

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6. Types of bronchoscope Flexible bronchoscope Rigid bronchoscope 7/24/2022 6

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8. Bronchoscopy is most commonly performed using a flexible bronchoscope. However, in certain situations, such as if there’s lot of bleeding in lungs or a large object is stuck in airway, a rigid bronchoscope may be needed. 7/24/2022 8

9. Purpose Diagnostic To diagnose disease of the lung, such as cancer or tuberculosis. To diagnose congenital deformity of the lungs. To visually examine possible tumor, obstruction, secretion or foreign body in the airways or lungs, as demonstrated on radiograph . 7/24/2022 9

10. To diagnose airway abnormalities such as T racheal Stenosis. To collect secretions for analysis and to obtain tissue sample for diagnosis . To diagnose sources of hemoptysis. 7/24/2022 10

11. Therapeutic To remove foreign bodies, malignant or benign tumors , mucus plugs or excessive secretions from airways or lungs. To control bleeding. 7/24/2022 11

12. Nursing intervention Before Procedure Nurse should verify that informed consent has been obtained . 2. Food and fluids are withheld for 4 to 8 hours before the test to reduce risk of aspiration when the cough reflex is blocked by anesthesia . 7/24/2022 12

13. 3. Explain the procedure to the patient to reduce fear and decrease anxiety. 4 . Tell the patient that chest x ray study and blood studies (PT, Platelets count) will be performed before the bronchoscopy . 5 . Administer preoperative medications (usually atropine and a sedative or opioid) as prescribed . 7/24/2022 13

14. 6. The examination is usually performed under local anesthesia; however general anesthesia may be used for rigid bronchoscopy. 7. If the procedure is not performed under general anesthesia, inform patient that a local anesthetic will be spread into his nose and mouth to suppress the gag reflex. 7/24/2022 14

15. 8. Check the patient’s history for hypersensitivity to anesthetic. 9 . If patient is wearing dentures, instruct him to remove them just before the test. 7/24/2022 15

16. During procedure Place the patient in a supine position on a table or bed or have him sit upright in the chair. 2.After local anesthetic is sprayed into the patient’s throat and takes effect (usually 1-2 minutes),then bronchoscope is introduced. 7/24/2022 16

17. Anatomical structure of trachea and bronchi is inspected . 4. Then biopsy forceps may be used to remove a tissue specimen from a suspect area. A suction apparatus is used to remove foreign bodies or mucus plugs. 5. Place the resulting specimens for microbiology, histology and cytology in their respective, properly labeled containers. 7/24/2022 17

18. After procedure Monitor vital signs. Notify immediately of any adverse reaction to anesthetic or sedative. 2. Place the conscious patient in semi-fowler’s position; place the unconscious patient on his side with the head of bed slightly elevated to prevent aspiration. 7/24/2022 18

19. 3. Provide an emesis basin and instruct the patient to split out saliva . Observe sputum for blood and notify immediately if excessive bleeding occurs. 4 . Nurses monitor patient’s respiratory status and observes for hypoxia, hypotension, tachycardia, hemoptysis, and dyspnea. Any abnormality report promptly . 7/24/2022 19

20. 5. A small amount of blood tinged-sputum and fever may be expected within the first 24 hours. 6 . Instructs the patient and care givers to report any shortness of breathe or bleeding immediately . 7. Keep resuscitation equipment and tracheostomy tray available for 24 hours after test . 7/24/2022 20

21. 8 . Restrict food and fluids until the gag reflex returns (usually 2-8 hours ) , then the patient may resume his usual diet, beginning with sips of clear liquids. 9 . Reassure the patient that hoarseness, loss of voice and sore throat after the procedure are temporary. 7/24/2022 21

22. Investigations of symptoms haemoptysis persistent cough recurrent infection Infection assessment of pulmonary infiltrates identification of organisms evaluate airways if recurrent or persistent infection clinical or radiological features of environmental mycobacterial infection Indications 7/24/2022 22

23. Contraindications Uncooperative patient Uncorrectable hypoxemia/ hypercapnia Unstable myocardium uncorrectable bleeding tendency Tracheal stenosis 7/24/2022 23

24. Complications Bleeding Over sedation Prolonged Fever Infection Collapsed lung 7/24/2022 24

25. References Sharma K S. and Madhavi S.(2018). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing,(south Asian edition). Wolters Kluwer(India) Pvt.Ltd . Page no 329,330. Mandal G.N.(2014). Textbook of Medical Surgical Nursing (Adult Nursing),(3 rd edition). Makalu Publication House. Page no 82,83. https://www. medscape.com https://www.mayoclinic.org 7/24/2022 25

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