BRONCHOSCOPY.pptx

bronchoscopy

1. BRONCHOSCOPY 1

2. Learning Objectives: Understand the purposes of bronchoscopy, including inspection of the airway, sample collection, and device placement. Differentiate between rigid tube bronchoscopy and flexible fiberoptic bronchoscopy techniques. Identify the advantages and disadvantages of each bronchoscopy technique. Recognize the indications and contraindications for performing bronchoscopy. Learn about the potential complications and hazards associated with bronchoscopy. Understand the importance of equipment preparation and airway preparation before bronchoscopy. 2

3. Learning Objectives: Describe the role of the respiratory therapist in assisting with bronchoscopy procedures. Explore the monitoring requirements for patients undergoing bronchoscopy. Gain knowledge of the equipment needed for bronchoscopy beyond bronchoscopes and patient monitoring devices. Understand the goals of premedication before bronchoscopy and the use of vasoconstrictors in airway preparation. 3

4. Definition and Purpose So, what exactly is bronchoscopy? It's a procedure used for several purposes: Inspecting the airway Removing foreign objects from the airway Collecting samples from the airway Placing medical devices into the airway 4

5. Types of Bronchoscopic Techniques There are two main types of bronchoscopy: Rigid Tube Bronchoscopy : Think of this as a sturdy metal tube. It's used mainly by otorhinolaryngologists and thoracic surgeons. They insert it through the mouth down into the trachea and bronchi. It's useful for certain tasks but has some drawbacks, like patient discomfort and limited access to small airways. 5

6. Rigid Tube Bronchoscopy The head of the rigid bronchoscope can be adapted to the desired tube, according to the different needs Rigid bronchoscope with ancillary tools and connection for ventilation 6

7. Types of Bronchoscopic Techniques Flexible Fiberoptic Bronchoscopy : This one is more versatile and can access even the tiniest airways. Pulmonologists , often with the assistance of respiratory therapists, primarily use this method. 7

8. Flexible Fiberoptic Bronchoscope 8

9. Indications for Bronchoscopy Checking chest lesions Evaluating recurrent pneumonia, atelectasis, or lung infiltrates Investigating symptoms like hemoptysis (coughing up blood), cough, wheezing, or stridor (noisy breathing) Collecting samples for further analysis Assessing injuries from toxic inhalation or aspiration Managing issues with airway tubes Removing foreign objects Performing various therapeutic procedures 9

10. Contraindications and Precautions Absolute contraindications include cases where we lack patient consent, experience, or facilities for emergencies. Relative contraindications come into play when there are increased risks, like recent heart issues or tracheal obstructions. 10

11. Hazards and Complications Complications may include Medication-related effects Hypoxemia (low oxygen levels) Bronchospasm (narrowing of airways) Mechanical issues Infection risk 11

12. Equipment Needed Instruments for the Bronchoscopist and Assistant : Masks Goggles Gloves (Sterile For Bronchoscopists) Gowns Appropriate-sized Bronchoscopes. 12

13. Equipment Needed Bronchoscopic Devices : A bronchoscopic light source, An adapter for endotracheal tubes (ETT’s) Cytology brushes, Flexible forceps, Trans bronchial aspiration needles, Retrieval baskets Syringes for medication delivery, Normal saline lavage Needle aspiration . 13

14. Equipment Needed A bronchoscopic light source 14

15. Equipment Needed Specimen Collection Devices and Fixatives : Specimen collection devices Fixatives. Other Supplies : Bite blocks, Sterile gauze pads for cleaning the bronchoscope tip, Water-soluble lubricant, Venous access equipment (in case intubation is required) Appropriate documentation paperwork. 15

16. Equipment Needed 16

17. Premedication and Airway Preparation Premedication : This step is essential to reduce patient anxiety and enhance cooperation. Medications such as codeine, midazolam, morphine, diazepam, and fentanyl are used. These medications can help alleviate pain and anxiety. We also have benzodiazepine antagonists like flumazenil and narcotic antagonists like naloxone on hand in case of adverse reactions. 17

18. Premedication and Airway Preparation Airway Preparation : To create an ideal environment for the procedure, we need to dry the patient's airway. This promotes better anesthetic deposition, improves visibility, and can reduce the duration of the procedure. Vasoconstrictors like pseudoephedrine or dilute epinephrine (usually 1:10,000) may be used to prevent or treat bleeding. 18

19. Airway Preparation Anesthesia is achieved through topical anesthetics like lidocaine (in various concentrations) administered via atomizers, mouthwash, or nebulizers. The RT often administers lidocaine via nebulizer, which can make the procedure less uncomfortable for the patient. Special nerve blocks may also be used to provide anesthesia in specific areas of the airway. 19

20. Monitoring During Bronchoscopy Continuous Monitoring This includes: Pulse Oximetry: To assess oxygen saturation (SpO2) Respiratory Rate: To observe the patient's breathing pattern ECG: To track the heart's electrical activity Blood Pressure: To check for any fluctuations 20

21. Role of the RT The respiratory therapist plays a crucial role in monitoring the patient's condition. They are responsible for adjusting oxygen therapy as needed, ensuring the patient's oxygen levels are optimal, and responding to any changes in the patient's respiratory status. If the patient is mechanically ventilated, the RT also monitors ventilator parameters like tidal volume, peak inspiratory pressure, and inspiratory flow. 21

22. Assisting With the Procedure Supplying Medications and Solutions : During bronchoscopy, the RT assists by supplying medications such as Anesthetics Vasoconstrictors Mucolytic agents Lavage solutions 22

23. Assisting With the Procedure Handling Instruments : The RT may be responsible for handling instruments like forceps or brushes that are inserted into the bronchoscope by the bronchoscopist . These instruments are used to perform specific tasks like collecting samples or removing foreign objects. Sample Collection : Additionally, the RT may collect sputum or tissue samples obtained by the bronchoscopist and prepare them for laboratory analysis. This is a crucial part of the procedure, as these samples can provide valuable diagnostic information. 23

24. Recovery and Post-Bronchoscopy Care After the procedure, we need to ensure the patient recovers well. Oxygen therapy continues for up to 4 hours, and we confirm adequate oxygenation using pulse oximetry. Also watch for any signs of stridor or wheezing, and if necessary, we provide aerosol therapy. 24

25. Reference Chapter 36 basic therapeutics page 784 Egan's fundamental of respiratory care 12 edition. 25