Bronchoscopy

Definition of the Procedure:

BRONCHOSCOPY :
a direct inspection and observation of the larynx, trachea, and bronchi through a flexible or rigid bronchoscope, has both diagnostic and therapeutic use.

Purpose of Procedure

Diagnostic Uses:
>to collect secretions for cytologic and bacteriologic studies
>to determine location and extent of pathologic process and to obtain biopsy for diagnosis
>to determine whether a tumor can be resected surgically
>to diagnose bleeding sites (source of hemoptysis)

Therapeutic Uses:
>Remove foreign objects
>Excise lesions



Preparation of the Patient :

Nursing instructions before bronchoscopy
>Informed consent, permit needed
>Atropine and diazepam pre-procedure; topical anesthesia sprayed followed by local anesthesia injected into larynx
>Nothing per orem for 6-8 hours
>Remove dentures, prostheses, contact lenses

Procedure

1. Rigid Bronchoscopy
>Generally performed in an operating room, with the patient under general anesthesia
>Rigid bronchoscopes are used for the retrieval of foreign bodies and the suctioning of massive hemorrhages, for which the small suction channel of the fiberoptic bronchoscope may be insufficient.

2. Flexible Fiberoptic Bronchoscopy
>This is an outpatient procedure usually performed in an awake but sedated patient.
>Port of entry is either thru the mouth or the nose, between the vocal cords, and into the trachea
>The ability to flex the scope makes it possible to visualize virtually all airways to the level of the subsegmental bronchi.
>Thru this method, we are able to identify endobronchial pathology, including tumors, granulomas, bronchitis, foreign bodies and site of bleedings. There are several methods for getting samples from airway lesions:
4.1. Washing : involves installation of sterile saline through a channel of the bronchoscope and onto the surface of the lesion
4.2. Brushing : using a small brush at the end of the long cable inserted through a channel of the bronchoscope, allows recovery of cellular materials or tissue for analysis by standard cytologic and histopathologic method
4.3. Biopsy : involves use of biopsy forceps or a hollow-bore needle passed through the bronchoscope for sampling of tissue.

Flexible Fiberoptic Bronchoscopy


Nursing Interventions After Bronchoscopy:
>Side-lying position
>Check for the return of cough and gag reflex before giving fluid per orem
>Watch for cyanosis, hypotension, tachycardia, arrythmias, hemoptysis, and dyspnea. These signs and symptoms indicate perforation of the bronchial tree

Bronchoscopy Result


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