Pulmonary
- Critical Care Associates
of East Texas
Jeffrey M.
Shea, M.D., F.C.C.P.
Venkatesh Donty, M.D.
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Jeffrey M.
Shea, M.D., F.C.C.P. |
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Purpose Bronchoscopy is a procedure that involves placement of a viewing instrument into the trachea (windpipe) and bronchi (airways) to diagnose or treat lung and airway problems. Types of Bronchoscopes The flexible bronchoscope is made up primarily of fiberoptic bundles that carry illuminating light into the bronchus and reflected light back to the lens, which allows direct visualization of the airways. The tip of the bronchoscope can be manipulated with a series of levers. Parallel channels of the bronchoscope can carry irrigating fluid and flexible biopsy forceps and can be used for suctioning at the end of the instrument. The rigid bronchoscope is a long, straight metal tube with a light at the tip. The rigid bronchoscope can be used to manipulate the wall of the trachea and bronchi; the large lumen allows suctioning of large particles, but vision is limited. The rigid bronchoscope is used if large particles (such as inhaled food, coins, other objects) must be cleared from the airways. It is also used to help control massive bleeding from the airway, and is generally done in the operating room. Technique Prior to being scheduled for a bronchoscopy, it is extremely important to notify your doctor if you are taking any blood thinners, aspirin, Plavix, or other medication that may interfere with your abililty to clot. These medications need to be held for 5 - 7 days prior to having biopsies due to the risk of bleeding only if it is felt to be safe by your doctor to be off these medications for this period of time. For this procedure, the doctor, a nurse, respiratory therapist and radiology tech are generally present. The patient has an IV started for sedation, placed on a cardiac monitor so that the heart rhythm, blood pressure, and oxygenation may be monitored during the procedure. The patient is then given an inhaled breathing treatment with medications to numb the airways which depresses the gag and cough reflexes. Oxygen is also placed on the patient to ensure adequate oxygenation during the procedure. Once this is completed, the patients nose, throat and upper airways are anesthetized with topical anesthetic. Sedation is given through the IV, which relaxes the patient. They are able to still follow commands if needed. Once the patient is sedated, the bronchoscope is passed through the nose or mouth, to the level of the vocal cords. Topical anesthetic is placed on the vocal cords through the scope and then the bronchoscope is passed between the vocal cords and into the airway. At this point the doctor may perform lavage, biopsies or cultures. When the procedure is complete the bronchoscope is withdrawn. The patient is generally awake but drowsy. Side Effects Some of the normal side effects from this procedure are:
Some of these conditions may last up to eight hours. If these symptoms do not resolve or increase in severity, the patient is advised to call their physician. Because of the sedation and agents given to reduce sensitivity to your throat, the patient will not be allowed to eat or drink anything for at least 2 hours after the bronchoscopy, and is not to drive, operate equipment or do any activities that requires complete alertness for 24 hours.
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