deciphering diagnostics
Take a look inside the
lungs with bronchoscopy
BRONCHOSCOPY VISUALIZES the larynx,
trachea, bronchi, and, depending on the
procedure, the upper airways. The most
common method of performing bronchoscopy is to use a thin, flexible fiberoptic
bronchoscope; a rigid bronchoscope can
also be used, but it’s rare. For more on the
procedure, see Picturing flexible bronchoscopy.
Diagnostic bronchoscopy can be used to
determine the location and extent of tumors
or lesions, find hemorrhage sites, obtain
biopsy specimens, take brushings for cytologic examination, and determine if a tumor
can be surgically resected. It can also be used
to evaluate the underlying etiology of nonspecific symptoms of pulmonary disease.
Therapeutic bronchoscopy is used to remove
foreign bodies and clear secretions to open
the airway. Bronchoscopy can be done as an
outpatient procedure or in a special procedure room or critical care unit.
Contraindications to bronchoscopy
include severe hypoxemia (low blood oxygen level), acute cardiac dysrhythmias,
uncorrected bleeding or coagulation disorders, and severe tracheal stenosis.
What do you need to do for your patient
before and after the procedure? We’re here
to fill you in!
In preparation
Before the procedure, obtain the patient’s
medical history and perform a physical
exam. He’ll need a chest X-ray and blood
work, as well as an electrocardiogram if
he’s over age 40 or has cardiovascular problems. Arterial blood gas analysis or pulmonary function studies may also be ordered, depending on his respiratory status.
A signed consent form is obtained by the
clinician performing the procedure, and
It’s pretty neat
food and fluids are withheld for 6 to 12
Picturing flexible bronchoscopy
During bronchoscopy, a flexible fiberoptic bronchoscope is
advanced into the bronchial structures through the patient’s
mouth or nose.
Smaller
bronchus
to be able to
see our inner
workings!
Fiberoptic
bronchoscope
March/April 2007 Nursing made Incredibly Easy! 11
deciphering diagnostics
As soon as
your patient
can cough
adequately, you
can send him
on his way.
hours before the procedure to reduce the
risk of aspiration.
Explain the procedure to your patient and
let him know that pain isn’t usually experienced because the lungs don’t have pain
fibers. Tell him that the topical anesthetic
may taste bitter and that he may feel like his
tongue is thickened or have the sensation of
something in the back of his throat that he
can’t cough out or swallow. Reassure him
that these sensations are normal and will go
away a few hours after the procedure, when
the anesthetic wears off. Make sure he
removes dentures or other oral prostheses.
Remember, the more relaxed your patient is,
the smoother the procedure will be, so be
sure to address any fear or anxiety he has.
During the procedure
Bronchoscopy is performed with the
patient under procedural (moderate)
sedation, which is administered by a
specially trained nurse. He’ll receive an
intravenous sedative, usually midazolam (Versed), and an opioid, usually
fentanyl or meperidine (Demerol), for
pain relief. A topical anesthetic will be
sprayed and swabbed onto the back of his
nose, the tongue, the pharynx, and the
epiglottis. The patient may also be given atropine to reduce secretions.
The bronchoscope is then carefully inserted through the patient’s mouth or nose into
the pharynx and trachea. The scope can also
be passed through an endotracheal or tracheostomy tube if necessary. During bronchoscopy, bronchial washing for cytology
and bronchial brushings of visible and
peripheral endobronchial lesions may be
done; transbronchial needle biopsy may also
be performed. Bronchoalveolar lavage can
be done to remove excessive secretions from
the bronchopulmonary tree.
Postgame report
After the procedure, don’t let your patient
have anything by mouth until he’s awake
and his swallow, gag, and cough reflexes
return. Monitor his vital signs, oxygen saturation, and respiratory status. Observe for
hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis (coughing up
blood), and dyspnea. Watch for complications, such as hypoxemia, pneumothorax,
laryngospasm, bronchospasm, bleeding, aspiration, and infection. Oxygen by mask
or nasal cannula may be ordered, and a
follow-up chest X-ray may be obtained.
The patient is discharged from the recovery area when an adequate cough reflex
returns and his respiratory status is normal.
If the bronchoscopy was performed as an
outpatient procedure, he’ll need someone to
drive him home. Let him know that his
throat may feel scratchy for a few days. Tell
him to report any shortness of breath, chest
pain, cough, or bleeding immediately.
Like clockwork
Bronchoscopy is an important diagnostic
tool for lung problems, especially for staging bronchogenic carcinoma. With proper
preparation and care before, during, and
after the procedure, your patient’s bronchoscopy will go like clockwork. ■
Learn more about it
Fischbach F, Dunning MB III. Nurse’s Quick Reference
to Common Laboratory & Diagnostic Tests, 4th edition.
Philadelphia, Pa., Lippincott Williams & Wilkins, 2005.
Smeltzer SC, Bare B. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2007.
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12 Nursing made Incredibly Easy! March/April 2007