Bronchoscopy

Stents are the devices designed for internal splinting of the airway lumen. Airway stents have been used to help reduce airway obstruction from malignant or benign processes that compress the airway from the outside. Airway stenting can offer immediate relief of acute respiratory distress, allow successful extubation, and may prolong survival.

24. What are endobronchial stents used for?

43. The endoscope reaches what generation of bronchi?

4th - 5th.

What is electromagnetic Navigational Bronchoscopy (ENB)?

A diagnostic tool that combines conventional bronchoscopy with virtual bronchoscopy using advanced CT imaging to guide biopsy of peripheral lung areas that lie beyond the reach of standard flexible bronchoscopy.

Airway stenting has been used to maintain airway patency when?

After dilation of any obstructed major airways.

28. What are the risks of flexible bronchoscopy?

Arrhythmias, fluctuations in blood pressure, and airway manipulation during bronchoscopy may lead to coughing, hypoxemia, vomiting, bleeding, laryngospasm, and bronchospasm.

What is BAL and when is it indicated?

BAL stands for Bronchoalveolar lavage and it is used to obtain specimens from the alveolar level of the lung.

What drugs would RTs nebulize prior to the procedure on a non-intubated patient? What about after the procedure?

Before - Lidocaine, After - Albuterol

What is the purpose of a bronchial washing?

Bronchial washings are generally obtained for the cytological examination to look for cancer and for microbiologic analysis to diagnose mycobacterial or fungal infections.

22. What is the difference between BAL and bronchial washings?

Bronchial washings are generally obtained for the cytological examination to look for cancer and for microbiologic analysis to diagnose mycobacterial or fungal infections. Unlike BAL, bronchial washings are obtained from the large airways.

What is a BAL, describe the procedure, and when is it indicated

Bronchoalveolar lavage (BAL) is performed by instilling a small volume of normal saline, up to 50 mL, deep into the airways and then suctioning the instilled liquid back, and it is used to obtain specimens from the alveolar level of the lung.

29. What maneuvers used if the patient becomes over-sedated during a bronchoscopy procedure?

Chin-lift and jaw-thrust.

Define the EBUS? What is it used for?

Endobronchial ultrasound used to obtain tissue specimens via needle, brush, or forceps for biopsy. EBUS is essentially a bronchoscope with a linear ultrasound probe attached at its distal end. EBUS provides real-time ultrasonographic guidance for transbronchial needle aspiration (TBNA) of target structures.

26. What are the four types of bronchoscopy?

Flexible bronchoscopy (FB), Rigid bronchoscopy (RB), Diagnostic bronchoscopy (DB), and Therapeutic bronchoscopy (TB).

What are some of the activities RTs might perform while assisting with the procedure?

Monitor the ventilator and patient, Assist the physician by injecting fluids through bronchoscope port, assisting with the forceps and brushes, and Handle specimens.

What effects could be seen during a flexible bronchoscopy procedure on an intubated patient receiving mechanical ventilation?

High peak inspiratory pressure

36. What are the complications of thermal ablation of an endobronchial lesion?

Hypoxemia, pneumothorax, and bronchopleural and bronchoesophageal fistula.

11. What is Bronchial thermoplasty?

It is a novel bronchoscopic technique for patients with steroid-dependent asthma.

Needle aspiration has a role in sampling mediastinal lymph nodes to diagnose what?

Lung cancer, sarcoidosis, and some infectious processes.

Define the procedure, Mini-BAL, typically perform by RTs?

Mini-BAL is defined as nonbronchoscopic BAL performed in intubated patients when a catheter is passed through an ETT into the bronchi until the catheter lodges, after which saline is instilled for the lavage and withdrawn.

37. What are the contraindications of thermal ablation of an endobronchial lesion?

Refractory hypoxemia, and extrinsic compression of the airway without an endobronchial lesion.

32. What are the types of therapeutic bronchoscopy?

Rigid bronchoscopy, thermal ablation of the endobronchial lesion, brachytherapy, cryotherapy, and endobronchial stents.

What has improved with the introduction of the EBUS?

The accuracy of TBNA, diagnosis, and staging of non-small cell lung cancer has improved dramatically with the use of EBUS (98% diagnostic accuracy).

what is the purpose of a bronchoscopy?

To inspect airways, collect samples, remove foreign objects, and place devices into airway.

What is TBNA?

Transbronchial needle aspiration (TBNA) is the technique that allows sampling tissue from the mediastinum or the peripheral lung by inserting needles through the bronchial wall.

What are the absolute contraindications for flexible bronchoscopy?

Uncorrectable hypoxemia, Lack of patient cooperation, Lack of skilled personnel, Lack of appropriate equipment and facilities, and Unstable angina.

27. A Rigid Bronchoscopy is always performed under what condition?

Under deep sedation with muscle relaxation.

When is rigid bronchoscopy indicated?

control of compromised airway, massive hemoptysis, asphyxiating foreign bodies, and stent placement

The major indication for rigid bronchoscopy is

managing airway obstruction

What are the goals of airway preparation?

prevent bleeding, decrease cough and gag, and decrease pain