Bronchoscopy is a procedure in which a cylindrical fiberoptic scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways.
Description
There are two types of bronchoscopes, a rigid tube and a fiberoptic tube. Because of its flexibility, the fiberoptic
tube is usually preferred. However, if the purpose of the procedure is to remove a foreign body caught in the wind-pipe or lungs of a child, the more rigid tube must be used because of its larger size. The patient will either lie face-up on his/her back or sit upright in a chair. Medication to decrease secretions, lessen anxiety, and relax the patient are often given prior to the procedure. While breathing through the nose, anesthesia is sprayed into the mouth or nose to numb it. It will take one to two minutes for the anesthesia to take effect. Once this happens, the bronchoscope will be put into the patient's mouth or nose and moved down into the throat. While the bronchoscope is moving down the throat, additional anesthesia is put into the bronchoscope to numb the lower parts of the airways. Using the eyepiece, the physician then observes the trachea and bronchi, and the mucosal lining of these passageways, looking for any abnormalities that may be present.
If the purpose of the bronchoscopy is to take tissue samples or biopsy, forceps or a bronchial brush are used to obtain cells. If the purpose is to identify an infectious agent, a bronchoalveolar lavage (BAL) can be used to gather fluid for culture purposes. Also, if any foreign matter is found in the airways, it can be removed.
Another procedure using bronchoscopy is called fluorescence bronchoscopy. This can be used to detect pre-cancerous cells present in the airways. By using a fluorescent light in the bronchoscope, precancerous tissue will appear dark red, while healthy tissue will appear green. This technique can help detect lung cancer at an early stage, so that treatment can be started early.
Alternative procedures
Depending upon the purpose of the bronchoscopy, alternatives might include a computed tomography scan (CT) or no procedure at all. Bronchoscopy is often performed to investigate an abnormality that shows up on a chest x ray or CT scan. If the purpose is to obtain biopsy specimens, one option is to perform surgery, which carries greater risks. Another option is percutaneous (through the skin) biopsy guided by computed tomography.
Who Performs the Procedure and Where Is It Performed?
The test is usually performed in a hospital or clinic by a pulmonologist, a physician specializing in diseases of the lungs. Nursing staff assist by providing education, monitoring the patient, and conducting tests, including checking blood pressure, pulse, and respiratory rate prior to the patient's discharge.
Questions to Ask the Doctor
What will happen during the procedure?
Will it hurt?
How long will the test last?
How many bronchoscopies do you perform each year?
Are there any risks associated with the procedure?
Definition
Bronchoscopy is a procedure in which a hollow, flexible tube called a bronchoscope is inserted into the airways through the nose or mouth to provide a view of the tracheobronchial tree. It can also be used to collect bronchial and/or lung secretions and to perform tissue biopsy.
Purpose
During a bronchoscopy, the physician can visually examine the lower airways, including the larynx, trachea, bronchi, and bronchioles. The procedure is used to examine the mucosal surface of the airways for abnormalities that might be associated with a variety of lung diseases. Its use may be diagnostic or therapeutic.
Bronchoscopy may be used to examine and help diagnose:
diseases of the lung, such as cancer or tuberculosis
persistent cough, or hemoptysis, that includes blood in the sputum
Bronchoscopy may also be used for the following therapeutic purposes:
to remove a foreign body in the lungs
to remove excessive secretions
Bronchoscopy can also be used to collect the following biopsy specimens:
sputum
tissue samples from the bronchi or bronchioles
cells collected from washing the lining of the bronchi or bronchioles
If the purpose of the bronchoscopy is to take tissue samples or biopsy, a forceps or bronchial brush are used to obtain cells. Alternatively, if the purpose is to identify an infectious agent, a bronchoalveolar lavage can be performed to gather fluid for culture purposes. If any foreign matter is found in the airways, it can be removed as well.
The instrument used in bronchoscopy, a bronchoscope, is a slender, flexible tube less than 0.5 in (2.5 cm) wide and approximately 2 ft (0.3 m) long that uses fiberoptic technology (very fine filaments that can bend and carry light). There are two types of bronchoscopes, a standard tube that is more rigid and a fiberoptic tube that is more flexible. The rigid instrument does not bend, does not see as far down into the lungs as the flexible one, and may carry a greater risk of causing injury to nearby structures. Because it can cause more discomfort than the flexible bronchoscope, it usually requires general anesthesia. However, it is useful for taking large samples of tissue and for removing foreign bodies from the airways. During the procedure, the airway is never blocked since oxygen can be supplied through the bronchoscope.
Demographics
In 2000, the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery Reports outlined the following rates for bronchoscopy with or without biopsy at short-stay hospitals in the United States:
Both sexes: 8.9 per 10,000 population
Males: 10.6 per 10,000 population
Females: 7.3 per 10,000 population
According to the National Cancer Institute, cancer of the lung and bronchi is the second most common cancer among both men and women and is the leading cause of cancer death in both sexes in the United States. Among men, lung cancer incidence rates per 100,000 people range from a low of approximately 14 among American Indians to a high of 117 among African Americans. Between these two extremes, rates fall into two groups ranging from 42 to 53 for Hispanics, Japanese, Chinese, Filipinos, and Koreans and from 71 to 89 for Vietnamese, Caucasians, Alaska natives, and Hawaiians. The range among women is much narrower, from a rate of about 15 among Japanese to nearly 51 among Alaska Natives, only a three-fold difference. Rates for the remaining female populations fall roughly into two groups with low rates of 16–25 for Korean, Filipino, Hispanic, and Chinese women, and rates of 31–44 among Vietnamese, Caucasian, Hawaiian, and African American women. The rates among men are about two to three times greater than the rates among women in each of the racial/ethnic groups.
Description
Bronchoscopy is usually performed in an endoscopy room, but may also be performed at the bedside. The patient is placed on his back or sits upright. A pulmonologist, a specialist trained to perform the procedure, sprays an anesthetic into the patient's mouth or throat. When anesthesia has taken effect and the area is numb, the bronchoscope is inserted into the patient's mouth and passed into the throat. If the bronchoscope is passed through the nose, an anesthetic jelly is inserted into one nostril. While the bronchoscope is moving down the throat, additional anesthetic is put into the bronchoscope to anesthetize the lower airways. The physician observes the trachea, bronchi, and the mucosal lining of these passageways looking for any abnormalities that may be present. If samples are needed, a bronchial lavage may be performed, meaning that a saline solution is introduced to flush the area prior to collecting cells for laboratory
Bronchoscopy can be performed via the patient's mouth (A) or through the nose (C). During the procedure, the scope is fed down the trachea and into the bronchus leading to the lungs (B), providing the physician with a view of internal structures (D). (Illustration by GGS Inc.)
analysis. Very small brushes, needles, or forceps may also be introduced through the bronchoscope to collect tissue samples from the lungs.
Preparation
The patient should fast for six to 12 hours prior to the procedure and refrain from drinking any liquids the day of the procedure. Smoking should be avoided for 24 hours prior to the procedure and patients should also avoid taking any aspirin or ibuprofen-type medications. The bronchoscopy itself takes about 45–60 minutes. Prior to the bronchoscopy, several tests are usually done, including a chest x ray and blood work. Sometimes a bronchoscopy is done under general anesthesia, in which case the patient will have an intravenous (IV) line in the arm. More commonly, the procedure is performed under local anesthesia, which is sprayed into the nose or mouth. This is necessary to inhibit the gag reflex. A sedative also may be given. A signed consent form is necessary for this procedure.
Aftercare
After the bronchoscopy, the vital signs (heart rate, blood pressure, and breathing) are monitored. Sometimes patients have an abnormal reaction to anesthesia. Any sputum should be collected in an emesis basin so that it can be examined for the presence of blood. If a biopsy was taken, the patient should not cough or clear the throat as this might dislodge any blood clot that has formed and cause bleeding. No food or drink should be consumed for about two hours after the procedure or until the anesthesia wears off. There is a significant risk for choking if anything (including water) is ingested before the anesthetic wears off, and the gag reflex has returned. To test if the gag reflex has returned, a spoon is placed on the back of the tongue for a few seconds with light pressure. If there is no gagging, the process is repeated after 15 minutes. The gag reflex should return in one to two hours. Ice chips or clear liquids should be taken before the patient attempts to eat solid food.
Patients are informed that after the anesthetic wears off the throat may be irritated for several days.
Patients should notify their health care provider if they develop any of these symptoms:
hemoptysis (coughing up blood)
shortness of breath, wheezing, or any trouble breathing
chest pain
fever, with or without breathing problems
Risks
Use of the bronchoscope mildly irritates the lining of the airways, resulting in some swelling and inflammation, as well as hoarseness caused from abrading the vocal cords. If this abrasion is more serious, it can lead to respiratory difficulty or bleeding of the lining of the airways.
The bronchoscopy procedure is also associated with a small risk of disordered heart rhythm (arrhythmia), heart attacks, low blood oxygen (hypoxemia), and pneumothorax (a puncture of the lungs that allows air to escape into the space between the lung and the chest wall). These risks are greater with the use of a rigid bronchoscope than with a fiberoptic bronchoscope. If a rigid tube is used, there is also a risk of chipped teeth. The risk of transmitting infectious disease from one patient to another by the bronchoscope is also present. There is also a risk of infection from endoscopes inadequately reprocessed by the automated endoscope reprocessing (AER) system. The Centers for Disease Control (CDC) reported cases of patient-to-patient transmission of infections following bronchoscopic procedures using bronchoscopes that were inadequately reprocessed by AERs. Investigation of the incidents revealed inconsistencies between the reprocessing instructions provided by the manufacturer of the bronchoscope and the manufacturer of the AER; or that the bronchoscopes were inadequately reprocessed.
Normal Results
If the results of the bronchoscopy are normal, the windpipe (trachea) appears as smooth muscle with C-shaped rings of cartilage at regular intervals. There are no abnormalities either in the trachea or in the bronchi of the lungs.
Bronchoscopy results may also confirm a suspected diagnosis. This may include swelling, ulceration, or deformity in the bronchial wall, such as inflammation, stenosis, or compression of the trachea, neoplasm, and foreign bodies. The bronchoscopy may also reveal the presence of atypical substances in the trachea and bronchi. If samples are taken, the results could indicate cancer, disease-causing agents, or other lung diseases. Other findings may include constriction or narrowing (stenosis), compression, dilation of vessels, or abnormal branching of the bronchi. Abnormal substances that might be found in the airways include blood, secretions, or mucous plugs.
Morbidity and Mortality Rates
Bronchoscopy belongs to the group of procedures associated with highest inpatient mortality with a 12.7% mortality rate.
Alternatives
Depending upon the purpose of the bronchoscopy, alternatives may include a chest x ray or a computed tomography (CT) scan. If the purpose is to obtain biopsy specimens, one option is to perform surgery, which carries greater risks. Another option is percutaneous biopsy guided by CT.
Resources
Books
Bolliger, C. T., and P. N. Mathur, eds. Interventional Bronchoscopy. (Progress in Respiratory Research, Vol. 30). Basel: S. Karger Publishing, 1999.
Koppen, W., J. F. Turner, and A. C. Mehta, eds. Flexible Bronchoscopy. 2nd ed. Oxford: Blackwell Publishers, 2004.
Pagana, Kathleen D., and Timothy J. Pagana. Diagnostic Testing and Nursing Implications. 5th ed. St. Louis: Mosby, 1999.
Periodicals
Diette, G. B., N. Lechtzin, E. Haponik, A. Devrotes, and H. R. Rubin. "Distraction Therapy with Nature Sights and Sounds Reduces Pain during Flexible Bronchoscopy: A Complementary Approach to Routine Analgesia." Chest 123 (March 2003): 941–948.
Nakamura, C. T., J. F. Ripka, K. McVeigh, N. Kapoor, and T. G. Keens. "Bronchoscopic Instillation of Surfactant in Acute Respiratory Distress Syndrome." Pediatric Pulmonology 31, no. 4 (April 2001): 317–320.
Starobin, D., G. Fink, D. Shitrit, G. Izbicki, D. Bendayan, I. Bakal, and M. R. Kramer. "The Role of Fiberoptic Bronchoscopy Evaluating Transplant Recipients with Suspected Pulmonary Infections: Analysis of 168 Cases in a Multi-organ Transplantation Center." Transplantation Proceedings 35 (March 2003): 659–660.
Wu, K. H., T. T. Man, K. L. Wong, C. F. Lin, C. C. Chen, and C. R. Cheng. "Bronchoscopy and Anesthesia for Preschool-aged Patients: A Review of 228 Cases." Internal Surgery 87 (October-December 2002): 252–255.
Yang, C. C., and K. S. Lee. "Comparison of Direct Vision and Video Imaging during Bronchoscopy for Pediatric Airway Foreign Bodies." Ear, Nose, and Throat Journal 82 (February 2003): 129–133.
Organizations
American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062. (800) 343-2227.
The Association of Perioperative Registered Nurses, Inc. (AORN). 2170 South Parker Rd, Suite 300, Denver, CO 80231-5711. (800) 755-2676. http://www.aorn.org/.
Public Health Advisory: Infections from Endoscopes Inadequately Reprocessed by an Automated Endoscope Reprocessing System. U. S. Food and Drug Administration, Center for Devices and Radiological Health. September 1999 [cited April 2003]. http://www.fda.gov/cdrh/safety/endoreprocess.html.
Bronchoscopy is a procedure in which a cylindrical fiberoptic scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways.
Purpose
During a bronchoscopy, a physician can visually examine the lower airways, including the larynx, trachea, bronchi, and bronchioles. The procedure is used to examine the mucosal surface of the airways for abnormalities that might be associated with a variety of lung diseases. Its use includes the visualization of airway obstructions such as a tumor, or the collection of specimens for the diagnosis of cancer originating in the bronchi of the lungs (bronchogenic cancer). It can also be used to collect specimens for culture to diagnose infectious diseases such as tuberculosis. The type of specimens collected can include sputum (composed of saliva and discharges from the respiratory passages), tissue samples from the bronchi or bronchioles, or cells collected from washing the lining of the bronchi or bronchioles. The instrument used in bronchoscopy, a bronchoscope, is a slender cylindrical instrument containing a light and an eyepiece. There are two types of bronchoscopes, a rigid tube that is sometimes referred to as an open-tube or ventilating bronchoscope, and a more flexible fiberoptic tube. This tube contains four smaller passages—two for light to pass through, one for seeing through and one that can accommodate medical instruments that may be used for biopsy or suctioning, or that medication can be passed through.
Bronchoscopy may be used for the following purposes:
to diagnose cancer, tuberculosis, lung infection, or other lung disease
to remove a foreign body in the lungs, such as a mucus plug, tumor, or excessive secretions
to remove tissue samples, also known as biopsy, to test for cancer cells, help with staging the advancement of the lung cancer, or to treat a tumor with laser therapy
to allow examination of a suspected tumor, obstruction, secretion, bleeding, or foreign body in the airways
to determine the cause of a persistent cough, wheezing, or a cough that includes blood in the sputum
to evaluate the effectiveness of lung cancer treatments
Precautions
Patients not breathing adequately on their own due to severe respiratory failure may require mechanical ventilation prior to bronchoscopy. It may not be appropriate to perform bronchoscopy on patients with an unstable heart condition. All patients must be constantly monitored while undergoing a bronchoscopy so that any abnormal reactions can be dealt with immediately.
Description
There are two types of bronchoscopes, a rigid tube and a fiberoptic tube. Because of its flexibility, the fiberoptic tube is usually preferred. However, if the purpose of the procedure is to remove a foreign body caught in the windpipe or lungs of a child, the more rigid tube must be used because of its larger size. The patient will either lie face-up on his/her back or sit upright in a chair. Medication to decrease secretions, lessen anxiety, and relax the patient are often given prior to the procedure. While breathing through the nose, anesthesia is sprayed into the mouth or nose to numb it. It will take 1-2 minutes for the anesthesia to take effect. Once this happens, the bronchoscope will be put into the patient's mouth or nose and moved down into the throat. While the bronchoscope is moving down the throat, additional anesthesia is put into the bronchoscope to numb the lower parts of the airways. Using the eyepiece, the physician then observes the trachea and bronchi, and the mucosal lining of these passageways, looking for any abnormalities that may be present.
If the purpose of the bronchoscopy is to take tissue samples or biopsy, forceps or a bronchial brush are used to obtain cells. If the purpose is to identify an infectious agent, a bronchoalveolar lavage (BAL) can be used to gather fluid for culture purposes. Also, if any foreign matter is found in the airways, it can be removed.
Another procedure using bronchoscopy is called fluorescence bronchoscopy. This can be used to detect precancerous cells present in the airways. By using a fluorescent light in the bronchoscope, precancerous tissue will appear dark red, while healthy tissue will appear green. This technique can help detect lung cancer at an early stage, so that treatment can be started early.
Alternative Procedures
Depending upon the purpose of the bronchoscopy, alternatives might include a computed tomography scan (CT) or no procedure at all. Bronchoscopy is often performed to investigate an abnormality that shows up on a chest x ray or CT scan. If the purpose is to obtain biopsy specimens, one option is to perform surgery, which carries greater risks. Another option is percutaneous
(through the skin) biopsy guided by computed tomography.
Preparation
The doctor should be informed of any allergies and all the medications that the patient is currently taking. The doctor may instruct the patient not to take medications like aspirin or anti-inflammatory drugs, which interfere with clotting, for a period of time prior to the procedure. The patient needs to fast for 6 to 12 hours prior to the procedure and refrain from drinking any liquids the day of the procedure. The bronchoscopy takes about 45 to 60 minutes, with results usually available in one day. Prior to the bronchoscopy, several tests may be done, including a chest x ray and blood work. Sometimes a bronchoscopy is done under general anesthesia. Patients usually have an intravenous (IV) line in the arm. Most likely, the procedure will be done under local anesthesia, which is sprayed into the nose or mouth. This is necessary to decrease the gag reflex. A sedative may also be used to help the patient relax. It is important that the patient understands that at no time will the airway be blocked and that oxygen can be supplied through the bronchoscope. A signed consent form is necessary for this procedure.
Aftercare
After the bronchoscopy, the patient will be monitored for vital signs such as heart rate, blood pressure, and breathing, while resting in bed. Sometimes patients have an abnormal reaction to anesthesia. All saliva should be spit into a basin so that it can be examined for the presence of blood. If a biopsy was taken, the patient should not cough or clear the throat as this might dislodge any blood clot that has formed and cause bleeding. No food or drink should be consumed for about two hours after the procedure or until the anesthesia wears off. Diet is gradually progressed from ice chips and clear liquids to the patient's regular diet. There will also be a temporary sore throat and hoarseness that may last for a few days.
Risks
Minor side effects arise from the bronchoscope causing abrasion of the lining of the airways. This results in some swelling and inflammation, as well as hoarseness caused from abrading the vocal cords. If this abrasion is more serious, it can lead to respiratory difficulty or bleeding of the airway lining. A more serious risk involved in having a bronchoscopy performed is the occurrence of a pneumothorax, due to puncturing of the lungs, which allows air to escape into the space between the lung and the chest wall. These risks are greater with the use of a rigid bronchoscope than with a fiberoptic bronchoscope. If a rigid tube is used, there is also a risk of chipped teeth.
Normal Results
Normal tracheal appearance consists of smooth muscle with C-shaped rings of cartilage at regular intervals. The trachea and the bronchi are lined with a mucous membrane.
Questions to Ask the Doctor
Did you see any abnormalities?
How soon will you know the results of the biopsy (if one was done)?
When can I resume any medications that were stopped?
What future care will I need?
For what type of problems should I call you?
Abnormal Results
Abnormal bronchoscopy findings may involve abnormalities of the bronchial wall such as inflammation, swelling, ulceration, or anatomical abnormalities. The bronchoscopy may also reveal the presence of abnormal substances in the trachea and bronchi. If samples are taken, the results could indicate cancer, diseasecausing agents or other lung disease. Other abnormalities include constriction or narrowing (stenosis), compression, dilation of vessels, or abnormal branching of the bronchi. Abnormal substances that might be found in the airways include blood, secretions, or mucous plugs. Any abnormalities are discussed with the patient.
Resources
Books
Fauci, Anthony S. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 2000.
The visual examination of the tracheobronchial tree using a standard rigid, tubular metal bronchoscope or a narrower, flexible, fiberoptic bronchoscope. Bronchoscopy is used to secure a biopsy, aspirate fluids, and diagnose such conditions as lung abscess, bronchial obstruction, and localized atelectasis.
Bleeding, fever, infection (uncommon), collapse of the lung (in 2-5% of cases), cessation of heartbeat or breathing (very rare).
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Other names
Flexible fiber-optic bronchoscopy or rigid bronchoscopy.
Purpose
To detect or rule out structural and other abnormalities of the airways, bronchial tumors, or the presence of a foreign body.
To obtain samples of lung secretions and tissues for analysis.
To obtain samples of lung tissue for analysis.
How it works
A thin fiber-optic tube with a light source is passed into the airways in the lungs (bronchi), allowing the doctor to see the tracheal and bronchial structures.
Preparation
You must fast for eight to 12 hours prior to the procedure.
You remove clothing above the waist and don a hospital gown.
Atropine and codeine or other medication may be injected intramuscularly to dry up saliva and suppress coughing.
A local anesthetic is sprayed into your mouth and/or nose, depending on which way the scope will be passed into your lungs (see figure). Alternatively, anesthesia is injected under your chin on both sides of your neck to numb the voice box area.
Electrocardiography electrodes are placed on your chest for monitoring your heartbeat, a blood pressure cuff is placed on your arm, and an oximeter is attached to your finger, earlobe, or toe to measure oxygen saturation in your blood.
A soft tube that delivers oxygen is inserted into your nose or mouth, and an intravenous (IV) infusion is placed on your arm in order to administer medications.
FIGURE Bronchoscopy
This test entails inserting a viewing tube with magnifying and lighting devices through the mouth or nose and down the windpipe (trachea) and into the lung's bronchial tubes.
Test procedure
The doctor inserts a long viewing tube, called a bronchoscope, through your nose or mouth. If it is introduced through your mouth, you are asked to hold a plastic mouthpiece called a bite block between your teeth, to prevent you from accidentally biting the tube. The bronchoscope is usually a flexible fiber-optic tube about the width of a pen. If a large foreign body must be removed or a large biopsy sample is required, the doctor may use a rigid bronchoscope--a hollow metal tube with a light source and a viewing device--which requires general anesthesia.
Through the bronchoscope, the doctor inspects your voice box, windpipe, and the branches of the airways.
Secretions from the lungs may be removed through the bronchoscope to clear the airways; the washings can be cultured or examined under a microscope.
Bronchoalveolar lavage, in which a sterile saline solution is introduced into the lung through the bronchoscope and sucked back out, may be performed to diagnose infection or other conditions. Usually, the lavage is performed in the portion of the lung that looks abnormal on the chest X-ray.
Bronchial brushing, in which a tiny brush on a long wire is introduced through the bronchoscope and rubbed against the airways or alveoli, may be used to obtain tissue samples from the lung. Samples are analyzed for the presence of fungi, bacteria, or other infectious agents, and for the presence of abnormal cells.
Tissue may also be removed (called endobronchial or transbronchial biopsy) with the help of tiny forceps. The lung has no pain sensation, but you may feel a tug when the tissue sample is removed. While the biopsy is performed, a fluoroscope, an X-ray device, may be used to visualize the lung. The picture, which is transmitted onto a TV monitor, helps the doctor guide the instruments.
A needle may be inserted through the bronchoscope to sample a lymph node and aspirate (withdraw) cells.
Bronchoscopy may also be used to place radiation therapy catheters or stents.
After the test
All monitoring equipment, the oxygen tube, and the IV infusion are removed.
If the test included a biopsy, a chest X-ray is performed to make sure the lung has not been punctured and no air has entered the pleural cavity.
If the test was performed under local anesthesia, you will be free to leave after sedation has worn off, which usually takes about two hours (you should have someone drive you home). If bronchoscopy was conducted under general anesthesia, you will be discharged to your hospital room or the recovery area.
Avoid eating or drinking until the gag reflex returns, which may take two to four hours.
You may experience hoarseness, mild fever, and coughing up small amounts of blood for about 24 hours. If you cough up large quantities of blood, have trouble breathing, have high fever, or experience pain, contact your doctor or go to a hospital emergency department immediately.
Factors affecting results
Excessive coughing or gagging can interfere with obtaining adequate results or even prevent the test from being completed.
Interpretation
Sometimes the doctor may establish or confirm the diagnosis simply by viewing the airways. In other cases, examinations of the tissue samples and secretions removed from the lung provide additional information.
Advantages
The test is less invasive than surgical biopsy and can be performed on an outpatient basis.
It requires only local anesthesia.
It entails relatively low risk and little discomfort.
It allows the doctor to view the airways directly.
It produces reliable results.
Disadvantages
It's more invasive than imaging techniques.
The biopsy sample may be too small to diagnose some disorders, particularly noninfectious inflammatory lung diseases.
The doctor can see only the airways, not the lung tissue itself.
The next step
If the bronchoscopy renders a diagnosis, no further testing may be needed, and treatment can be started.
If the bronchoscopy does not yield a diagnosis, further testing may be required, including surgical biopsy, needle aspiration of the lung, or further radiographic evaluation.
PATIENT TIPS
If you must take medication during the fast, you may take it with small sips of water.
Up to two weeks before the test, you should stop taking any medication, such as aspirin or coumarin (Coumadin), that may cause excess bleeding.
Inspection of the interior of the tracheobronchial tree through a bronchoscope. Bronchoscopy is used as a diagnostic aid and therapeutically. As an aid to diagnosis the bronchoscope allows for visualization of the bronchial mucosa and removal of tissue for biopsy. Bronchial washings and collection of secretions are done at the time of bronchoscopy to obtain samples for culture and cytological examination. Therapeutically, the bronchoscope permits removal of foreign bodies that have been aspirated into the bronchial tree.
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs: biopsies, fluid (bronchoalveolar lavage), or endobronchial brushing. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible fibreoptic instruments with realtime video equipment.
A German, Gustav Killian, performed the first bronchoscopy in 1897. From then until the 1970s, rigid bronchoscopes were used exclusively.
Types
Rigid
A rigid bronchoscope is a straight, metal tube with an inner diameter of up to one centimetre. It is inserted through the mouth, the patient lying in a supine position and the neck hyperextended. The procedure causes significant discomfort and is performed under general anesthesia.
Rigid bronchoscopy is less often used today, but it remains the procedure of choice for removing foreign materials, as the greater diameter of the rigid bronchoscope allows instruments to be more easily inserted through it. Rigid bronchoscopy also becomes useful when bleeding interferes with viewing the examining area, and allows for more interventions, such as cautery to stop the bleeding.
Flexible (fiberoptic)
A flexible bronchoscope is longer and thinner than a rigid bronchoscope. It contains a fiberoptic system that transmits an image from the tip of the instrument to an eyepiece or video camera at the opposite end. Using Bowden cables connected to a lever at the handpiece, the tip of the instrument can be oriented, allowing the practitioner to navigate the instrument into individual lobe or segment bronchi. Most flexible bronchoscopes also include a channel for suctioning or instrumentation, but these are significantly smaller than those in a rigid bronchoscope.
Flexible bronchoscopy causes less discomfort for the patient than rigid bronchoscopy and the procedure can be performed easily and safely under moderate sedation. It is the technique of choice nowadays for most bronchoscopic procedures.
Stent insertion to palliate extrinsic compression of the tracheobronchial lumen from either malignant or benign disease processes
Bronchoscopy is also employed in percutaneous tracheostomy
Surgical procedures on the airways, such as tracheal reconstruction, often require the use of bronchoscopy
Intubation of patients with difficult airways is often performed using a flexible bronchoscope
Procedure
Bronchoscopy can be performed in a special room designated for such procedures, operating room, intensive care unit, or other location with resources for the management of airway emergencies. The patient will often be given antianxiety and antisecretory medications (to prevent oral secretions from obstructing the view), generally atropine, and sometimes an analgesic such as morphine. During the procedure, sedatives such as midazolam or propofol may be used. A local anesthetic is often given to anesthetise the mucous membranes of the pharynx, larynx, and trachea. The patient is monitored during the procedure with periodic blood pressure checks, continuous ECG monitoring of the heart, and pulse oximetry.
A flexible bronchoscope is inserted with the patient in a sitting or supine position. Once the bronchoscope is inserted into the upper airway, the vocal cords are inspected. The instrument is advanced to the trachea and further down into the bronchial system and each area is inspected as the bronchoscope passes. If an abnormality is discovered, it may be sampled, using a brush, a needle, or forceps. Specimen of lung tissue (transbronchial biopsy) may be sampled using a real-time x-ray (fluoroscopy). Flexible bronchoscopy can also be performed on intubated patients, such as patients in intensive care. In this case, the instrument is inserted through an adapter connected to the tracheal tube.
Rigid bronchoscopy is performed under general anesthesia. Rigid bronchoscopes are too large to allow parallel placement of other devices in the trachea; therefore the anesthesia apparatus is connected to the bronchoscope and the patient is ventilated through the bronchoscope.
Recovery
Although most patients tolerate bronchoscopy well, a brief period of observation is required after the procedure. Most complications occur early and are readily apparent at the time of the procedure. The patient is assessed for respiratory difficulty (stridor and dyspnea resulting from laryngealedema, laryngospasm, or bronchospasm). Monitoring continues until the effects of sedative drugs wear off and gag reflex has returned. If the patient has had a transbronchial biopsy, doctors may take a chest x-ray to rule out any air leakage in the lungs (pneumothorax) after the procedure. The patient will be hospitalized if there occurs any bleeding, air leakage (pneumothorax), or respiratory distress.
Complications and Risks
Besides the risks associated with the drug used, there are also specific risks of the procedure. Although a rigid bronchoscope can scratch or tear airways or damage the vocal cords, the risk of bronchoscopy is limited. Complications from fiberoptic bronchoscopy remain extremely low. Common complications include excessive bleeding following biopsy. A lung biopsy also may cause leakage of air, called pneumothorax. Pneumothorax occurs in less than 1% of lung biopsy cases . Laryngospasm is a rare complication but may sometimes require intubation. Patients with tumors or significant bleeding may experience increased difficulty breathing after a bronchoscopic procedure, sometimes due to swelling of the mucous membranes of the airways.
