pulmonary disorders
Bronchoscopy
Procedure for Bronchoscopy
Bronchoscopy should be done only by a pulmonologist or trained surgeon in a monitored setting, typically a bronchoscopy suite, operating room, or intensive care unit. Except in true emergencies, patients should receive nothing by mouth for at least 6 hours before bronchoscopy and have IV access, intermittent blood pressure monitoring, continuous pulse oximetry, and cardiac monitoring. Supplemental oxygen should be used. and airway control via endotracheal intubation or use of a Laryngeal Mask Airways (LMA) ) is commonly used before bronchoscopy. The pharynx and vocal cords are anesthetized with nebulized or aerosolizedlidocaine(1 or 2%, to a maximum of 250 to 300 mg for a 70-kg patient). The bronchoscope is lubricated and passed either through a nostril, the mouth with use of an oral airway or bite block, or an artificial airway such as an endotracheal tube. After inspecting the nasopharynx and larynx, the clinician passes the bronchoscope through the vocal cords during inspiration, into the trachea, and then further distally into the bronchi. Several ancillary procedures can be done as needed, with or without Chest x-ray : Bronchial washing:Saline is injected through the bronchoscope and subsequently aspirated from the airways. Bronchial brushing:A brush is advanced through the bronchoscope and used to abrade suspect lesions to obtain cells. Bronchoalveolar lavage:50 to 200 mL of sterile saline is infused into the distal bronchoalveolar tree and subsequently suctioned out, retrieving cells, protein, and microorganisms located at the alveolar level. Local areas of pulmonary edema created by lavage may cause transient hypoxemia. Endobronchial and transbronchial biopsy:Endobronchial biopsy obtains a tissue sample from a lesion that can be seen in the airway lumen. Transbronchial biopsy uses forceps that are advanced through the bronchoscope and airway to obtain samples from one or more sites in the lung parenchyma. Transbronchial biopsy can be done without fluoroscopic guidance, but some evidence supports increased diagnostic yields and lower incidence of pneumothorax when fluoroscopic guidance is used. A retractable needle is inserted through the bronchoscope and can be used to sample enlarged mediastinal lymph nodes or masses. Ultrasonography of the Chest (EBUS) can be used to help guide the needle biopsy. Patients are typically given supplemental oxygen and observed for 2 to 4 hours after the procedure. Return of a gag reflex and maintenance of oxygen saturation when not receiving supplemental oxygen are the two primary indices of recovery. Standard practice is to obtain a Chest x-ray after transbronchial lung biopsy to exclude 