What is a bronchoscopy?
Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is a flexible tube with an external diameter of 0.6cm and length of 80cm that is inserted into the airways, usually through the nose or mouth, or occasionally during a tracheostomy. Endobronchial Ultrasound (EBUS) has a video camera with an ultrasound probe attached to create local images of your lungs and nearby lymph nodes to accurately locate and evaluate areas.
 
Indications:
  1. Diagnosis of a lung problem: identification of lesions in the trachea, diagnosis ,and staging of lung cancer, or identification of organisms for pneumonia. 
  2. Treatment of a lung problem: removal of foreign bodies, clearance of airway secretion, performing bronchial alveolar lavage, insertion of airway stents, or endobronchial ablation of tumor (electrocautery, laser, cryotherapy, or photodynamic therapy).
 
Contraindications:
Abnormal blood coagulation, severe hypoxemia, dangerous arrhythmia, heart failure, respiratory failure, myocardial infarction, or angina pectoris in the past 6 weeks, severe airway obstruction, open tuberculosis, hypercapnia, uremia, pulmonary hypertension, inability to cooperate with the examination, etc.
 
Preparation:
  1. Your doctors will review your medical history, evaluate your physical conditions, order blood routine tests, and take a chest X-ray or CT scan. If the bronchoscopy is arranged, then your doctor will explain the purpose, procedure, and risks of the bronchoscopy to you and your closest relatives. You then need to sign the informed consent form.  
  2. You will need to avoid eating or drinking anything more than 4 hours before the bronchoscopy to prevent   aspiration pneumonia caused by coughing or vomiting during the procedure. Therefore, if the exam is scheduled in the morning, then fasting begins since midnight; if performed in the afternoon, then fasting begins after breakfast. Please take your regular antihypertensive drugs in the morning even though you are fasting. Please follow the instructions of your nurses.
  3. Before the exam, you will need to remove any movable dentures or braces and take off your glasses.
  4. Anesthesia consultation: If a painless bronchoscopy is arranged, then an anesthesiologist will evaluate your medical history and explain the procedures and risks. To improve the safety of anesthesia, please feel free to ask about any anesthesia-related questions. You then need to sign the anesthesia consent form and the self-pay consent form.
 
During the Bronchoscopy:
  1. Local anesthesia: the physicians will spray anesthetic in your throat or nose to achieve the local anesthetic effect. During the process, the doctor will drip anesthetic into the trachea as needed.
  2. Painless bronchoscopy: You will be given a short-acting sedative medicine intravenously by an anesthesiologist to help you relax.
  3. Position: lie flat on your back with your head tilted back so that your mouth and throat and trachea are in a straight line to facilitate bronchoscopy.
  4. Bronchoscope entry method: the bronchoscope is placed in your nose, nose, endotracheal tube, or tracheal cannula. The bronchoscope is advanced slowly down your throat, through the vocal cords, and into the airways. Please follow the doctor’s instructions to cooperate with the swallowing action to help reduce discomfort. Do not move your head during the process to avoid injury.
  5. The bronchoscopy usually takes about 30 minutes, oxygen will be given through a nasal cannula during the whole process, and the oxygen saturation concentration in the blood will be monitored.
  6. When the physicians perform bronchoscope placement and removal for you, please do some deep breathing to relieve tension.
 
After the Bronchoscopy:
  1. Back in the ward, do not eat or drink after the procedure for 1 to 2 hours until the numbness in your mouth/throat has completely worn away. You may then start with a sip of warm water. If you can swallow without any discomfort or choking, you can begin to have some soft food, such as porridge, yogurt, or steamed egg. 
  2. After the exam, you may have a sore throat, cough, increased airway secretion, or bloody sputum for 2 to 3 days, which is expected to recover gradually. However, if you experience fever, shortness of breath, chest pain, cough, or massive bloody sputum, then you should immediately inform the medical staff or seek emergency medical evaluation. 
  3. After the exam, you may have a chest X-ray a few hours later so that your doctor can evaluate whether you have a pneumothorax. 
  4. In the case of a bronchoscopy that is done in the outpatient department, someone must accompany you home. You should not drive or operate any form of machinery on the exam day.
 
Reference
  1. Dhooria, S., Chaudhary, S., Ram, B., Sehgal, I. S., Muthu, V., Prasad, K. T., ... & Agarwal, R. (2020). A Randomized Trial of Nebulized Lignocaine, Lignocaine Spray, or Their Combination for Topical Anesthesia During Diagnostic Flexible Bronchoscopy. Chest, 157(1), 198-204. https://doi.org/10.1016/j.chest.2019.06.018
  2. Jeng, T.H., Hsiao, Y.H., Chen, Y.M., Chang, S.C.(2019). Adult Airway Foreign Body Aspiration, Clinical Medicine, 83(6), 417-422(in Mandarin Chinese).  https://doi.org/10.6666/ClinMed.201906_83(6).0069
  3. Pastis, N. J., Yarmus, L. B., Schippers, F., Ostroff, R., Chen, A., Akulian, J., ... & Feldman, G. (2019). Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest, 155(1), 137-146. https://doi.org/10.1016/j.chest.2018.09.015
  4. Yao, Y., Su, Z., Chen, Y., Ye, Y., Lu, L., Zhong, C., Chen, X., Tang, C., & Li, S. (2019). Safety and efficacy of sufentanil combined with midazolam in bronchoscopy under conscious sedation: retrospective study of 11,158 cases. Journal of thoracic disease, 11(10), 4127. https://doi.org/10.21037/jtd.2019.10.03
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