Bronchoscopy

What is a bronchoscopy?

Bronchoscopy refers to inserting a flexible tube with a diameter of 0.6 cm and a length of 80 cm into the bronchus from the mouth, nose or endotracheal tube or tracheostomy tube, so that the doctor can take tissue cells or secretions do pathological sections or bacterial cultures. In recent years, further examination and treatment methods have been developed by means of bronchoscopy instruments:

Endobronchial ultrasound (EBUS): Combines a bronchoscope and an ultrasound probe to perform more in-depth examination or treatment can reach areas that are more difficult to obtain a biopsy.
Laser bronchoscopy: Laser therapy is used under the guidance of a bronchoscope to remove granulation tissue, scarring, benign or malignant tumors, tumor blood vessels, improve tracheal stenosis or obstruction.

Indications for bronchoscopy

Disease diagnosis: identification of endobronchial lesions, histological diagnosis and staging of tumors, and bacterial culture of pneumonia
Treatment: removal of bronchial secretions and foreign bodies, whole lung lavage, electrocautery, treatment of tracheal stenosis, hemorrhage in pulmonary bronchi, and photodynamic therapy force therapy, etc.

Contraindications for bronchoscopy

Abnormal coagulation function, severe hypoxemia, arrhythmia, heart failure, respiratory failure, myocardial infarction or angina occurs in the past six weeks, severe tracheal stenosis, open TB, hypercapnia, uremia, pulmonary hypertension, and inability to cooperate with the examinations...etc.

Preparations before bronchoscopy:

The purpose of bronchoscopy, operating procedures and precautions before, during and after the examination are explained by the physician, and the treatment consent form is filled out after consent with a hazard statement.
You will need to fast for at least 4 hours to avoid coughing, or vomiting cause aspiration pneumonia. If the test is scheduled to be performed in the morning, you will need to start fasting at midnight, the night before the exam. If it is scheduled to be performed in the afternoon, you need to begin fasting after breakfast. It is still necessary to take regular blood pressure medicine in the morning when fasting, so please follow the instructions of the nurse.
Glasses and removable dentures must be removed..
Anesthesia consultation: If painless bronchoscopy is arranged, the anesthesia consultation should be completed before the examination. An anesthesiologist will evaluate the medical, surgical, anesthesia, and medication history, and refer to various other physiological test reports to explain the process of anesthesia and underlying risks. If you have any anesthesia-related questions, feel free to ask the doctor to improve the safety of anesthesia, and complete the signing of the anesthesia consent form and the self-pay consent form.

Matters needing attention during bronchoscopy:

Local anesthesia: While waiting in the examination room, the doctor will first spray an anesthetic on the throat or nasal cavity to achieve local anesthesia effect. Painless bronchoscopy: An anesthesiologist will administer a short-acting anesthetic in an intravenous drip, and then undergo an examination.
Checking the position: Lie on your back with your head tilted back so that the mouth and throat are in line with the trachea.
When the bronchoscope enters the throat, please cooperate with the swallowing action according to the doctor's command to help enter the airway smoothly and reduce discomfort. Do not shake your head during the procedure to avoid injuring your throat.
The inspection process will take about 30 minutes, and the oxygen will be given via a nasal cannula throughout the process, and the oxygen saturation concentration in the blood will be monitored.
When physicians perform bronchoscope placement and removal, try to take deep breaths to relax and reduce discomfort.

Matters needing attention after bronchoscopy:

Rest for 1-2 hours after the examination to let the effect of the anesthesia wear off. First, have a small sip of water slowly. If there is no choking, nausea, or vomiting, you can start eating. When eating, you should choose foods with a softer texture, such as porridge or steamed eggs to reduce discomfort in the throat.
About 1 to 2 days after the exam, there will still be a sore throat, cough, sputum, or small amount of blood tinge in the sputum, but if you have fever, difficulty breathing, chest pain, or cough up few spoons of bloody sputum, you should go to the ER immediately.
According to the doctor's evaluation after the examination, X-ray examination may be required in a few hours to determine whether there is pneumothorax.
After the examination, please be sure to have family members accompany you home. The patient should not drive by him or herself, nor engage in dangerous mechanical operation on the day of examination.

Reference

Chao, H. S., & Chiu, C. H. (2021). The role of interventional bronchoscopy in lung cancer. Clinical Medicine, 87(5), 287-289. https://doi.org/10.6666/ClinMed.202105_87(5).0047
Lin, C. W. (2021). Technology imformation: The role of interventional bronchoscopy in respiratory disease. Changhua Christian Medical Prevention and Treatment, 44, 30-32. https://doi.org/10.6527/PVMN.202106_(44).0011
Tsai, T. Y. & Luo, Y. H. (2020). Endobronchial ultrasound: Case report. Clinical Medicine, 86(4), 645-650. https://doi.org/10.6666/ClinMed.202010_86(4).0115

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