What is a flexible bronchoscopy:
Bronchoscopy refers to an endoscopic technique using an instrument (bronchoscope) with an external diameter of 0.6 cm to visualize the airway. Flexible bronchoscopy is usually performed via the oral, nasal route or artificial airway such as endobronchial tube. Once the bronchoscope reaches the trachea and then bronchial branches, the physician is able to collect respiratory cells, tissue or secretion for diagnostic or therapeutic purposes. Endobronchial ultrasound (EBUS) is technique that uses ultrasound along with bronchoscope to visualize airway wall and structures adjacent to it, including lymph nodes and mediastinal lesions.
 
Indications:
Indications for bronchoscopy can be divided into two categories:
  1. Diagnosis: identification of lesions in the trachea, diagnosis and staging of lung cancer, or identification of organisms for pneumonia. 
  2. Treatment: removal of foreign bodies, clearance of airway secretion, performing whole lung bronchial alveolar lavage, insertion of airway stents, endobronchial ablation of tumor (electrocautery, laser, cryotherapy or hotodynamic therapy).
 
Contraindications:
Including abnormal coagulation function, bleeding diathesis, hypoxia that cannot corrected by oxygen supplementation, hemodynamic instabilities, such as arrhythmia, heart failure, myocardial infarction, or any angina pectoris within six weeks. In addition, complete trachea obstruction, uncontrolled pulmonary tuberculosis, uremia, uncontrolled pulmonary hypertension, and uncooperative patients are also contraindications.
 
Preparing for a bronchoscopy:
  1. Before Examination:
    1. Your doctor will review your medical histories, evaluate physical conditions, order blood routine tests and chest radiograph. The doctor will make sure your coagulation function is normal. The physician will explain to the patient and family the purpose, procedure, and precautions before, during, and after the bronchoscopy. If there are no further questions, then the patient or family member need to sign the consent form. 
    2. You can neither eat nor drink anything before the exam for at least four hours. If the exam is planned for the morning, the nurse may request the patient to abstain from food and liquids after midnight. If the exam is planned in the afternoon, please do not have anything after breakfast. The patient can take anti-hypertensive medication with a sip of water during this period of time. Follow the nurse’s directions to prevent aspiration pneumonia from happening. 
    3. Before the exam, the patient will need to remove any movable dentures and take off the glasses.
    4. Half an hour before the exam, either in the ward or in the bronchoscopy room, a local anesthesia spray is applied to your throat. Its purpose is to reduce the sensitivity of the airway and prevent gag reflex or cough reflex during the exam.
  2. During the examination:
    1. Position: Please follow the directions during the bronchoscopy. Lie on the examination table facing up. Please throwback your head so that your throat and trachea are in a straight line.
    2. Local anesthesia is applied in two ways:
      • Thirty minutes before examination in the ward, the nurse will spray local anesthetic that you should breathe into your lung. Please follow the instructions correctly. Afterwards, you will be sent to the bronchoscopy room.
      • In the bronchoscopy room, while waiting for examination, the physician will spray anesthesia in the throat. Please keep it in the mouth for a few seconds. During the procedure, further anesthetic will be used to numb your voice box and breathing passages.
    3. During the bronchoscopy, the physician will insert a bronchoscope which is 80 cm in length and 0.5~0.6 cm in diameter, through a “guard” in the mouth or one of your nostrils. Those patients having a tracheotomy, the tube will go down through the tracheotomy into the bronchus for checkups and treatments.
    4. When the bronchoscope goes down the back of your throat, please swallow. While the numbness will make you feel as if you can’t swallow, you will still be able to. This will lessen the discomfort. Do not shake or move your head during the procedure to avoid hurting the throat.
    5. The whole examination takes about 30 minutes. The physician will be monitoring oxygen levels and heart rate throughout the whole exam. You will be given some oxygen into your nose or mouth.
    6. Take a deep breath and follow the doctor’s instruction while examination processing. Try to relax preventing further discomfort.
  3. After the examination:
    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. Then starting with a sip of warm water. If you can swallow without any discomfort or choking, you can begin to eat soft food, such as porridge, yogurt, or steamed egg. It would reduce the discomfort in the throat.
    2. After the exam, you may have sore-throat, cough, increased sputum production, 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, you should immediately inform the medical staff or seek emergency medical evaluation.
    3. After the exam, you may have a chest radiography a few hours after the examination. The doctor can evaluate whether you have pneumothorax.
    4. In the case of a bronchoscopy that is done in the outpatient department, it is essential that someone accompanies you home. You should not drive or operate any form of machinery on the exam day.
 
Reference
  1. John, T. H. (2016, Nov 10). Placement and management of thoracostomy tubes. Retrieved from https://www.uptodate.com/contents/placement-and-management-of-thoracostomy-tubes 
  2. Jacomelli, M., Demarzo, S. E., Cardoso, P. F. G., Palomino, A. L. M., & Figueiredo, V. R. (2016). Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions. Jornal Brasileiro de Pneumologia, 42(4), 248–253. doi: 10.1590/S1806-37562015000000079
  3. Ong, P. G., Debiane, L. G., & Casal, R. F. (2016). Recent advances in diagnostic bronchoscopy. Journal of Thoracic Disease, 8(12), 3808–3817. doi: 10.21037/jtd.2016.12.70.
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    Update
    2018-05-25 00:00:00