Clinical Instruction (Kass) > Bronchoscopy > Flashcards

Bronchoscopy Flashcards

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1
Q

What are the clinical indications for a bronchoscopy?

A

Assessment of hemoptysis to including determining the site of bleeding
Removal of foreign bodies in the airway
Assessment of various pulmonary problems
Infection
Lung mass or nodule

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2
Q

Describe hemoptysis

A

Coughing up blood

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3
Q

When would it be necessary to perform a bronchoscopy on a patient with pneumonia

A

If they are unable to produce a sputum sample

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4
Q

Describe massive hemoptysis

A

Massive blood loss from the bronchopulmonary tree of approximately 200-600 ml of blood within a 12 to 24 hour time frame

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5
Q

What is usually ordered when a patient is experiencing hemoptysis?

A

CBC and assessment of coagulation factors
Bronchoscopy to establish cause of bleeding

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6
Q

What risk do aspirated foreign bodies pose to patients?

A

Can cause PNAs that do not resolve
Can cause significant SOB

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6
Q

Why are bronchoscopies used to sample tissues in the transbronchial region?

A

Safer
More accurate

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7
Q

What is an option for the removal of foreign bodies from the tracheobronchial tree?

A

Flexible bronchoscopy examination evaluate the foreign body and potentially remove it
Have rigid bronchoscope on hand in case foreign body cannot be successfully removed

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8
Q

What is interstitial lung disease?

A

An abnormality of the lung parenchyma involving the space between the alveoli

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9
Q

What is a risk associated with removing foreign bodies via bronchoscopy?

A

Foreign body may move further down the tracheobronchial tree

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10
Q

What is needed to diagnose ILD?

A

High resolution CT scan

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11
Q

How can a bronchoscopy be useful when evaluating ILD?

A

Can be used for biopsies of lung tissue for testing

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12
Q

Describe a diagnostic bronchoscopy

A

A procedure that involves using a bronchoscope to visualize the major airways and obtain tissue, secretion or fluid samples

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13
Q

Describe a flexible bronchoscopy

A

Comprised of a flexible sheath containing the necessary cables to allow flexion and extension of the tip of the scope

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14
Q

List some uses for the flexible bronchoscopy

A

Sampling of parenchymal masses and nodules suspicious for cancer
Obtaining brinchoalveolar samples to diagnose infection
Diagnostic sampling of mediastinal lymphadenopathy
Assessing endobronchial tissue for an obstrucint lesion
Sampling of both endobronchial and parenchymal tissues to asses for conditions
Removal of foreign bodies and suctioning of the airway to clear an obstruction

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15
Q

What is included in the prebronchoscopy assessment?

A

Evaluate the patients airway
See if the patient uses dentures or other oral appliances
Check recent medical history
Patients vital signs

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15
Q

What are relative contraindications for bronchoscopies?

A

Recent myocardial infarction
Unstable arrhythmias
Unstable bronchial asthma
Respiratory insufficiency with hypoxia or hypercarbia
Coagulopathy
Uremia
Hypo-hypertension

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16
Q

When should a flexible bronchoscopy not be performed

A

Without formal patient consent
Without adequate support
Bronchoscopist is inexperienced

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17
Q

What is the order of anatomical features that are bypassed/examined in a bronchoscopy?

A

Advanced through oropharynx
Past epiglottis and through vocal cords (lidocaine applied to vocal cords)
Right upper, right middle, and right lower lobe and subsegmental bronchi are inspected
Left upper and left lower lobes and subsegmental bronchi are examined

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18
Q

What should be monitored during a bronchoscopy?

A

Patient vitals
Patient oxygenation

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19
Q

What are the options for insertion of a flexible bronchoscope?

A

Nasal passages
Oropharnx

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20
Q

Oral insertion of the bronchoscope requires what?

A

A bite block

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21
Q

What are the methods that a bronchoscopist has at their disposal to gather samples?

A

Sterile brush
Cytologic brush
TBBx

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22
Q

What is the sterile brush on the bronchoscope used to sample?

A

Microbiology

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23
What is the cytologic brush used to sample?
Assess for malignant cells
24
What is the TBBx used for?
Tissue sampling to assess for infection or malignancy
25
What is the BAL used for?
Sample collection from the alveoli looking for malignant cells
26
What instruments are used to collect samples?
Smooth or serrated forceps Sterile brush Cytology brush
27
When are serrated forceps used?
Used when a mass is visualized and a larger piece of tissue is required Capable of cutting tissue and are preferred if a larger sample is needed
28
Describe a shielded brush
Shielded brushes have an inner layer with a plastic outer layer to protect the sterile brush from contamination
29
Describe unshielded brushes
Unshielded brushes are not protected by an outer sterile plastic sheath and are primarily used to obtain samples of masses or suspicious parenchymal tissues to send for cytologic analysis
30
What are the risks associated with bronchoscopy
Infection Bleeding Pneumothorax
30
Describe the procedure for a BAL
Bronchoscopist locates subsegment of the lung of interest with the tip of the scope wedged in the subsegment of the lung 20-40 mL of saline is instilled into the side port of the scope and into small airway Fluid is flushed down airway and suction back into a trap that is attached to scope
31
What is special about EBUS (endobronchial ultrasound)
Has an ultrasound probe at the end with doppler capability
31
What is a thoracentesis performed for?
Remove pleural fluid Reduce respiratory distress in patients with large pleural effusions
31
What conditions can produce exudative pleural effusions
Infection Cancer Pulmonary embolism
31
What is a rigid bronchoscopy?
Long hollow straight metal tube with light source, telescopes and viewing monitor Allows for access to the trachea and proximal airways to remove large foreign bodies
32
What conditions can cause transudative pleural fluid?
Left ventricular failure Renal failure Liver failure/cirrhosis
32
What is used to locate areas for thoracentesis?
Ultrasound is used to locate deep pockets of pleural fluid located away from structures
33
What are potential complications of a thoracentesis?
Pneumothorax (rare) Pain, coughing, localized infection Hemothorax Intra-abdominal organ injury Air embolism Post expansion pulmonary edema
34
When is a surgical lung biopsy indicated?
Indicated in patients who have clinical findings suggestive of interstitial lung disease Chest imaging consistent suggestive of ILD Exclusion of infectious processes and cancer Evaluating of unexplained hypoxia, hemoptysis or signs of an inflammatory lung process
35
When is a surgical lung biopsy not indicated?
In cases of ILD if the complications outweigh the benefits
36
What are complications associated with open lung biopsy
Infection Bleeding Creation of bronchopleural fistula Post procedure PNA Post op atelectasis
36
During a BAL, the RT inserts approximately how much normal saline into the side port of the scope?
20-40 ml
36
What solution anesthetizes the vocal cords?
lidocaine
36
Describe the VATS procedure
Patient is mechanically ventilated via double lumen ETT Non dependent lung is collapsed by suction or by positive pressure in pleural cavity Requires 3 incision points Chest tubes places for drainage
37
What is the gold standard for obtaining lung tissue samples
Open lung biopsy
38
What is used to sample malignant cells during a bronchoscopy?
cytologic brush BAL transbronchial biospy
39
what is the least invasive test which may determine the causative agent for PNA patients?
sputum sample
40
What can foreign bodies aspirated into the lung cause
significant dyspnea PNA
41
When is a thoracentesis performed?
To drain large pleural effusions
42
T/F: Transbronchial biopsies via flexible bronchoscopy can diagnose both central lesions and peripheral lesions
true
43
What can be an indication for a bronchoscopy
Sudden oxygen desaturation Hemoptysis Chest xrays with complete opacifications
44
T/F: Bronchoscopy is necessary for every PNA patient
False
45
Where are rigid bronchoscopies usually performed?
the operating room
46
Clinical indications for a bronchoscopy include
Removal of foreign bodies Assessment of various pulmonary problems Assessment of hemoptysis
47
When are rigid bronchoscopies usually performed?
usually performed on patients with large foreign bodies in their airways
48
Flexible bronchoscopy should not be performed without
Formal patient consent Adequate facilities An experienced bronchoscopist
49
In order to sample microbiology during a bronchoscopy, you need a
sterile brush
50
What do open lung biopsies allow us to do?
Visualize the pleural space Repair damaged structures Visualize anatomical structures
51
Risks associated with bronchoscopies include
Bleeding Pneumothorax Infection
52
What are unshielded brushes used for during a bronchoscopy?
collect samples of masses or suspicious tissue
53
What would cause an transudative pleural effusion?
left ventricular failure
54
What are relative contraindications for bronchoscopies?
Hypoxia Hypercarbia Unstable arrythmias Myocardial infarction less than 6 weeks ago Unstable bronchial asthma
55
What are serrated forceps used for during a bronchoscopy?
to cut tissue for large tissue samples
56
ILD can be diagnosed with
A transbronchial biopsy Specific antibodies A high resolution cat scan An autoimmune panel
57
What could cause an exudative pleural effusion?
Cancer
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