What do we use a rigid bronchoscopy (RB) for?
- Control of a compromised airway
- Massive hemoptysis
- Silicone stent placement
- Removing asphyxiating foreign bodies
What are the two purposes of bronchoscopy?
Diagnostic (airway anatomy and airway sampling) and therapeutic
What are some therapies we use rigid bronch for?
Thermal ablation, cryotherapy, brachytherapy and endobronchial stent placement
What is a contraindication of RB?
Presence of a pacemaker
What is the main advantage of brachytherapy?
Higher dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue
Who is brachytherapy indicated for?
Pts with inoperable lung cancer or cancer metastatic to the airways
What are the 2 types of airway stents?
Metallic and silicone
What is the best, easiest and safest way to obtain info about the airway?
Flexible bronchoscopy
What are the contraindications of a flexible bronch?
Uncorrectable hypoxemia, lack of skilled personnel, equipment or patient cooperation, unstable angina and uncontrolled arrythmias
When performing a flexible bronch bedside in the ICU, what is important to continuously monitor?
Cardiac, BP, oximetry and capnography
What is the total dose of lidocaine in adults?
5-7 mg/kg
Who should we take added caution for when administering medication lidocaine?
Elderly and those with liver and cardiac disease
What do we give to dry the patient airway before a flexible bronch?
Atropine (anticholinergic)
What can we give as a vasoconstrictor to stop bleeding during a flexible bronch?
Epinephrine
What is a bronchial lavage used to obtain?
Specimens from the alveolar level of the lung
How is a bronchial lavage performed?
By instilling a small volume (up to 50 mL) of normal saline solution deep into the airways and then suctioning it back out
Where is the bronchoscope wedged during a BAL?
At the level of fourth or fifth generation bronchus
Where should we obtain the fluid from during a BAL?
From the nondependent part of the lung
How much lavage fluid should we obtain to conduct an adequate lab?
15-20 mL
What is bronchial washing?
Used for cytologic exam to look for cancer and for microbiologic analysis
Where do we obtain fluid from in bronchial washing?
From the large airways
What is bronchial brushing?
(Added to a BAL of bronchial washing)
Brushing the surface of suspicious lesion back and forth 5-10 times
How many samples should we obtain when performing an endobronchial biopsy?
3 specimens
What is a transbronchial biopsy?
Where we obtain a specimen of the lung parenchyma by using flexible forceps positioned distally through the working channel of the bronchoscope
