Unit 12 - Bronchoscopy

Question 1

Where are bronchoscopies done?

Answer 1

ICU + OR + ER

Question 2

What are the 2 types of bronchoscopy scopes?

Answer 2

1. Flexible Bronchoscopy Schopes
2. Rigid Bronchoscopy Scopes

Question 3

What can the flexible scope do?

Answer 3

Sends fluids through
- Has a suction port

Includes EBUS scopes

Question 4

What about rigid scopes?

Answer 4

It is a steel tube used in the OR

Question 5

What are some important things about the flexible scopes?

Answer 5

1. Often fibre optic
2. Secondary cord goes to light source
3. Diffrent sizes avaulable
4. Bigger ones easier to send down vs smaller
5. Flex 180 degrees

Question 6

What is EBUS?

Answer 6

Endobrinchial Ultrasound
- Specialized scopes
- Built in ultrasound unit at tip (built in suction needle)
- Diagnostic for suspicions of cancer

Question 7

How does it work?

Answer 7

Needle pokes in lymph node –> Needle aspirate via (-) pressure –> Goes to area you are concerned most with.

Question 8

What does EBUS allow us to see?

Answer 8

Deeper tissues for more accurate retrieval of specimens

Question 9

What 2 main things is it used for?

Answer 9

1. Assess lung cancer for diagnosis and staging
2. Assess lymph nodes to see if cancer has metastasized

Question 10

Where are rigid scopes used more?

Answer 10

In surgeries for neonatal

Question 11

What position must Pt be in when using rigid scopes?

Answer 11

Sniffing Position

Question 12

What other things are needed for a bronchoscopy besides a scope?

Answer 12

• Suction
• Light source
• Video monitor to display image
• Bite-Block

Question 13

While it is NOT CRITICAL, what might you also want to have with you?

Answer 13

• Backup airway equipment
• Ability to deliver O2
• Access to required meds

Question 14

What are the 3 purposes for bronchoscopies?

Answer 14

1. Diagnostic purposes
2. Therapeutic purposes
3. Procedural purposes

Question 15

Define: Diagnostic purposes

Answer 15

Determining the presence or severity of a condition

Where it’s used most*

Question 16

Define: Therapeutic Purposes

Answer 16

Using the bronch to try and treat, or remedy, a condition

Ex: Bronchial hygeine, especially in atelectatic areas

Question 17

Define: Procedural purposes

Answer 17

Using the bronch to assist entry/removal of equipment

Ex: Intubation, foreign body removal

Question 18

What are 5 diagnostic purposes?

Answer 18

1. Retrieval of tissue samples
2. Bronchial Alveolar Lavages (BALs)
3. Locating sources of symptoms
4. Determine extent of injuries (spread)
5. Vizualize airway abnormalities

Question 19

Explain BALs

Answer 19

Finding segment of lung you want to sample.
- Bronch plugs off that area
- Fluid fills, then you pull bronch out
- Whatever you pull out is the sample you get.

Question 20

Explain retrieving a sample via Biopsy

Answer 20

• Physician controls/directs tool
• RT controls working on jaws to obtain sample
• Usually use formaldehyge mix that sample obtained gets put into
• Usually need 6-8 samples

Question 21

How is sample obtained via brushing?

Answer 21

• Sealed brush hidden in tube
• Can send deeper and can go into airways blind
• Scrub to relieve any surface tissue samples

Question 22

Needle Aspiration

What is used here?

Answer 22

• EBUS
• Target = carina to scan lymph node (in this pic)
• Deplooy needle into tissue and suction will aspirate tissue into needle to get sample
• Requires extra training

Question 23

What is BALs used for?

Answer 23

• Wash cells out for sampling
• Very target specific
• Bronchoscope used as a plug into subsegment (wedging bronchi so diametre is stuck in the airways
• Take larger syringe, inject saline into subsegment, use some syringe to suction fluid out with same syringe.
• Get more defined sample from specific area of lungs
• Can collapse airways due to suction, so have to go gently.

Question 24

Tell me characteristics of bleeding symptoms

Answer 24

• Delicate tissue
• Biopsy and brush to a certain degree can cause bleeding
• Inject epinephrine or cold saline to vasoconstrict to avoid bleeding.

Question 25

Describe characteristics of stridor (stenosis)

Answer 25

- Swelling around epiglottis - Difficult intubation - May see stridor due to swelling

Question 26

What happens during inspiration for stridor?

Answer 26

Laryngeal tissue above the vocal cords collapses into the airway - Causes obstruction and stridor

Question 27

This shows burns. Describe the characteristics of this photo

Answer 27

- Redness and tissue swelling - Look at diagnostics - Take photos with bronch system for physician to look at

Question 28

Soot + Wall Damage

Answer 28

- Intubate + Ventilate patient - Burn ward

Question 29

What are 5 therapeutic procedures?

Answer 29

1. Placing intra-bronchial blockers 2. Foreign body removal 3. Hemostasis 4. Electro and Laser surgery 5. Sputum clearance

Question 30

Describe placing intra-bronchial blockers

Answer 30

lung segment of issue gets plugged off to not communicate with rest of the lung

Question 31

describe: Foreign body removal

Answer 31

Definitive tool bronchoscope is good at doing

Question 32

Describe: Hemostasis

Answer 32

- Identify bleeding - Use epi/cold saline to vasoconstrict - This helps prevent more bleeding

Question 33

Describe: Electro and laser surgery

Answer 33

(Thermoplasty/Cauterization) - Maybe bleed, not responsing so scar it over instead

Question 34

Describe: Sputpm Clearing

Answer 34

Bronchial Hygeine

Question 35

What do intra-bronchial blockers do?

Answer 35

- Therapeutic purpose - Block off problematic area of lungs to alleviate issue - Spring loaded, or balloon inflated

Question 36

What is the challenge with hemostasis?

Answer 36

Getting the tool as far as it needs to go down the airway

Question 37

For sputum clearing (bronchial hygeine), what can occur?

Answer 37

- VERY thick secretions can plug the bronchoscope - Secretions can move in/out depending on the phase of breathing.

Question 38

Describe the first 3/6 steps for ***Percutaneous Tracheostomy***

Answer 38

1. Add epi and lidocaine 2. Slip just below trachea 3. Send in needle and vizualise it, guidewire through needle and remove needle.

Question 39

Describe the second (3/6) steps for ***Percutaneous Tracheostomy***

Answer 39

4. Guidewire used for subsequent bronchodilators 5. Use ***blue rhino tule*** to widen hole then add obturator 6. Send bronch down trach to make sure lumen of tracheostomy is at trachea

Question 40

What can be dine during a ***Difficult Airway Intubation?***

Answer 40

1. Can target direction and how to land the tube 2. Seldinger Principle 3. Preload ETT on top of bronchoscope 4. At carina, hold steady and push ETT down over bronch into trachea

Question 41

For nasal intubation, what size is best to send down airways?

Answer 41

Size 8 ETT

Question 42

When are rigid scopes used?

Answer 42

Usually in the OR. - Certain procedures in trachea and primary airways

Question 43

What does the rigid scope require?

Answer 43

The ability to put the patient in a "sniffing" position.

Question 44

Although rare, what do absolute contraindications occur due to?

Answer 44

1. Inability to get the scope in 2. The lack of ppl skilled to perform it

Question 45

Why are there too many relative contraindications to list for bronchoscopy?

Answer 45

Because the procedure is invasive and always carries risks — decisions become about whether relative risks are less than relative benefits.

Question 46

If a patient has a high risk of bleeding, what question should you ask before performing a biopsy?

Answer 46

Does the benefit of obtaining a biopsy (e.g., tailoring cancer treatment) outweigh the risk of bleeding?

Question 47

When might you still proceed with a biopsy despite bleeding risk?

Answer 47

If the cancer type is unknown and obtaining tissue will guide treatment, the benefit may outweigh the risk.

Question 48

If a patient has significant hypoxemia, what potential benefit of bronchoscopy could outweigh the risk?

Answer 48

Clearing retained secretions may improve oxygenation. (Bronchial hygiene can help prevent worsening hypoxia.)

Question 49

If a patient's blood pressure is very low, what risk do we consider during bronchoscopy?

Answer 49

The risk of lowering BP further during the procedure, possibly causing the patient to crash.

Question 50

What medications might be needed if blood pressure decreases during the procedure?

Answer 50

Vasopressors (BP-supporting medications).

Question 51

If O₂ levels could change during bronchoscopy, what monitor is required?

Answer 51

Pulse oximetry (monitor saturations).

Question 52

If effective ventilation can be affected, what monitor is required?

Answer 52

CO₂ monitoring (end-tidal CO₂).

Question 53

What is included in standard monitoring for procedural sedation like bronchoscopy?

Answer 53

Full ECG, blood pressure, oxygen saturation, and end-tidal CO₂.

Question 54

If the heart may undergo stress during the procedure, what monitor is needed?

Answer 54

ECG monitoring.

Question 55

If blood pressure can change during bronchoscopy, what monitor is needed?

Answer 55

Non-invasive BP monitoring.

Question 56

What medication is used to numb the upper airway and reduce coughing during bronchoscopy?

Answer 56

Lidocaine (liquid, spray, or syrup).

Question 57

In what forms can lidocaine be delivered during bronchoscopy?

Answer 57

Liquid or thick syrup.

Question 58

If the patient's O₂ levels fluctuate during the procedure, what “medication” can be given?

Answer 58

Oxygen.

Question 59

If a patient experiences bronchospasm after bronchoscopy, what medication can treat it?

Answer 59

Ventolin (salbutamol).

Question 60

Why is epinephrine kept on hand during bronchoscopy?

Answer 60

For its vasoconstriction properties to limit or stop airway bleeding.

Question 61

How would epinephrine best be delivered if bleeding occurs deeper in the lungs?

Answer 61

Through the bronchoscope to the bleeding site.

Question 62

Why are propofol, ketamine, or midazolam commonly used for bronchoscopies?

Answer 62

They have strong sedative properties appropriate for a sedated procedure.

Question 63

What respiratory concerns should you have when giving sedatives like propofol, ketamine, or midazolam?

Answer 63

Risk of respiratory depression, decreased respiratory drive, and hypoxia.

Question 64

Why might fentanyl be given during bronchoscopy?

Answer 64

For sedation and analgesia.

Question 65

What respiratory concern exists when giving fentanyl?

Answer 65

Respiratory depression leading to hypoventilation and low sats.

Question 66

What must be ensured before increasing sedation during bronchoscopy?

Answer 66

Patient has good O₂ saturations and is safely progressing through stepwise sedation.

Question 67

Why must we check whether a patient is awake or responsive during sedation?

Answer 67

To ensure they do not wake suddenly, grab equipment, or compromise respiratory drive.