This study guide was created to make the learning process easier for you to develop an understanding of this topic. It contains practice questions for your benefit as well. So if you’re ready, let get started.
What is Flexible Bronchoscopy?
A bronchoscopy is a procedure where a flexible tube, known as a bronchoscope, is inserted into the airways of the lungs. It contains a camera and light source which allows the physician to view the airways.
This process can be used for both diagnostic and therapeutic purposes. However, a flexible bronchoscope is more maneuverable which makes it better for diagnostic purposes. A rigid bronchoscope, on the other hand, is typically used for surgical procedures and thus for therapeutic purposes.
A Respiratory Therapist is usually present to assist with the procedure and ensure that all tools and equipment are present and functioning properly. They also help monitor and keep the patient in stable condition.
Flexible Bronchoscopy Practice Questions:
1. Flexible Bronchoscopy has been used for what?
It has been used for most diagnostic and therapeutic indications in patients with pulmonary diseases.
2. What is the goal of sedation during a bronchoscopy?
It is used to improve the patient’s comfort during the procedure.
3. The continuous monitoring of what is important during the procedure?
The monitoring of oxygenation and hemodynamic stability.
4. What are the most commonly used diagnostic procedures in Flexible Bronchoscopy?
BAL, biopsy, and TBNA.
5. BAL obtains samples from what?
6. Needle aspiration has a role in sampling mediastinal lymph nodes to diagnose what?
Lung cancer, sarcoidosis, and some infectious processes.
7. Biopsy has value in the diagnosis of what?
Infiltrative pulmonary diseases.
8. What has been used along with flexible bronchoscopy as treatments?
Various thermal ablation techniques.
9. When using thermal ablation techniques, what is the most important point to keep in mind?
You should ensure a low FiO2 environment before the use of any thermal ablative therapy.
10. Airway stenting has been used to maintain airway patency when?
After dilation of any obstructed major airways. It is important to recognize the difference between silicone and metallic stents.
11. What is Bronchial thermoplasty?
It is a novel bronchoscopic technique for patients with steroid-dependent asthma.
12. What is being studied in the management of patients with severe emphysema as a minimally invasive lung volume reduction therapy?
Endobronchial valves and coil placement.
13. Who plays a vital role in assisting before, during, and after bronchoscopy?
The Respiratory Therapist.
14. What does a Respiratory Therapist do in regards to helping with a bronchoscopy procedure?
There are many aspects to this role, but they include ensuring appropriate documentation (e.g., physician’s order), preparing the patient and the equipment, patient monitoring, and responding to adverse events.
15. What are the special considerations that the Respiratory Therapist and other members of the bronchoscopy team must consider when performing this procedure on mechanically ventilated patients?
Patients on the ventilator are more susceptible to adverse events. These considerations include ensuring adequate ventilation and gas exchange before, during, and after the procedure.
16. What are the clinical situations where flexible bronchoscopy would be indicated?
Hemoptysis, Wheeze and stridor; suspected upper airway obstruction, Pulmonary infiltrate of unknown cause, Unexplained lung collapse, Suspected or known bronchogenic carcinoma, Mediastinal, and hilar lymphadenopathy, Lung transplantation, Endotracheal intubation, Evaluation of foreign body aspiration, chemical or burn-related injury to the airway, Unexplained superior vena cava syndrome, Unexplained vocal cord paralysis or hoarseness, and Suspected fistulas.
17. What are the absolute contraindications for flexible bronchoscopy?
Uncorrectable hypoxemia, Lack of patient cooperation, Lack of skilled personnel, Lack of appropriate equipment and facilities, and Unstable angina.
18. What are the relative contraindications for flexible bronchoscopy?
Unexplained or severe hypercarbia, Uncontrolled asthma attack, Lack of patient cooperation, Uncorrected coagulopathy, Recent myocardial infarction, Unstable cervical spine, and impaired neck mobility, and the Need for large size tissue specimen.
19. What is the primary goal of sedation during flexible bronchoscopy?
The goal of sedation is to improve the patient’s comfort during the procedure. In addition to risks of arrhythmias and fluctuations in blood pressure related to the procedure, airway manipulation during bronchoscopy may lead to coughing, hypoxemia, vomiting, bleeding, laryngospasm, and bronchospasm. All of these responses can affect the outcomes of the procedure. Therefore, adequate sedation is an important part of the procedure.
20. What is BAL and when is it indicated?
BAL stands for Bronchoalveolar lavage and it is used to obtain specimens from the alveolar level of the lung.
21. When is rigid bronchoscopy indicated?
Although the role of rigid bronchoscopy (RB) has declined, RB remains an invaluable tool for the control of a compromised airway, massive hemoptysis, and silicone stent placement and for removing asphyxiating foreign bodies. The major indication for rigid bronchoscopy is in managing central airway obstruction.
22. What is the difference between BAL and bronchial washings?
Bronchial washings are generally obtained for the cytological examination to look for cancer and for microbiologic analysis to diagnose mycobacterial or fungal infections. Unlike BAL, bronchial washings are obtained from the large airways.
23. What should a Respiratory Therapist consider regarding oxygen delivery during thermal ablation?
During the application of “hot therapies” (thermal ablation) like a laser, electrosurgery, or argon plasma coagulation, the FiO2 should always be maintained below 40% to prevent endobronchial ignition.
24. What are endobronchial stents used for?
Stents are the devices designed for internal splinting of the airway lumen. Airway stents have been used to help reduce airway obstruction from malignant or benign processes that compress the airway from the outside. Airway stenting can offer immediate relief of acute respiratory distress, allow successful extubation, and may prolong survival.
25. What is a bronchoscopy?
It is the process of passing a bronchoscope into the airways for either diagnostic testing or therapeutic purposes.
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26. What are the four types of bronchoscopy?
Flexible bronchoscopy (FB), Rigid bronchoscopy (RB), Diagnostic bronchoscopy (DB), and Therapeutic bronchoscopy (TB).
27. A Rigid Bronchoscopy is always performed under what condition?
Under deep sedation with muscle relaxation.
28. What are the risks of flexible bronchoscopy?
Arrhythmias, fluctuations in blood pressure, and airway manipulation during bronchoscopy may lead to coughing, hypoxemia, vomiting, bleeding, laryngospasm, and bronchospasm.
29. What maneuvers used if the patient becomes over-sedated during a bronchoscopy procedure?
Chin-lift and jaw-thrust.
30. What is recommended to prevent the patient from slipping into deep sedation?
Capnography monitoring while performing flexible bronchoscopy under moderate sedation.
31. What is flexible bronchoscopy monitoring consisted of?
You must keep track of patient responses to verbal commands or spontaneous movements. Their chest movement may continue despite near-total obstruction of the airway. There should be continuous cardiac, blood pressure, and pulse oximetry monitoring. Capnography should be used to monitor and prevent the patient from entering deep sedation.
32. What are the types of therapeutic bronchoscopy?
Rigid bronchoscopy, thermal ablation of the endobronchial lesion, brachytherapy, cryotherapy, and endobronchial stents.
33. What is the major indication for rigid bronchoscopy?
Managing central airway obstructions.
34. What are the three types of thermal ablation of an endobronchial lesion?
Endobronchial electrocautery, argon plasma coagulation (APR), and laser photocoagulation.
35. What are the risks of thermal ablation of an endobronchial lesion?
Improper use of thermal modalities can lead to perforation of the airway, vascular structures, or the esophagus.
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36. What are the complications of thermal ablation of an endobronchial lesion?
Hypoxemia, pneumothorax, and bronchopleural and bronchoesophageal fistula.
37. What are the contraindications of thermal ablation of an endobronchial lesion?
Refractory hypoxemia, and extrinsic compression of the airway without an endobronchial lesion.
38. What is the relation of flexible bronchoscopy and an endotracheal tube?
You can use a flexible bronchoscope to place an ET tube through the mouth or nose. It allows for awake intubations with topical anesthesia. It is used in patients with cervical injuries, where immobilization of the neck is crucial. It may also help identify causes of acute hypoxia and help to remove secretions of blood in the airway. It is limited to experience of operator and there must be patient cooperation.
39. What is the Respiratory Therapist’s role in bronchoscopy before the procedure begins?
We help identify potential need for bronchoscopy (retained secretions or foreign body removal). We verify physician’s order or protocol. We review the patient’s record for contraindications (excessive clotting times), hazards, and informed consent. We prepare/ensure proper function of equipment. We outline the plan for adequate oxygenation during the procedure. We evaluate the patient for bronchospasm and administer aerosolized bronchodilators if required. We assist nurses in application of topical anesthesia.
40 What is the Respiratory Therapist’s role in bronchoscopy during the procedure?
We monitor the patient’s vital signs (including capnography). We help identify and respond to adverse reactions, and we administer oxygen as needed. We provide proper positioning of the patient. We assist with the use of accessories (bite block, oral airways, nasopharyngeal tube, biopsy forceps, brushes, etc.) We set up instruments for rigid bronchoscopy and silicone stents. We help place chest or ET tubes in emergent situations.
41. What does a Respiratory Therapist do in bronchoscopy during mechanical ventilation?
We establish adequacy of the length and the diameter of the ET or trach tube. We ensure that the bite block is in place (to avoid equipment damage). We adjust ventilator settings for safety reasons and oxygenation purposes (and then return settings to pre-procedure).
42. What are the main complications and risks of bronchoscopy?
Bleeding, Infection, Bronchial perforation, Bronchospasm, Laryngospasm, and Pneumothorax.
43. The endoscope reaches what generation of bronchi?
4th – 5th.
44. What is the rigid tube?
An open metal tube with a distal light source and port for oxygen/ventilating equipment.
45. Who uses the rigid tube?
Otorhinolaryngologists and Thoracic surgeons.
46. What type of bronchoscope do Respiratory Therapists most often assist with?
47. Which bronchoscope can access very small airways?
48. What are the channels in a flexible fiberoptic bronchoscope?
Light transmission, Visualizing, and Multipurpose open.
49. Who uses the flexible fiberoptic bronchoscope?
The pulmonologist along with assistance from the Respiratory Therapist.
50. What is the most common method of anesthesia during a bronchoscopy?
So there you have it. Hopefully, this study guide can help you develop a better understanding of the flexible bronchoscope medial procedure. Because, as we mentioned, a Respiratory Therapist is essential during the process.
We also have a guide on Endotracheal Intubation as well that I think you will enjoy. Thank you for reading and as always, breathe easy my friend.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Faarc, Cairo J. PhD Rrt. Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017. [Link]
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
- “Guidelines for Diagnostic Flexible Bronchoscopy in Adults: Joint Indian Chest Society/National College of Chest Physicians (I)/Indian Association for Bronchology Recommendations.” PubMed Central (PMC), 1 July 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6681731.
- “Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications.” PubMed Central (PMC), 1 Oct. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7586410.
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