Flexible bronchoscopy is a procedure that offers multiple important uses in the medical field. Respiratory Therapists play a pivotal role in assisting with this procedure.

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’s get started.

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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 that allows the physician to visualize 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.

What is the Respiratory Therapist’s Role in a Bronchoscopy Procedure?

A respiratory therapist’s role in a bronchoscopy procedure may vary depending on the hospital or clinic setting.

However, in general, respiratory therapists are usually required 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.

Before

Before the procedures, the respiratory therapist helps identify the potential need for a bronchoscopy. Some common indications include retained secretions or the presence of foreign body obstruction.

They are responsible for verifying the physician’s order or protocol and reviewing the patient’s record for any contraindications, hazards, and informed consent.

The respiratory therapist must prepare and ensure that all equipment is functioning properly. They also must outline a plan for adequate oxygenation during the procedure.

Additionally, they must evaluate the patient for bronchospasm and administer aerosolized bronchodilators before the procedure, if required.

During

During the procedure, the respiratory therapist must monitor the patient’s vital signs and help identify and respond to any adverse reactions. They must also continue to administer oxygen as needed.

The RT must provide proper positioning of the patient and assist with the use of accessories, such as bite blocks, oral airways, nasopharyngeal tubes, biopsy forceps, and brushes.

After

After the procedure, the respiratory therapist must provide post-procedure care. This includes helping the patient with deep breathing and coughing exercises to clear secretions, as well as administering oxygen as needed.

The RT must continue monitoring the patient’s vital signs and report any changes to the physician. They must also document all aspects of care in the patient’s medical record.

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Flexible Bronchoscopy Practice Questions:

1. What is flexible bronchoscopy used for?
It can be used for diagnostic and therapeutic purposes; however, it is most often indicated to help with the diagnosis of 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?
The alveoli

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 is often used along with flexible bronchoscopy?
Various thermal ablation techniques

9. When using thermal ablation techniques, what is the most important thing to remember?
You should ensure a low FiO2 environment before the use of any thermal ablative therapy.

10. When can airway stenting be used to maintain airway patency?
It is used after the dilation of any obstructed major airways. It is important to recognize the difference between silicone and metallic stents.

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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?
A respiratory therapist

14. How does a respiratory therapist help 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 special considerations should be made when performing a bronchoscopy 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, wheezing and stridor, pulmonary infiltrates, unexplained lung collapse, suspected or known bronchogenic carcinoma, mediastinal and hilar lymphadenopathy, lung transplantation, endotracheal intubation, evaluation of foreign body aspiration, unexplained superior vena cava syndrome, unexplained vocal cord paralysis, suspected fistulas, and treatment of refractory asthma

17. What are the absolute contraindications for flexible bronchoscopy?
Refractory hypoxemia, lack of patient cooperation, lack of skilled personnel, lack of appropriate equipment and facilities, unstable angina, uncontrolled arrhythmias, increased intracranial pressure, and uncorrectable bleeding diathesis

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 a large tissue specimen

19. Is sedation important during a flexible bronchoscopy procedure?
Yes, 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 essential part of the procedure.

20. What is BAL, and when is it indicated?
BAL stands for Bronchoalveolar lavage. It is used to obtain specimens from the alveolar region of the lung.

21. When is rigid bronchoscopy indicated?
Although the role of rigid bronchoscopy (RB) has declined, it remains an invaluable tool for the control of a compromised airway, massive hemoptysis, silicone stent placement, and for removing asphyxiating foreign bodies. The primary indication for rigid bronchoscopy is for managing a central airway obstruction.

22. What is the difference between BAL and bronchial washings?
Bronchial washings are generally obtained for the cytological examination of cancer and for microbiological 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 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 the definition of 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?
It is preferred when the patient is 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 are used if the patient becomes over-sedated during a bronchoscopy procedure?
The chin-lift and jaw-thrust maneuvers may be used

30. What is recommended to prevent the patient from slipping into deep sedation?
Capnography monitoring while performing flexible bronchoscopy under moderate sedation is recommended.

31. What does flexible bronchoscopy monitoring consist 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.

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 between 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 remove secretions from the airway. It is limited to the experience of the operator, and there must be patient cooperation.

39. What is the respiratory therapist’s role in bronchoscopy before the procedure begins?
RT’s help identify the potential need for bronchoscopy (retained secretions or foreign body removal). They verify the physician’s order or protocol and review the patient’s record for contraindications (excessive clotting times), hazards, and informed consent. They prepare/ensure the proper function of equipment. They outline a plan for adequate oxygenation during the procedure. They evaluate the patient for bronchospasm and administer aerosolized bronchodilators if required. They assist nurses in the application of a topical anesthetic.

40. What is the respiratory therapist’s role in bronchoscopy during the procedure?
RT’s monitor the patient’s vital signs (including capnography). They help identify and respond to adverse reactions and administer oxygen as needed. They provide proper positioning of the patient and assist with the use of accessories (bite block, oral airways, nasopharyngeal tube, biopsy forceps, brushes, etc.) They set up instruments for rigid bronchoscopy and silicone stents and help place chest or ET tubes in emergency situations.

41. What does a respiratory therapist do in bronchoscopy during mechanical ventilation?
RT’s help establish adequacy of the length and diameter of the ET or tracheostomy tube. They ensure that the bite block is in place to avoid equipment damage. They adjust ventilator settings for safety reasons and oxygenation purposes and then return settings back to the patient’s pre-procedure settings.

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 a rigid tube?
It’s 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?
Flexible fiberoptic

47. Which bronchoscope can access very small airways?
Flexible fiberoptic

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 a respiratory therapist.

50. What is the most common method of anesthesia during a bronchoscopy?
The use of a topical anesthetic is most common

FAQ

What is a flexible bronchoscopy?

Flexible bronchoscopy is a minimally invasive procedure that is used to visualize the airways. The procedure is performed under sedation in order to minimize patient discomfort.

What are the indications for this procedure?

Flexible bronchoscopy can be used to diagnose a variety of conditions, such as lung cancer, pneumonia, and tuberculosis. It can also be used to remove foreign bodies from the airway, such as inhaled food or a piece of jewelry.

What is a flexible bronchoscopy used for?

Flexible bronchoscopy is a minimally invasive procedure that is used to visualize the airways. The procedure is performed under sedation in order to minimize patient discomfort.

What are the risks of flexible bronchoscopy?

Some risks associated with flexible bronchoscopy include bleeding, infection, and airway damage. However, these risks are rare, and the procedure is generally considered safe.

How is flexible bronchoscopy performed?

The procedure is performed under sedation in order to minimize patient discomfort. A bronchoscope, which is a thin and flexible tube with a light and camera attached, is inserted through the nose or mouth and passed down into the airways. The bronchoscope is then used to examine the airways and take biopsies if necessary.

What are the side effects of flexible bronchoscopy?

Some side effects associated with flexible bronchoscopy include sore throat, coughing, and hoarseness. These side effects are usually mild and resolve within a few days.

What is the most common indication for flexible bronchoscopy?

Respiratory infections were the most common indication for flexible bronchoscopy in a study of over 1,000 procedures. Other indications included foreign body removal, lung cancer, and tuberculosis.

How often is flexible bronchoscopy performed?

The procedure is performed on an as-needed basis, depending on the indications. For example, it may be performed once to remove a foreign body, or it may be performed multiple times to monitor the progression of a disease.

What are the benefits of flexible bronchoscopy?

Flexible bronchoscopy is a minimally invasive procedure that can provide valuable information about the airways. It is generally well-tolerated by patients and has a low risk of complications.

What are the disadvantages of flexible bronchoscopy?

Some disadvantages of flexible bronchoscopy include the need for sedation and the potential for side effects such as sore throat and coughing. In rare cases, more serious complications such as bleeding or infection can occur.

What are some potential complications of this procedure?

Some potential complications of flexible bronchoscopy include bleeding, airway damage, and infection. However, these complications are rare and usually occur when the procedure is not performed properly.

Final Thoughts

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 have a similar guide on endotracheal intubation that I think you will find helpful. Thank you for reading, and as always, breathe easy, my friend.

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • 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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Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.