Bronchoscopy

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Outline

Overview

Purpose – to visualize airways to diagnose issues or remove obstructions.

Nursing Points

General

  1. Indications
    1. Diagnose
      1. Persistent Cough
      2. Hemoptysis
      3. Abnormal CXR
      4. Biopsy/Sampling
    2. Treat
      1. Washout Sputum
      2. Remove Obstruction

Assessment

  1. Before Procedure
    1. Informed Consent
    2. Patient Education
    3. NPO 6-8 hours prior
    4. Emergency Equipment at bedside
    5. IV access for sedation
    6. Baseline Assessment
  2. Possible Complications
    1. Bronchospasm
    2. Bleeding
    3. Respiratory Distress
    4. Aspiration

Therapeutic Management

  1. During Procedure
    1. Stay with patient if at bedside
    2. Conscious sedation
    3. Continuous telemetry
    4. Monitor VS and LOC q5 min
    5. Monitor for Respiratory Distress
    6. Give O2 as needed
  2. After Procedure
    1. High-Fowler’s Position
    2. NPO until gag reflex returns
    3. Monitor respiratory status
    4. Monitor vital signs
    5. Monitor for bronchospasm
    6. Monitor for bleeding

Nursing Concepts

  1. Oxygenation/Gas Exchange
    1. Monitor respiratory status
    2. Give O2 as needed
  2. Safety
    1. Airway protection
    2. Prevent Aspiration
  3. Comfort
    1. Conscious sedation
    2. Pain control after

Patient Education

  1. No driving or heavy machinery x 24 hours
  2. Procedure may induce cough
  3. Take medications as prescribed before procedure
  4. NPO after midnight or at specific time (importance)
  5. May not be able to swallow x 1-2 hours post procedure
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Nursing Care Plan for Bronchoscopy (Procedure)

Transcript

Let’s talk about Bronchoscopy and what you need to do for these patients before, during, and after the procedure.

The purpose of bronchoscopy is to visualize the airways. You can see the scope passes through their vocal cords into their bronchi. This could be done for diagnostic purposes if the patient has had a persistent cough or is coughing up blood or maybe had abnormal findings on a chest x-ray. We can also take a sample of secretions or tissue while we’re in there. We will also use this therapeutically to washout deep, thick secretions that we haven’t been able to mobilize or to remove any obstructions like foreign bodies or masses.

Before any procedure we need to make sure informed consent is obtained – remember that is the provider’s job. We want to educate the patient on what to expect and what they need to be prepared for. The patient needs to be kept NPO for 6-8 hours prior to the procedure. We don’t want the patient to vomit and aspirate when they can’t protect their airway. We need to make sure our emergency equipment is at bedside – that’s suction, an ambu bag, and possibly medications if the provider anticipates needing to intubate the patient. This procedure is typically done under conscious sedation if the patient isn’t already sedated, so we need to make sure we have good IV access for that. And then, of course we’ll get a baseline assessment including lung sounds, vital signs, and oxygenation.

Bronchoscopies or “Bronchs” may be done in a special procedure suite or they could be done at the bedside. Typically you only have to stay with the patient if it’s done at the bedside. The nurse is responsible for administering conscious sedation. This also typically requires continuous telemetry and frequent monitoring of blood pressure and level of consciousness – usually every 3-5 minutes. Make sure you follow your facility policy for this. During the procedure we will be monitoring the patient for any signs of respiratory distress since bronchospasm can happen when you’re in here irritating the airways. And of course we’ll give supplemental O2 as needed.

Possible complications, like I said, are bronchospasm, as well as bleeding – especially if they took a biopsy or removed a lesion. Patients might also experience a severe cough or respiratory distress. The patient is also at risk for aspiration because their throat has been numbed during the procedure by a local anesthetic. So they will actually not have a good gag reflex for an hour or two after the procedure. So to protect their airway we sit them in High-Fowler’s position and we do not let them take ANYTHING by mouth until their gag reflex returns. We will also monitor their respiratory status and vital signs according to your facility’s post-procedure vital signs protocol. And we’re going to continue to monitor the patient for bronchospasm or bleeding. It’s common for patients to cough up dark red blood or clots for a few days, but any bright red blood should be reported immediately.

Check out the careplan attached to this lesson for more specific nursing interventions, but let’s look at the priorities. Of course, since we’re entering their airway, we are concerned about oxygenation and gas exchange. Since we are numbing their gag reflex and they’re at risk for aspiration, we will also consider safety as a priority before, during, and after the procedure. And finally this patient needs conscious sedation and may be uncomfortable afterwards, so we will manage those medications as needed.

Some key takeaways are that bronchoscopy is used to visualize the airways to diagnose issues or remove obstructions like secretions or masses. Before the procedure we need to keep the patient NPO, establish IV access, and have emergency equipment available. During the procedure we will manage the conscious sedation and monitor the patient continuously. After the procedure, we keep the patient NPO until their gag reflex returns, usually 1-2 hours, and we monitor closely for complications.

So those are the highlights of nursing care for bronchoscopy. Don’t forget to check out the care plan to learn more. Happy Nursing!