The purpose for bronchoscopy is to visualize the airways in order to diagnose issues or remove obstructions. Indications include persistent cough of unknown origin, excessive thick secretions (patient unable to clear on their own), abnormal findings on a chest x-ray, coughing up blood (hemoptysis), or a lesion or mass that requires biopsy or sampling.
Process – patient is placed under conscious sedation unless they already have an advanced airway in place. The patient’s throat is sprayed with a numbing solution to decrease their gag reflex. A scope is inserted into the airway, through the trachea, into the bronchi and bronchioles. The provider can visualize the airways and wash them out as the procedure goes along – this involves using sterile saline solution to thin any secretions and suction to remove them from the airways. Providers can also take tissue samples for culture or biopsy, as well as remove any obstruction by a foreign body (beads, chicken bones, etc.)
To identify the cause of symptoms or abnormal findings, obtain samples as needed, or to clear any airway obstructions like foreign bodies or thick sputum. Minimize the occurrence of any possible complications.
Ensure informed consent is obtained and the patient is educated about the procedure
Informed consent should be obtained by the provider, including indications, risks, and possible complications of the procedure. You, the nurse, should simply ensure it is done and witness the patient’s signature.
Keep patient NPO for 6-8 hours prior to the procedure
The patient is at high risk for aspiration, which is increased if they have had anything to eat or drink in the last 6-8 hours. Emesis could be aspirated into their lungs.
Ensure emergency equipment available at bedside
As with any procedure involving the airway, emergency equipment should be kept ready at the bedside, including suction, ambu bag, and artificial/advanced airways in case of respiratory distress.
Insert IV. Administer and manage conscious sedation
Sedation should be given to make the patient drowsy and comfortable, but still able to follow commands. Follow facility policy and medication orders from the provider for conscious sedation administration/monitoring.
Monitor Vital Signs, LOC, Respiratory status before, during, and after procedure per facility policy.
Place in High-Fowler’s position and administer supplemental O2 as needed
Patient is at risk for aspiration and respiratory distress post-procedure. Placing the patient in high-fowler’s position can improve oxygenation and prevent aspiration. As patients may still be drowsy or could experience some bleeding in the lungs after the procedure, supplemental O2 can help improve oxygen levels.
NPO after procedure until gag reflex returns
Patients’ throats will be numb because of the numbing spray, this means they may not have a good gag reflex until 1-2 hours post-procedure. Keep NPO until gag reflex returns and patient can safely swallow – prevents aspiration.
Monitor for possible complications:
Educate patient on post-procedure instructions:
For more information, visit www.nrsng.com/cornell
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