Bronchoscopy

Definition;
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient’s airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs: biopsies, fluid (bronchoalveolar lavage), or endobronchial brushing. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible fibreoptic instruments with realtime video equipment.
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A bronchoscope is a long snakelike instrument with a tiny video camera and biopsy instruments on one end. It can be maneuvered through your mouth and directly into the airways of your lungs. Bronchoscopy is usually done to obtain a sample of deep lung mucus or lung tissue to help diagnose cancer, pneumonia, or other lung disease.
Why it is done?
Bronchoscopy is usually done to find the cause of a lung problem. Samples of mucus or tissue may be taken from the patient’s lungs during the procedure to test in a lab.

Bronchoscopy may show a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or something blocking the airway, like a piece of food.

Sometimes bronchoscopy is used to treat lung problems. It may be done to insert a stent in an airway. An airway stent is a small tube that holds the airway open. It is used when a tumor or other condition blocks an airway.

In children, the procedure is most often used to remove something blocking the airway. In some cases, it is used to find out what’s causing a cough that has lasted for at least a few weeks.
How do you prepare for the test?
You will need to sign a consent form giving your doctor permission to perform this test. Some patients have this test done in a clinic procedure area, while others are admitted to the hospital for it. Generally your doctor will decide whether you need to be in the hospital based on your medical condition. If you are not staying in the hospital afterward, you should arrange for a ride home.

Talk with your doctor ahead of time if you are taking insulin, or if you take aspirin, nonsteroidal antiinflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications. Also tell your doctor if you have ever had an allergic reaction to the medicine lidocaine or the numbing medicine used at the dentist’s office.

Usually you will be told not to eat anything after midnight on the night before the test. This is so you will have an empty stomach in case you experience nausea from anti-anxiety medicines (sedatives) or have a choking sensation or nausea when the camera is first lowered past your throat.

What happens when the test is performed?
You wear a hospital gown during the procedure. You have an IV (intravenous) line inserted into a vein in case you need medicines or fluid during the procedure.

Bronchoscopy can be performed in a special room designated for such procedures, operating room, intensive care unit, or other location with resources for the management of airway emergencies. The patient will often be given antianxiety and antisecretory medications (to prevent oral secretions from obstructing the view), generally atropine, and sometimes an analgesic such as morphine. During the procedure, sedatives such as midazolam or propofol may be used. A local anesthetic is often given to anesthetise the mucous membranes of the pharynx, larynx, and trachea. The patient is monitored during the procedure with periodic blood pressure checks, continuous ECG monitoring of the heart, and pulse oximetry.

During the procedure, a thin, flexible tube called a bronchoscope is passed through the patient’s nose (or sometimes the mouth), down the throat, and into the airways. If the patient has a breathing tube, the bronchoscope can be passed through it to the airways.

At the bronchoscope’s tip are a light and a mini-camera, so the doctor can see your windpipe and airways. The patient will be given medicine to make them relaxed and sleepy during the procedure.

In some cases, your doctor decides that this procedure would be safer or easier if you were intubated before the test and for a short time afterward. This means having a plastic tube placed through your mouth into your main airway. If you are intubated, you are able to breathe, but you cannot speak while the tube is in place, as it passes between your vocal cords in your voice box. Intubation is always done with the assistance of an anesthesiologist, who gives you medicines to relax your throat muscles and make you unconscious for a minute or two while the tube is placed. Most patients do not require intubation.

If you are not intubated, your doctor or nurse sprays a numbing medicine onto the back of your throat just before the procedure. This medicine makes it easier for you to have the bronchoscope placed. Most patients are also given some medicine through the IV to relax them.

You lie on a hospital bed for the procedure. Your doctor (usually a pulmonary specialist) moves one end of the bronchoscope through your mouth and throat and into your trachea (windpipe). Some patients cough or gag briefly when this is done. The bronchoscope is much narrower than your trachea, so you are able to breathe easily during the procedure.

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The doctor can see into your lungs by watching a TV screen that shows the view from the camera on the end of the bronchoscope. Your doctor can control a miniature vacuum at the end of the scope that allows him or her to take a sample of mucus from inside the lung. It is also possible for the doctor to take a biopsy sample of the lung tissue using a needle that can be moved through the scope. At the end of the test, the bronchoscope is pulled out, and you might cough forcefully a few times, possibly coughing out some phlegm.

Bronchoscopy usually takes 30 minutes to an hour, including setup time. The camera is usually in place for less than 20 minutes.
What risks are there from the test?
Besides the risks associated with the drug used, there are also specific risks of the procedure. Although the rigid bronchoscope can scratch or tear airway or damage the vocal cords, the risk of bronchoscopy is limited. Complications from fiberoptic bronchoscopy remain extremely low. Common complications include excessive bleeding following biopsy. A lung biopsy also may cause leakage of air called pneumothorax. Pneumothorax occurs in less than 1% of cases requiring lung biopsy. Laryngospasm is a rare complication but may sometimes require intubation. Patients with tumors or significant bleeding may experience increased difficulty breathing after a bronchoscopic procedure, sometimes due to swelling of the mucous membranes of the airways.

The risks of bronchoscopy are primarily associated with the needle biopsy procedure that is sometimes done through the bronchoscope. If a biopsy is done, the risks include bleeding in the lung or the formation of an air leak. If a patient vomits during the procedure and stomach contents leak down around the bronchoscope, this can irritate the lung and cause a type of pneumonia called aspiration pneumonia. Some patients have a hoarse voice or a sore throat for a day or two after bronchoscopy. Most people have no side effects from the procedure.

The other risks include:

*A drop in a patient’s oxygen level during the procedure. Oxygen will be administered if this happens.
*A slight risk of minor bleeding and developing a fever or pneumonia.

A rare but more serious side effect is a pneumothorax. A pneumothorax is a condition in which air or gas collects in the space around the lungs. This can cause the lung(s) to collapse.

This condition is easily treated and may go away on its own. If it interferes with breathing, a tube may need to be placed in the space around the lungs to remove the air.

A chest X-ray may be done after bronchoscopy to check for problems

Must you do anything special after the test is over?
You will probably feel sleepy after the procedure for a few hours, due to the anti-anxiety medicines. Generally, patients either spend a few hours in a recovery room or stay overnight in the hospital after bronchoscopy. If you do go home the same day, you should not drive or drink alcohol.

What does bronchoscopy show?
Bronchoscopy may show a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or something blocking the airway.

The doctor will use the procedure results to decide how to treat any lung problems that were found. Other tests may be needed.
Recovery and recuperation :
Patients will be advised by their doctors about when they can return to their normal activities, such as driving, working, and physical activity. For the first few days, a sore throat, cough, and hoarseness are common. The doctor should be called right away if the patient:

*Develops a fever
*Has chest pain
*Has trouble breathing
*Coughs up more than a few tablespoons of blood

How long is it before the result of the test is known?
Your doctor can tell you what the airways in your lungs look like as soon as the test is over. If a sample of mucus or lung tissue was obtained, analysis will require anywhere from a few hours to a few days.

Resources:
https://www.health.harvard.edu/diagnostic-tests/bronchoscopy.htm
http://www.daviddarling.info/encyclopedia/B/bronchoscopy.html
http://en.wikipedia.org/wiki/Bronchoscopy

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