Indications for a Bronchoscopy
Bronchoscopy can be a diagnostic as well as therapeutic procedure. Note that a detailed history is key in determining whether the procedure is warranted. Some indications are listed here (note that this list is far from exhaustive):
Diagnostic indications: Unexplained and/or persistent cough, profuse/repeated haemoptysis, recent onset/persistent wheeze, persistent/recurrent pneumonia or pulmonary collapse, severe trauma, unexplained extrathoracic indications (lymphadenopathy, etc.)
Therapeutic indications: Foreign body removal, accumulated secretions, atelectasis, aspiration, lung abscess, etc.
A further role that bronchoscopy can play is in preoperative evaluation (e.g. prior to resection of malignancy or surgery for bronchiectasis).
How is it performed?
In a clinical scenario, always remember to do the basics first: introduce yourself, check the patient's identity and explain what you are going to talk to them about.
Preparation: Patients will be asked to not eat or drink for at least 4-6 hours before the test.
The procedure: Local anaesthetic sprays are used to numb the back of the throat. They can taste quite bitter, and come in assorted flavours. The banana one is quite nice, although, rather unsurprisingly, does not taste of banana. Sedation can also be used, depending on the individual patient. If used, this is usually a benzodiazepine such as Midazolam. Remember Flumazenil: this can be used to reverse the effects of benzodiazepines, and is used in cases of over-sedation and respiratory depression. For this reason, the patient's respiratory rate and pulse will be monitored by a dedicated nurse during the procedure.
The bronchoscope is passed through the nose, and down the throat. The camera from the tip of the bronchoscope will then relay pictures to a screen. Photographs of any suspicious lesions can be taken, and biopsies can be taken.
As the local anaesthetic takes effect, it will help the patient relax their throat. The test usually takes about 15-20 minutes. If sedation has been used, patients are left to recover for a while prior to being allowed to go home. As their throat will be numb, it is not safe to eat or drink straight away, due to the risk of both aspiration and burns. The anaesthetic normally wears off in a few hours. If sedation has been used, patients should not drive, operate machinery or drink alcohol. The following
Complications
As with most 'invasive' procedures, patients in the UK will be required to sign a standardised consent form prior to the procedure. In order to do this, the patient must be competent, the consent must be based upon comprehensive information, and must be free from coercion (should not be forced). Bear in mind though, that despite this (and rather bizarrely), a consent form is not a legally valid document! In any case, you should discuss the significant risks of the procedure with patients.
Bronchoscopy is a very safe procedure. The main risks remain the low risks of bleeding and perforation of any of the respiratory tracts. If biopsies have been taken, patients may notice some bleeding from their nose. This should pass in about a day, and is not serious. There may also be some soreness of the region, which, again, will resolve.
