Nursing Responsibilities • Provide routine preoperative care as ordered. Bronchoscopy is an invasive procedure requiring conscious sedation or anesthesia. Care provided prior to the procedure is similar to that provided before many minor surgical procedures.
• Provide mouth care just prior to bronchoscopy. Mouth care reduces oral microorganisms and the risk of introducing them into the lungs. • Bring resuscitation and suction equipment to the bedside. Laryngospasm and respiratory distress may occur following the procedure. The anesthetic suppresses the cough and gag reflexes, and secretions may be difficult to expectorate. • Following the procedure, closely monitor vital signs and respiratory status. Possible complications of bronchoscopy include laryngospasm, bronchospasm, bronchial perforation with possible pneumothorax or subcutaneous emphysema, hemorrhage, hypoxia, pneumonia or bacteremia, and cardiac stress. • Instruct to avoid eating or drinking for approximately 2 hours or until fully awake with intact cough and
gag reflexes. Suppression of the cough and gag reflexes by systemic and local anesthesia used during the procedure increase the risk for aspiration. • Provide an emesis basin and tissues for expectorating sputum and saliva. Until reflexes have returned, the client may be unable to swallow sputum and saliva safely. • Monitor color and character of respiratory secretions.
Secretions normally are blood tinged for several hours following bronchoscopy, especially if biopsy has been obtained. Notify the physician if sputum is grossly bloody. Grossly bloody sputum may indicate a complication such as perforation. • Collect postbronchoscopy sputum specimens for cytologic examination as ordered. Cells in the sputum may be examined if a tumor is suspected.  Client and Family Teaching • Fiberoptic bronchoscopy requires 30 to 45 minutes to complete. It may be done at the bedside, in a special procedure room, or in the surgical suite. • The procedure usually causes little pain or discomfort, because an anesthetic is given. You will be able to breathe during the bronchoscopy. • Some voice hoarseness and a sore throat are common following the procedure.Throat lozenges or warm saline gargles may help relieve discomfort. • You may develop a mild fever within the first 24 hours following the procedure. This is a normal response. • Persistent cough, bloody or purulent sputum, wheezing, shortness of breath, difficulty breathing, or chest pain may indicate a complication. Notify your physician if they develop. OverviewBronchoscopy is a procedure that lets doctors look at your lungs and air passages. It's usually performed by a doctor who specializes in lung disorders (a pulmonologist). During bronchoscopy, a thin tube (bronchoscope) is passed through your nose or mouth, down your throat and into your lungs. Bronchoscopy is most commonly performed using a flexible bronchoscope. However, in certain situations, such as if there's a lot of bleeding in your lungs or a large object is stuck in your airway, a rigid bronchoscope may be needed. Common reasons for needing bronchoscopy are a persistent cough, infection or something unusual seen on a chest X-ray or other test. Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways or lungs, or to provide treatment for lung problems. Mayo Clinic's approach Why it's doneBronchoscopy is usually done to find the cause of a lung problem. For example, your doctor might refer you for bronchoscopy because you have a persistent cough or an abnormal chest X-ray. Reasons for doing bronchoscopy include:
During some procedures, special devices may be passed through the bronchoscope, such as a tool to obtain a biopsy, an electrocautery probe to control bleeding or a laser to reduce the size of an airway tumor. Special techniques are used to guide the collection of biopsies to ensure the desired area of the lung is sampled. In people with lung cancer, a bronchoscope with a built-in ultrasound probe may be used to check the lymph nodes in the chest. This is called endobronchial ultrasound (EBUS) and helps doctors determine the appropriate treatment. EBUS may be used for other types of cancer to determine if the cancer has spread. RisksComplications from bronchoscopy are uncommon and usually minor, although they are rarely severe. Complications may be more likely if airways are inflamed or damaged by disease. Complications may be related to the procedure itself or to the sedative or topical numbing medicine.
How you preparePreparation for bronchoscopy usually involves food and medication restrictions, as well as discussion about additional precautions. Food and medicationsYou may be asked to stop taking blood-thinning medications such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin, Jantoven) several days before bronchoscopy. You'll also be asked not to eat or drink for four to eight hours before the procedure. Clothing and personal itemsOn the day of the procedure, you'll be asked to put on a gown and take out any dentures, partial dentures or removable bridges. You may also be asked to remove hearing aids, contact lenses or glasses. Other precautionsIf you'll be going home after the procedure, you'll need a friend or family member to take you home. You won't be able to drive because of the lingering effects of the medications used during the procedure. It's also a good idea to have someone stay with you for the rest of the day. What you can expectBronchoscopy is usually done in a procedure room in a clinic or in a hospital operating room. The entire procedure, including prep and recovery time, typically takes about four hours. Bronchoscopy itself usually lasts about 30 to 60 minutes. Before the procedureYou'll be asked to sit or lie back on a table or a bed with your arms at your sides. You'll be connected to monitors so that the health care team can track your heart rate, blood pressure and oxygen level during the procedure. You'll be given a sedative medicine through a vein (intravenously) to help you relax. You'll feel sleepy, but you'll still be awake, breathing on your own, and able to indicate a response to any questions your doctor may ask you during the procedure. Sedative medications often result in you having very little memory of the bronchoscopy procedure once it is completed. A numbing medication called an anesthetic will be sprayed in your throat. Sometimes an anesthetic gel is rubbed in your nose. These medications numb the areas, helping to lessen gagging and coughing as the bronchoscope is placed into your throat. At first the medicine may taste unpleasant, but the taste will go away. During the procedureDuring bronchoscopy, the bronchoscope is placed in your nose or mouth. The bronchoscope has a light and a very small camera at its tip that displays pictures on a monitor to help guide your doctor in performing the procedure. The bronchoscope is advanced slowly down the back of your throat, through the vocal cords and into the airways. It may feel uncomfortable, but it shouldn't hurt. Your health care team will try to make you as comfortable as possible. Samples of tissue and fluid may be taken and procedures may be performed using devices passed through the bronchoscope. Your doctor may ask if you have pain in your chest, back or shoulders. In general, you shouldn't feel pain. After the procedureYou'll be monitored for several hours after bronchoscopy. Your mouth and throat will probably be numb for a couple of hours. You won't be allowed to eat or drink until the numbness wears off. This helps keep food and liquids from entering your airways and lungs. When your mouth and throat are no longer numb, and you're able to swallow and cough normally again, you can have something to drink. Start with sips of water. Then you may eat soft foods, such as soup and applesauce. Add other foods as you feel comfortable. You may have a mild sore throat, hoarseness, a cough or muscle aches. This is normal. Warm water gargles and throat lozenges can help lessen the discomfort. Just be sure all the numbness is gone before you try gargling or sucking on lozenges. Call your doctor right away if you:
ResultsYour doctor will usually discuss bronchoscopy results with you one to three days after the procedure. Your doctor will use the results to decide how to treat any lung problems that were found or discuss procedures that were done. It's also possible that you may need other tests or procedures. If a biopsy was taken during bronchoscopy, it will need to be reviewed by a pathologist. Because the tissue samples need special preparation, some results take longer than others to return. Some biopsy specimens will need to be sent for genetic testing, which might take two weeks or more. Clinical trialsExplore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Which action is most appropriate for the nurse to take before the bronchoscopy?Instruct the patient to do oral care and remove any dentures if appropriate. Administer preoperative medications as ordered. Explain to the patient that an IV sedative such as Propofol may be given as an anesthetic agent. Prepare for local anesthesia.
What should I do before a bronchoscopy?You may be asked to stop taking blood-thinning medications such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin, Jantoven) several days before bronchoscopy. You'll also be asked not to eat or drink for four to eight hours before the procedure.
What is the nursing intervention for patient post bronchoscopy to prevent risk of aspiration?Keep NPO until gag reflex returns and patient can safely swallow – prevents aspiration. Monitor for possible complications: Bleeding.
What complications should the nurse be aware may occur during a bronchoscopy?Following the procedure, closely monitor vital signs and respiratory status. Possible complications of bronchoscopy include laryngospasm, bronchospasm, bronchial perforation with possible pneumothorax or subcutaneous emphysema, hemorrhage, hypoxia, pneumonia or bacteremia, and cardiac stress.
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What is the priority nursing action taken by the nurse before preparing the patient for bronchoscopy?
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