Definition
Assisting with a bronchoscopy a procedure that allows direct visualization of the airways is a critical nursing responsibility that requires preparation, vigilance, and sterile technique
It refers to assisting with direct inspection and examination of the larynx, trachea and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope.
The fiberoptic scope allows for less discomfort and better visualization of smaller airways. Rigid bronchoscopy is preferred for small children and endobronchial tumor resection.
Purposes
1. Diagnostic:
- For examination of tissue.
- For further evaluation of a tumor for potential surgical resection.
- To collect tissue specimen for diagnosis.
- To evaluate bleeding sites.
2. Therapeutic:
- To remove foreign bodies.
- To remove thick, viscous secretions.
- To treat postoperative atelectasis.
- To remove and destroy lesions.
Preparation of the Patient
Preparing to assist with a bronchoscopy involves several important steps to ensure patient safety and the success of the procedure:
- Fasting:
- Patients are typically required to avoid eating or drinking for 6-8 hours before the procedure to ensure the airways are clear.
- Medication Adjustments:
- Confirm with the healthcare provider if the patient needs to stop taking blood thinners or other medications.
- Check for any allergies, especially to sedatives or local anesthetics.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent before proceeding.
- Clothing and Accessories:
- Advise the patient to wear loose, comfortable clothing and remove any dentures, glasses, or metallic items.
- Transportation:
- Arrange for someone to drive the patient home after the procedure, as sedation may impair their ability to drive.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient and family members. | Helps in obtaining cooperation and providing reassurance. |
| 2. | Obtain informed consent from patient. | Prevents legalities to the staff members. |
| 3. | Instruct patient to be on NPO for 6-12 hours before procedure. | Reduces risk of aspiration during procedure. |
| 4. | Remove dentures, contact lens and other prosthesis before procedure. | Ensures safety of patient during procedure. |
| 5. | Administer pre-medications as per physician’s instruction (usually atropine, sedative, and an opioid). | Inhibits vagal stimulation. |
| 6. | Administer local anesthetic agent as per physician’s order (general anesthesia may be needed for rigid bronchoscopy). | |
| 7. | Spray topical anesthetic-lignocaine on the pharynx or on the epiglottis and vocal cords and into the trachea. | Suppresses cough reflex and minimizes discomfort. |
| 8. | Administer sedatives intravenously as prescribed. | |
| 9. | Instruct patient to lie supine with head hyperextended. | |
| 10. | Monitor vital signs, O2 saturation, and cardiac rhythm and reassure the client during the procedure. |
Postprocedural care
- Monitor vital signs.
- Observe the client for signs of respiratory distress including dyspnea, changes in respiratory rate, use of accessory muscles and absent lung sounds.
- Inspect expectorated secretions for hemoptysis.
- Keep patient on nil per orally (NPO) until gag reflex returns.
- Give ice chips and small sips of water when patient regains swallowing reflex.
- Monitor lung sounds for 24 hours.
- Assess for lethargy and confusion in elderly patients which may be due to large doses of lignocaine given during the procedure.
- Instruct the patient and family (caregivers) to report any shortness of breath or bleeding immediately.
Complications
- Pneumothorax.
- Dysrhythmias.
- Bronchospasm.
- Infection.
- Aspiration.
- Perforation.
Special considerations
- Confirm the patient has followed pre-procedure instructions, such as fasting.
- Review the patient’s medical history, including allergies and respiratory conditions.
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent and reassure the patient to reduce anxiety.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure all equipment, including the bronchoscope, is properly sterilized and functioning.
- Observe the patient for signs of discomfort, respiratory distress, or adverse reactions to sedation.
- Continuously monitor vital signs, including oxygen saturation, heart rate, and blood pressure.
- Assist the patient in achieving the correct position, typically semi-reclined or supine, for optimal access.
- Monitor the patient for delayed complications, such as bleeding, infection, or breathing difficulties.
- Provide clear post-procedure instructions, including when to resume eating and drinking.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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