LITFL go into considerable detail with this item.

From CICM, there are a couple of bronchoscopy questions:

  • Question 1 from the second paper of 2005 (anatomy of the bronchial tree)
  • Question 5 from the second paper of 2009 (safety of bronchoscopy in an infectious patient)

Indications for fiberoptic bronchoscopy

Diagnostic:

    • Visual diagnostic inspection of the tracheobronchial tree
    • Biopsy collection
    • BAL
    • Washings/brushings for cytology

Therapeutic:

    • difficult intubation (e.g. awake fiberoptic intubation)
    • suction of secretions or blood
    • guide placement of a percutaneous tracheostomy
    • confirm position of a dual-lumen tube
    • Control bleeding (haemoptysis)

Complications of bronchoscopy:

  • Accidental extubation
  • Airway trauma
  • Bronchospasm
  • Loss of PEEP
  • Damage to the expensive bronchoscope
  • Infection (poorly sterilised bronchoscope)
  • Infection of operator (aerosolised patient lung filth)

Cleaning your bronchoscope:

  • Wipe scope from head to tip
  • Place distal tip in detergent and aspirate through suction channel
  • Remove the suction adaptor valve and place in the detergent.
  • Attach the suction cleaning adapter to the instrument channel port and place distal end into the detergent solution and depress the suction button for 30 seconds.
  • Then separate the endoscope from the light source
  • The endoscope can now be autoclaved

The swivel connector for bronchoscopy

  • allow ventilation without gas leak during bronchoscopy or suctioning
  • disposable plastic
  • right angled design for greater patient comfort
  • 22 mm / 15 mm universal connectors
  • airway access port is self sealing or with removable cap
  • Causes a loss of PEEP when the circuit is broken
  • extra resistance and dead space in the circuit