Safe use of the fiberoptic bronchoscope

LITFL go into considerable detail with the fiberoptic bronchoscope.

From CICM, Question 5 from the second paper of 2009 addresses the problem of safely performing a bronchoscopy in an infectious patient.

The major points are detailed in the discussed answer to that question.

For ease of revision, they are reproduced below:

• Maintain standard precautions, including full barrier clothing - gloves, gown and eye protection.
• Indications for the bronchoscopy must be carefully considered (i.e. can it be delayed until after the patient has been treated?) Given the story about haemoptysis, I would say not.
• Fit-tested N95 particulate respirators should be worn at least by the bronchoscopist, and ideally by all staff involved.
  • Fit-testing and familiarity with the equitment is essential for all staff
  • The ideal equipment for this is a power air-purifying respirator (PAPR)
• A procedure log should be maintained which retains in it the names of the staff involved, the patient details, the name of the bronchoscopist, the serial number of the bronchoscope and the details of which automated endoscope reprocessor was used to clean it afterwards.
• The bronchoscopy should be performed in a negative pressure room.
• The negative pressure room should have at least 12 air exchanges per hour (or at least 6 exchanges if the room was constructed before 2001...)
• The air must be discharged outside, or through a HEPA filter.
• A liberal amount of topical anaesthetic should be used to minimise coughing
• Alternatively, one could perform bronchoscopy with apneic oxygenation, using neuromuscular paralysis.
• Mechanical cleaning of the bronchoscope should be scrupulous and should occur immediately after the procedure.