Bronchoscopy (cont.)
What should a patient expect during bronchoscopy?
As the patient arrives in the bronchoscopy suite (or if
the patient is already in the hospital), an intravenous
catheter (IV) will be started for administration of medication and fluid.
The patient is then connected to a monitor for continuous
monitoring of the heart rate, blood pressure, and oxygen
level in the blood. If needed, supplemental oxygen will be
supplied either through a ½ inch tube inserted into the
nostrils (cannula) or a facemask. Medication is then
given through the IV to make the patient feel relaxed and
sleepy for the flexible fiber optic bronchoscopy. If rigid
bronchoscopy is to be performed, an anesthesiologist will
be present to induce and monitor the general anesthesia.
Patients will be lying on their back with oxygen
supplemented through the mouth or the nose. Prior to the
insertion of the flexible bronchoscope, a local anesthesia
with topical lidocaine is given in the nose and to the back
of the throat. The flexible bronchoscope can be introduced
either through the mouth or the nose. Some patients may require a special tube called an
endotracheal tube to be inserted through the mouth, passing
the vocal cord, and into the trachea to protect and secure
the airway. Once the bronchoscope is in the airway, an
additional topical anesthetic will be sprayed into the
airway for local anesthesia to minimize discomfort and
coughing spells. The rigid bronchoscope is inserted by
mouth only. This is usually done after the patient is
under general anesthesia.
Flexible bronchoscopy rarely causes any discomfort or
pain. Patients may feel the urge to cough because of the
sensation of a foreign object in the "windpipe." Again,
this feeling can be minimized by pre-procedural medication
given for relaxation and local anesthesia with lidocaine.
The procedure usually takes between 15 to 60 minutes. If a
specific area needs to be more thoroughly evaluated or an
abnormality is detected during the procedure, samples can
be collected by several methods listed below:
- Washing - Squirts of salt water (saline) are injected
through the bronchoscope into the area of interest and the fluid is then
suctioned back. This process is repeated several times to obtain adequate
samples, which are then submitted to the laboratory for analysis. Brushing - A
soft brush is inserted through the bronchoscope to the area of interest. Cells
around the airway are collected by brushing up and down the airway. The
samples are also sent to the laboratory for analysis.
- Needle aspiration - A small needle is inserted into
the airway and through the wall of the airway to obtain samples outside of the
airway for analysis under a microscope.
- Forceps biopsy - Forceps may be used to biopsy
either a visible lesion in the airway or a lung lesion.
Abnormal tissue that is visible in the airway is usually
easily biopsied. However, a mass that is in the lung
tissue is deep within the lung and usually requires a
biopsy using special x-ray guidance (fluoroscopy).
Specimens obtained are sent to a pathologist for inspection
under a microscope.
Next: What can a patient expect after a bronchoscopy? »
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