Bronchoscopy and Bronchoscopy and Chest TubesChest Tubes

RC 275RC 275

Fiberoptic BronchoscopyFiberoptic Bronchoscopy((F.O.BF.O.B.).)

Indications

TherapeuticTherapeutic Remove mucus and/or foreign bodiesRemove mucus and/or foreign bodies

DiagnosticDiagnostic Identify tumors, inflammation, Lavage Identify tumors, inflammation, Lavage

sample for C & S, etcsample for C & S, etc

Respiratory Therapist’s Respiratory Therapist’s RoleRole

Patient EducationPatient Education Explain procedure Explain procedure

and answer and answer questionsquestions

Be reassuring and Be reassuring and put patient at put patient at easeease

Administer pre-Administer pre-bronch anesthesiabronch anesthesia

Assist physician during Assist physician during procedureprocedure Suction PRNSuction PRN Monitor vitals (POx, Monitor vitals (POx,

EKG, ETCO2, as well as EKG, ETCO2, as well as TPR and BP)TPR and BP)

Instill lavageInstill lavage Assist with specimen Assist with specimen

collectioncollection Monitor patient post-Monitor patient post-

bronchbronch Clean and maintain Clean and maintain

bronchoscope and cartbronchoscope and cart

Equipment

Bronchoscope and Bronchoscope and fiberoptic light sourcefiberoptic light source

Medications and Medications and lavage solutionslavage solutions

Monitoring equipment Monitoring equipment including: EKG, POx, including: EKG, POx, ETCO2, etcETCO2, etc

Resuscitation Resuscitation supplies`supplies`

Biopsy materialsBiopsy materials Forceps, brushes, Forceps, brushes,

slides and fixativeslides and fixative

Sampling Techniques

Lavage with suction Lavage with suction traptrap Use non-bacteriostatic Use non-bacteriostatic

lavage solutionlavage solution Brush – minimal Brush – minimal

hemorrhagehemorrhage Forceps – excellent Forceps – excellent

sample but may sample but may cause significant cause significant bleedingbleeding

Possible ComplicationsPossible Complications

HypoxiaHypoxia ArrhythmiasArrhythmias Bronchospasm/LaryngospasmBronchospasm/Laryngospasm HemorrhageHemorrhage PneumothoraxPneumothorax InfectionInfection

Chest Tube Drainage

Indications: whenever there is Indications: whenever there is significantsignificant air or fluid in the pleural air or fluid in the pleural spacespace

PneumothoraxPneumothorax Pleural effusionsPleural effusions

Transudates or exudatesTransudates or exudates

Chest Tube PlacementChest Tube Placement For pneumothorax, 2For pneumothorax, 2ndnd

or 3or 3rdrd intercostal space intercostal space at midclavicular lineat midclavicular line

For effusion, 5For effusion, 5thth intercostal space at intercostal space at mid-axillary line with mid-axillary line with tip positioned tip positioned posteriorlyposteriorly

Always go over the top border of the rib that is the lower margin of the of the intercostal spaceintercostal space

Chest Tube Insertion

Drainage Setup: 1st “Bottle”

Water seal – prevents air Water seal – prevents air from getting into pleura from getting into pleura but allows it to exitbut allows it to exit

Water seal height is Water seal height is usually 2 cmusually 2 cm The water seal level The water seal level

fluctuates with fluctuates with respiration!respiration!

It bubbles as air exitsIt bubbles as air exits Spontaneous breathing Spontaneous breathing

during exhalationduring exhalation Positive pressure Positive pressure

ventilation during ventilation during inspiration inspiration

2 bottle system2 bottle system

Trap– it goes between Trap– it goes between patient and water seal patient and water seal and collects any fluid and collects any fluid that exits the pleural that exits the pleural spacespace

It prevents fluid from It prevents fluid from accumulating in the accumulating in the water seal bottle (this water seal bottle (this would increase would increase expiratory resistance)expiratory resistance)

3 Bottle System Suction– it measures Suction– it measures

and controls suction and controls suction applied to pleural applied to pleural spacespace

Comes AFTER the Comes AFTER the water sealwater seal

Suction is Suction is determined by the determined by the height of the waterheight of the water Usually 10-20 cmUsually 10-20 cm

Should “bubble” Should “bubble” continuouslycontinuously

3 Chambered System

Today, chest Today, chest tube systems are tube systems are disposable, three disposable, three chambered setschambered sets Trap, water seal, Trap, water seal,

and suction and suction chamberschambers

Function the Function the same as “3 same as “3 Bottle System”Bottle System”

Chest Tube Care Chest tube should Chest tube should

be sutured to be sutured to chest, and all chest, and all connections secure connections secure and taped.and taped.

Do not allow any Do not allow any gravity dependent gravity dependent loops to formloops to form

Never raise Never raise drainage container drainage container above the chestabove the chest

If transporting patient, If transporting patient, disconnect suction hose disconnect suction hose ((Don’t just turn it off!)Don’t just turn it off!)

Check system operation Check system operation frequentlyfrequently Adequate fluid levelsAdequate fluid levels Fluctuation in water seal Fluctuation in water seal

chamberchamber Continuous bubbling in Continuous bubbling in

suction chambersuction chamber Follow hospital protocol Follow hospital protocol

in regard to clamping in regard to clamping and milking tubesand milking tubes