Bronchoscopy is a procedure in which a specialized tube is inserted into the lungs to aid in monitoring, diagnosis and treatment of several lung disorders. It is usually conducted by a physician, whereas a respiratory therapist provides assistance during the entire procedure. The respiratory therapist prepares the patient for the procedure, monitors the condition, handles the samples obtained, provides post-operative care, maintains records, and ensures that the bronchoscope equipment is functioning normally.
Some therapists can also be trained to understand adverse reactions during bronchoscopy and can take immediate action. They can also be trained to provide certain drugs in aerosolized form and offer aid during mechanical ventilation. Bronchoscopy can be performed at an intensive-care unit, trauma-care center, operating theater, outpatient facility or a clinic. The tube is generally passed from the mouth or the nose, and requires the use of anesthesia. There are 2 types of bronchoscope, namely rigid bronchoscope and fixed bronchoscope.
The rigid bronchoscope is a long, thin flexible tube that is more frequently utilized compared to the rigid one. Its use usually does not require general anesthesia. It is frequently utilized in smaller airways. The individual may require the application of local anesthetic agent in the mouth and nose to reduce discomfort. A rigid bronchoscope is a straight flat metal tube that may be utilized when excessive bleeding occurs within the airways or to clear the airways of any objects that may be difficult to remove with the help of a flexible bronchoscope.
The procedure requires administration of general anesthesia. Flexible fiber-optic bronchoscopy (FFB) is a procedure in which a specialized fiber-optic tube is inserted into the airways and the lungs to visualize these structures and diagnose and treat several inflammatory, infectious and cancerous conditions involving the chest and the lungs. It can also be performed for broncho-alveolar lavage, therapeutic bronchoscopy or to take a sample of the tissues (through bronchial brush, forceps, Wang needle, etc).
Broncho-alveolar lavage (BAL) is a procedure in which a sample of the fluids and cells present in the airways and the lungs are obtained by introducing saline through the fiber-optic bronchoscope and withdrawing it immediately (washings). A flexible forceps is a device that is introduced through one of the channels of the bronchoscope to help remove a sample of the lung tissue for biopsy. The removal of the lung tissue can be performed under direct visualization from the bronchoscope.
A cytology brush is a specialized brush-like device introduced through one of the channels of the bronchoscope to collect a sample of the lung tissue for biopsy. A Wang needle is a specialized needle that is utilized often with a bronchoscope to remove tissue samples from the lungs for biopsy. It consists of a set of two needles, one used for holding the tissue and the other used for shearing off a piece from the lungs. This kind of an arrangement ensures that pneumothorax is prevented. Wang needle aspiration is not a FNAC technique but involves taking a piece of the lung tissue.
Therapeutic bronchoscopy is a technique in which a fiber-optic bronchoscope is introduced into the lungs to treat certain conditions such as removing objects that may block the airways, manage growths (such as cancers or benign tumours of the airways), control bleeding, etc. References: AARC (1993). Fiberoptic Bronchoscopy Assisting, Respiratory Care, 38, 1173-1178. http://www. rcjournal. com/online_resources/cpgs/fbacpg. html Kaufman, D. A. (2007). Bronchoscopy. Retrieved January 20, 2007, Medline Plus Web site: http://www.
nlm. nih. gov/medlineplus/ency/article/003857. htm Kaufman, D. A. (2007). Bronchoscopy with transbronchial biopsy. Retrieved January 20, 2007, Medline Plus Web site: http://www. nlm. nih. gov/medlineplus/ency/article/003859. htm Nissl, J. (2005). Bronchoscopy. Retrieved January 20, 2007, Web MD Web site: http://www. webmd. com/hw/lung_disease/hw200474. asp Oulu University Library (2000). Bronchoalveolar lavage. Retrieved January 20, 2007, Oulu University Web site: http://herkules. oulu. fi/isbn9514253728/html/x207. html