Flexible bronchoscope

OVERVIEW

• flexible bronchoscope may be fibre optic, video or hybrid systems

USES

Diagnosis

• diagnose diseases of the tracheobronchial tree (e.g. burns, tumours)
• obtain lung samples (e.g. airway biopsies, bronchial washings, bronchoalveolar lavage (BAL) specimens)

Therapies and procedures

• difficult intubation (e.g. awake fiberoptic intubation)
• suction of secretions or blood from the airways
• guide placement of a percutaneous tracheostomy, double-lumen tube, bronchial blockers and endobronchial valves
• treatment of specific disorders (e.g. control bleeding from focal lesions)

DESCRIPTION

• Flexible long, thin plastic tube enclosing a fibre optic system that attaches to a light source and transmits views from the distal tip to an eyepiece
• eyepiece can attach to a camera and/or video system that displays images on a screen
• flexible tip can be moved to negotiate passage of the tip into the airways using a lever controlled by the operators hand (Bowden cable system)
• suctioning channel connected to the tip and controlled on the proximal hand piece
• instrumentation port (for inserting instruments such as brushes or biopsy forceps or injecting saline)
• ergonomic design of the control section that fits the hand
• 120° field of view with 180° up and 130° down angulation
• Range of tip diameters (e.g. 2.8 mm to 5.9 mm for Olympus scopes), sizes of instrument channels and lengths (e.g. longer length with smaller diameter needed for double-lumen tubes)
• Accessories can be either disposable or autoclavable (e.g. suction connector; instrument channel cover)

METHOD OF INSERTION/ USE

• assemble bronchoscope (details are device dependent)
• patients’ airway is anesthetised (e.g. either deep sedation or topical local anaesthetic)
• adjust ventilator settings and alarms as required
  • set high peak pressures
  • administer FiO2 1.0
  • use volume-controlled ventilation
• full monitoring
• suction airway
• insert a Y connector
• perform diagnostic and/or therapeutic bronchoscopy
  (see videos below)
• turning: combine flex/ extend with rotation
• lavage with saline with suction into a Lukens trap

COMPLICATIONS

• Trauma to the airways
• coughing and bronchospasm (if inadequate anaesthesia)
• loss of PEEP with derecruitment and oxygen desaturation
• barotrauma
• bronchoscope damage (e.g. biting; friction from inadequate lubrication especially if a tight fit down a tube; needle injury during a tracheostomy if not sufficiently pulled back while the procedure is being performed)
• infection (scope to patient and patient to operator especially if inadequate respiratory precautions adopted)
• accidental extubation

OTHER INFORMATION

• Cleaning and engineering maintenance is critical — inadequate sterilisation can lead to transmission of infective organisms
• Bowden cable system involves a flexible cable that converts a mechanical force by movement of an inner cable relative to the outer housing

References and Links

FOAM and web resources

• Bronchoscopy International Youtube Channel
• Bronchoscopy Simulator (ThoracicAnaesthesia.com)
• American Thoracic Society — Bronchoalveolar lavage

Lots of great videos on the Bronchoscopy International Youtube Channel