Complications of bronchoscopy: A concise synopsis

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Bronchoscopy | Johns Hopkins Medicine

What is bronchoscopy?

Bronchoscopy is a procedure to look directly at the airways in the lungs
using a thin, lighted tube (bronchoscope). The bronchoscope is put in the
nose or mouth. It is moved down the throat and windpipe (trachea), and into
the airways. A healthcare provider can then see the voice box (larynx),
trachea, large airways to the lungs (bronchi), and smaller branches of the
bronchi (bronchioles).

There are 2 types of bronchoscope: flexible and rigid. Both types come in
different widths.

A rigid bronchoscope is a straight tube. It’s only used to view the larger
airways. It may be used within the bronchi to:

• Remove a large amount of secretions or blood

• Control bleeding

• Remove foreign objects

• Remove diseased tissue (lesions)

• Do procedures, such as stents and other treatments

A flexible bronchoscope is used more often. Unlike the rigid scope, it can
be moved down into the smaller airways (bronchioles). The flexible
bronchoscope may be used to:

• Place a breathing tube in the airway to help give oxygen

• Suction out secretions

• Take tissue samples (biopsy)

• Put medicine into the lungs

Why might I need bronchoscopy?

A bronchoscopy may be done to diagnose and treat lung problems such as:

• Tumors or bronchial cancer

• Airway blockage (obstruction)

• Narrowed areas in airways (strictures)

• Inflammation and infections such as tuberculosis (TB), pneumonia,
  and fungal or parasitic lung infections

• Interstitial pulmonary disease

• Causes of persistent cough

• Causes of coughing up blood

• Spots seen on chest X-rays

• Vocal cord paralysis

Diagnostic procedures or treatments that are done with bronchoscopy
include:

• Biopsy of tissue

• Collection of sputum

• Fluid put into the lungs and then removed (bronchoalveolar lavage
  or BAL) to diagnose lung disorders

• Removal of secretions, blood, mucus plugs, or growths (polyps) to
  clear airways

• Control of bleeding in the bronchi

• Removing foreign objects or other blockages

• Laser therapy or radiation treatment for bronchial tumors

• Placement of a small tube (stent) to keep an airway open (stent
  placement)

• Draining an area of pus (abscess)

Your healthcare provider may also have other reasons to advise a
bronchoscopy.

What are the risks of bronchoscopy?

In most cases, the flexible bronchoscope is used, not the rigid
bronchoscope. This is because the flexible type has less risk of damaging
the tissue. People can also handle the flexible type better. And it
provides better access to smaller areas of the lung tissue.

All procedures have some risks. The risks of this procedure may include:

• Bleeding

• Infection

• Hole in the airway (bronchial perforation)

• Irritation of the airways (bronchospasm)

• Irritation of the vocal cords (laryngospasm)

• Air in the space between the lung covering (pleural space) that
  causes the lung to collapse (pneumothorax)

Your risks may vary depending on your general health and other factors. Ask
your healthcare provider which risks apply most to you. Talk about any
concerns you have.

In some cases, a person may not be able to have a bronchoscopy. Reasons for
this can include:

• Severe narrowing or blockage of the trachea (tracheal stenosis)

• High blood pressure in the lungs’ blood vessels (pulmonary
  hypertension)

• Severe coughing or gagging

• Low oxygen levels

If you have high levels of carbon dioxide in the blood (hypercapnia) or
severe shortness of breath, you may need to be on a breathing machine
before the procedure. This is done so oxygen can be sent right into your
lungs while the bronchoscope is in place.

How do I get ready for bronchoscopy?

Give your healthcare provider a list of all of the medicines you take. This
includes prescription and over-the-counter medications, vitamins, herbs,
and supplements. You may need to stop certain medicines before the
procedure.

You will be asked to sign an informed consent document. This document
explains the benefits and risks of the procedure. Make sure all of your
questions are answered before you sign it.

If the procedure is being done on an outpatient basis, arrange to have
someone drive you home.

What happens during bronchoscopy?

You may have your procedure as an outpatient. This means you go home the
same day. Or it may be done as part of a longer stay in the hospital. The
way the procedure is done may vary. It depends on your condition and your
healthcare provider’s methods. In most cases, a bronchoscopy will follow
this process:

1. You may be asked to remove your clothes. If so, you will be given a
   hospital gown to wear. You may be asked to remove jewelry or other
   objects.

2. You will sit on a procedure table with the head raised like a
   chair.

3. An IV (intravenous) line may be put into your arm or hand.

4. You may be given antibiotics before and after the procedure.

5. You will be awake during the procedure. You will be given medicine
   to help you relax (sedative). You will also be given a liquid
   medicine to numb your nose and throat. For a rigid bronchoscopy,
   you will be given general anesthesia. This is medicine that
   prevents pain and lets you sleep through the procedure.

6. You may be given oxygen through a nasal tube or face mask. Your
   heart rate, blood pressure, and breathing will be watched during
   the procedure.

7. Numbing medicine will be sprayed into the back of your throat. This
   is to prevent gagging as the bronchoscope is passed down your
   throat. The spray may have a bitter taste to it. Once the tube
   passes down your throat the gagging feeling will go away.

8. You won’t be able to talk or swallow saliva during the procedure.
   Saliva will be suctioned from your mouth as needed.

9. The healthcare provider will move the bronchoscope down your throat
   and into the airways. You may have some mild pain. Your airway will
   not be blocked. You can breathe around the bronchoscope. You will
   be given extra oxygen if needed.

10. As the bronchoscope is moved down, the lungs will be examined.
    Tissue samples or mucus may be taken for testing. Other procedures
    may be done as needed. This may include giving medicine or stopping
    bleeding.

11. When the exam and other procedures are done, the bronchoscope will
    be taken out.

What happens after bronchoscopy?

After the procedure, you will spend some time in a recovery room. You may
be sleepy and confused when you wake up from general anesthesia or
sedation. Your healthcare team will watch your vital signs, such as your
heart rate and breathing.

A chest X-ray may be done right after the procedure. This is to make sure
your lungs are okay. You may be told to gently cough up and spit your
saliva into a basin. This is so a nurse can check your secretions for
blood.

You may have some mild pain in your throat. You will not be allowed to eat
or drink until your gag reflex has returned. You may notice some throat
soreness and pain with swallowing for a few days. This is normal. Using
throat lozenges or gargle may help.

If you had an outpatient procedure, you will go home when your healthcare
provider says it’s OK. Someone will need to drive you home.

At home, you can go back to your normal diet and activities if instructed
by your healthcare provider. You may need to not do strenuous physical
activity for a few days.

Call your healthcare provider if you have any of the below:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider

• Redness or swelling of the IV site

• Blood or other fluid leaking from the IV site

• Coughing up significant amounts of blood

• Chest pain

• Severe hoarseness

• Trouble breathing

Your healthcare provider may give you other instructions after the
procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s
  qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or
  problems

• How much will you have to pay for the test or procedure

How is lung bronchoscopy performed in adults? Bronchoscopy of the lungs price.

Bronchoscopy of the lungs in Moscow.

What is it
like this?

Bronchoscopy
related to endoscopic examinations. During the procedure, the doctor
inserts an endoscope (bronchoscope) into the nose of the patient and assesses the condition of the mucous membranes
membranes of the respiratory tract (trachea, bronchi). The bronchoscope is
construction of a flexible, movable tube, at the end of which there is a source
light and a highly sensitive camera that transmits images to a monitor. Diameter
bronchoscope does not exceed 6 mm.

Why
doing a bronchoscopy?

Research
performed for both therapeutic and diagnostic purposes.

Diagnostic
bronchoscopy helps to clarify the diagnosis if the patient is suspected of having neoplasms
respiratory tract (lung cancer), or you need to decide on a treatment plan for
already confirmed process, or to understand, as a result of which the patient has experienced
narrowing of the airways. During this procedure, the doctor takes tissue samples.
(performs a biopsy) for subsequent histological examination.

Usage
bronchoscopy and bronchial lavage allows you to remove the substrate (content) from the alveoli
and small bronchi.

Bronchoscope
helps to find and remove foreign objects from the respiratory tract, flush out mucous membranes
plugs, it is used if it is necessary to install a stent – a design that
strengthens the airways and prevents them from collapsing.

Medical
bronchoscopy is necessary for patients on mechanical ventilation (artificial ventilation of the lungs), it
helps to keep the breathing tube in the correct position.

What is
indication for diagnostic bronchoscopy?

Bronchoscopy
use if the patient is suspected of having:

neoplasms of the bronchi or trachea;

anomalies in the structure of the bronchi and trachea;

foreign body in the airways;

hemoptysis;

lung atelectasis.

Using
diagnostic bronchoscopy, differential diagnosis of diseases is carried out
with similar manifestations. It is also used for frequent pneumonia,
to obtain bacteriological analysis of the contents of the respiratory tract.

What is
indication for therapeutic bronchoscopy?

This type
bronchoscopy is used for:

extract from respiratory
ways of foreign bodies;

preparation for surgery
lungs;

stent placement at
compression of the airways by the tumor.

When
Is bronchoscopy contraindicated?

Bronchoscopy
not carried out if the patient has at least one of these diseases:

acute stroke;

acute myocardial infarction;

hypertonic disease;

violation of the heart rhythm;

bronchial asthma in the acute stage;

tracheal stenosis;

severe decrease in lung function;

mental disorders;

epilepsy;

blood clotting disorders;

allergic to the anesthetic used for
conducting research.

In these situations, the decision to
bronchoscopy should only be considered after careful consideration of the benefits
and possible consequences for a particular patient!

Will
does it hurt during a bronchoscopy?

Before start
examination, the endoscopist irrigates the patient’s pharynx with an anesthetic, which
helps reduce vomiting. After that, he gradually introduces the bronchoscope into the respiratory
path – while advancing the device, it is important for the patient to focus on frequent and
shallow breathing. It is important to know that the diameter of the endoscope is as small as possible
may cause difficulty in breathing. Its promotion may cause
discomfort, but there will be no pain, and even a biopsy will be painless, because
bronchial mucosa does not have pain receptors.

Bronchoscopy
can be performed under medical sedation (“in sleep”) if the patient does not
has contraindications for its implementation.

How
prepare for brochoscopy?

Preparation
is made up of two parts. The first part includes general training
patient to the study: psychological adaptation (acceptance of the upcoming
procedures) and examinations.

1.
The patient must consent to bronchoscopy. After
after the doctor explains in detail the sequence of actions during the study,
The patient has the right to ask all questions that interest him. For example, will it hurt
whether anesthesia is needed and how it will be, how you will feel after the procedure,
when you can start drinking, eating, smoking, etc.

2.
The patient should tell the doctor if he has
there are concomitant diseases, allergies, diabetes mellitus.

3.
The patient should inform the doctor if he receives
insulin or anticoagulants.

4.
Before bronchoscopy, you will need to perform
the following examinations: X-ray of the lungs, ECG, donate blood for tests.

5.
The day before the procedure, it is forbidden to drink alcohol.

6.
Research
performed on an empty stomach (diet
does not need to be observed).

Second part
consists of direct preparation for the procedure.

1.
The last meal should be no later than 8
hours before the procedure. If bronchoscopy is scheduled for the morning hours, then dinner should be
schedule no later than 18 hours. It is advisable to choose products for him,
which are quickly and easily digested.

2.
Smoking before the procedure is prohibited.

3.
Before the procedure, the doctor will ask you to remove (if any) contact
lenses, dentures, bite correction plates, piercings.

What will happen during
bronchoscopy?

Procedure
takes place in an endoscopy room that meets all standards
sterility accepted for operating rooms. It can be done in an outpatient setting
conditions.

1.
The introduction of a bronchoscope is often accompanied by a gag reflex.
and pain during the passage of the pharynx and nasal passage. If the patient does not
an allergic reaction to anesthetics is detected, then the endoscopist uses it to
irrigation of these surfaces a few minutes before the procedure.

2.
Examinations are carried out in a sitting position: the patient
sits on a chair and tilts his head slightly. Hands can be put on your knees
or lower between the legs.

3. Endoscopist
gradually begins to introduce the device through the lower nasal passage into the nasopharynx. When
the device reaches the vocal cords, the doctor irrigates them and the epiglottis with an anesthetic.
With the patient’s tendency to nosebleeds, narrowing of the nasal passages,
a bronchoscope is passed through the oral cavity.

4. Respiratory
paths are devoid of pain receptors – bronchoscopy will not cause pain.

5. By
bronchoscope, the doctor carefully examines the condition of the mucous membrane of the bronchial tree.
If the diameter of the bronchoscope and the condition of the patient allows, then, in addition to large
bronchi, it is possible to examine and branches.

6. If
it is required to obtain material (bacteria, cells of the respiratory tract) for
subsequent laboratory test, then the doctor conducts bronchial lavage.
To do this, 20-100 ml of sterile liquid is injected into the lower respiratory tract, after
what it is removed. Lavage does not interfere with the patient’s spontaneous breathing.

7. If
it is required to obtain tissue samples for histological analysis, the doctor performs
biopsy. The tissue is taken with miniature forceps through the instrumental
bronchoscope channel. The procedure does not cause pain.

How
How long does a bronchoscopy take?

On average, bronchoscopy can take 10-15 or 30 minutes. It depends on the
the purpose and nature of the study (diagnostic or therapeutic).

What can and cannot be done after the procedure?

Patient
may experience a feeling of numbness after the application of an anesthetic, therefore
it is advisable to postpone the intake of water and food for a while so as not to choke. Through
1-2 hours after the procedure, you can drink a few sips of water. If swallowing
recovered, and the process does not cause discomfort, you can start eating and drinking.

Within 2
hours after bronchoscopy should refrain from smoking.

Required
ask your doctor when you can start taking your medication.

If
the study was carried out “in a dream”, then within 24 after anesthesia the patient did not
will be able to drive a vehicle and will need an accompanying person
in order to get home.

What
Complications and consequences can be after bronchoscopy?

At
bronchoscopy, the risk of complications increases with patient age. Therefore, before
prescribing the procedure, the doctor carefully assesses the state of health of each
patient, weighs the benefits and possible risks.

After
bronchoscopy of the patient for several days may be disturbed by perspiration in
throat, hoarseness. Often the day after bronchoscopy,
there is a desire to cough. These events go away on their own.

Rare
cases, the bronchoscope can injure surrounding tissues, which causes
sore throat, difficulty swallowing, may cause hoarseness or cough,
provoke nosebleeds, extremely rarely there is an injury to the larynx.

If
the patient underwent a biopsy, then expectoration in the first couple of days after
bronchoscopy may occur with a small amount of blood. When
severe bleeding requires immediate medical attention. Stop such
bleeding is carried out using an endoscope.

Experts on this issue

Solodinina Elena Nikolaevna

Surgeon

ElectedMikhailIgorevich

Surgeon

Candidate of Medical Sciences.

Bronchoscopy | Kamsky doctor

Bronchoscopy is an examination of the trachea and bronchi using an endoscope. The study is done both for diagnostic and therapeutic purposes. The essence of the study is to examine the inner surface of the respiratory tract with a bronchoscope throughout their entire length, starting from the throat, vocal cords, larynx and trachea up to the bronchial tree itself.

Why is bronchoscopy performed?

The purpose of bronchoscopy is to detect signs of the disease and, if possible, eliminate the cause.

For diagnostic purposes, bronchoscopy is performed in diseases of: trachea, bronchi, lungs, accompanied by prolonged persistent cough, shortness of breath, hemoptysis, changes on radiographs (for example, if a tumor, pulmonary tuberculosis, foreign body of the bronchi) is suspected, with purulent-inflammatory processes, systemic diseases with damage to the lungs and organs of the mediastinum. If necessary, it is possible to introduce dyes that selectively accumulate in the affected tissues and stain them under different lighting conditions (chromobronchoscopy).
If necessary, during bronchoscopy, in addition to examining the mucous membrane of the trachea and bronchi, biological material is taken for diagnostic studies – for example, a biopsy (its various types) for histological examination, or taking washings directly from the lumen of the bronchial tree to study their cellular, biochemical and microbiological composition.

Also during bronchoscopy it is possible to carry out therapeutic measures:
• bloodless removal of foreign bodies in the bronchi,
• sanitation (washing) of the lumen of the bronchial tree with the removal of pathological contents (sputum, blood, etc.),
• administration of drugs directly to the foci of inflammation,
• drainage through the bronchi of abscesses (cavities with purulent contents) of the lung with the introduction of drugs into the cavity drugs
• installation of endoprostheses (to restore the patency of something narrowed airways)
• identifying the source and stopping pulmonary bleeding

Thus, it is fashionable to distinguish the following indications for bronchoscopy:

• signs of disseminated pathological processes on x-ray (small foci, cysts, cavities)
• suspicion of a tumor of the trachea or bronchi
• suspicion of a foreign body
• prolonged shortness of breath (with the exclusion of bronchial asthma and heart failure)
• hemoptysis
• multiple lung abscesses
• cysts in the lungs
• chronic inflammation of the bronchi of an unexplained cause
• recurrent pneumonia
• abnormal structure and dilation of the bronchi
• finding out the causes of bronchial asthma
• collection of contents to determine the sensitivity of the flora to antibiotics
• preparation for lung surgery
• treatment of chronic obstructive pulmonary disease (COPD), pneumonia, chronic bronchitis , lung abscesses.

Like any endoscopic procedure, bronchoscopy has a number of contraindications. Currently, doctors are reducing the number of contraindications for bronchoscopy . But with some pathologies, the examination can do more harm than good:

• Stenosis of the larynx and trachea II and III degree. A sharp narrowing of the lumen makes it difficult to insert a bronchoscope and can cause respiratory failure.
• Respiratory insufficiency III degree. It is accompanied by a sharp narrowing of the bronchi. Therefore, during the study, the risk of damage is high.
• Acute period of bronchial asthma. Carrying out the procedure at this moment can increase bronchospasm and aggravate the patient’s condition.
• Aortic aneurysm. Nervous stress and manipulation of the bronchoscope can cause an aneurysm to rupture.
• Myocardial infarction and cerebral infarction (stroke) less than six months ago. Stress and vasospasm and some lack of oxygen during the procedure can cause a second episode of circulatory failure.
• Bleeding disorder – minor damage to the bronchial mucosa can cause life-threatening bleeding.
• Anesthesia drug intolerance – danger of developing severe allergic reactions that can cause suffocation.
• Mental illness: schizophrenia, epilepsy, condition after traumatic brain injury. Stress and a decrease in the concentration of oxygen in the blood can trigger an attack of seizures.

It is recommended to postpone the procedure in such cases:

• acute infectious diseases
• menstruation
• bronchial asthma attack
• in the second half of pregnancy

However, in emergency cases, therapeutic bronchoscopy is performed despite contraindications.

What is the difference between fiber bronchoscopy and video bronchoscopy?

The only difference is the devices used for the examination. There are video bronchoscopes and conventional ocular bronchoscopes. At first glance, these bronchoscopes do not differ much or even do not differ at all. But this is only at first glance and with the naked eye…
Video bronchoscopy is an informative diagnostic method that provides high accuracy of examination (the camera transmits an image in HD or HD + quality). The tube has a small diameter, so it does not cause much discomfort during the examination. This diagnostic method is often used to detect cancer at an early stage, due to the microscopic precision of the device.
The advantages of VIDEOBronchoscopy are obvious: improved image quality, enlarged picture, enhanced image clarity, the ability to save pictures and videos on a computer, the use of recording during dynamic monitoring, and other features.

How do I prepare for a bronchoscopy?

What tests should be done before bronchoscopy?

• X-ray of the lungs. The picture will indicate which parts of the lungs you need to pay special attention to during bronchoscopy.
• Electrocardiography. This method will help identify the risk of developing complications from the heart
• Blood test. (complete blood count)
• Coagulogram – blood clotting test
• Blood urea level

How to prepare for bronchoscopy?

• During the initial interview, tell your doctor about any allergies to medications, chronic conditions (heart failure, diabetes) and medications (antidepressants, hormones, anticoagulants, insulins). If any medicines are not recommended to be taken, the doctor will inform you about this.
• Tranquilizers (Elenium, Seduxen) will help reduce anxiety on the evening before the test. They can be combined with sleeping pills to fully relax before the study.
• The last meal should be no later than 8 hours before the procedure. This is the prevention of food debris entering the respiratory tract during bronchoscopy.
• No smoking on the day of the test.
• In the morning before the procedure, it is advisable to cleanse the intestines. To do this, you can use an enema or glycerin suppositories.
• It is recommended to empty the bladder just before the procedure.
• If necessary, sedatives may be administered immediately prior to the procedure to reduce anxiety.

What to bring?

You must have a towel with you for the examination, as short-term hemoptysis is possible after the procedure. If you suffer from bronchial asthma or COPD, don’t forget your inhaler.

Preparation for bronchoscopy in people with pathology of the cardiovascular system

Bronchoscopy is contraindicated in patients with the following pathologies:

• severe heart rhythm and conduction disturbances
• increased diastolic (lower) blood pressure over 110 mm Hg
• myocardial infarction less than 6 months ago
• aortic aneurysm

In other cases, in patients with heart pathologies, the study is carried out after special training and consultation with a cardiologist. It starts 2-3 weeks before bronchoscopy. Training is aimed at compensating impaired functions and includes the following steps:

• normalization of heart rhythm
• taking beta-blockers that improve the nutrition of the heart muscle
• lowering blood pressure
• taking sedatives, tranquilizers

How is bronchoscopy performed?

• Examination is carried out in a specially equipped endoscopy room. The procedure is performed by a doctor who has undergone special training in the study of the bronchi (endoscopy).
• Bronchodilators given by aerosol. They have a bronchodilatory effect and contribute to the unimpeded advancement of the bronchoscope.
• Examination is performed in a sitting position. In this case, you can not stretch your head forward and arch your chest so that the device does not injure the respiratory mucosa.
• When inserting a bronchoscope, it is recommended to breathe quickly and shallowly, this inhibits the gag reflex.
• The bronchoscope is inserted through the nostril or through the mouth. Then anesthesia of the vocal folds is performed to eliminate the cough reflex and facilitate the passage of the apparatus. Next, the bronchoscope is passed into the trachea and bronchi. The bronchoscope tube is much thinner than the airways, so it does not interfere with breathing.
• During the examination, you may feel pressure in different parts of the respiratory system, but you will not experience pain.
• The study begins with an examination of the larynx and glottis, then the trachea and bronchi are examined. The thin bronchioles and alveoli of the lungs remain inaccessible due to their small diameter.
• During the procedure, the doctor may take a piece of tissue for a biopsy, remove the contents of the bronchi, wash them with a medicinal solution, take swabs for research, etc.
• After the procedure, the feeling of numbness remains for half an hour. It is not recommended to smoke and eat for 2 hours, so as not to provoke bleeding.
• Sedatives used to reduce anxiety slow down reactions. Therefore, driving is not recommended for 8 hours.
• It is recommended to remain under observation for some time. Medical staff will monitor your condition to rule out complications.

Bronchoscopy analgesia.

Local anesthesia. For anesthesia, a 2-10% lidocaine solution is used. It causes numbness of the palate, feeling of a lump in the throat, difficulty in swallowing, and mild nasal congestion. Anesthesia will also help suppress the cough and gag reflexes. When introduced through the bronchoscope tube, the mucosa of the larynx, vocal cords, trachea and bronchi are gradually sprayed with an anesthetic spray.

What are the consequences of a bronchoscopy?

Most often, bronchoscopy for pneumonia does not cause any complications. All that the patient can feel is a slight numbness and nasal congestion throughout the day.

When should I contact my doctor after a bronchoscopy?

There is a small risk of complications after bronchoscopy (bleeding, infection). It is important not to miss their symptoms and consult a doctor in a timely manner. Should alert you:
• prolonged hemoptysis
• chest pain
• unusual wheezing
• nausea and vomiting
• fever, chills.

Generalized opinion of people who have had bronchoscopy.

The opinion of patients is that this procedure is very unpleasant. It is performed quickly, but it must be remembered that bronchoscopy is a minor surgical intervention.