Bronchoscopy, Assisting
Bronchoscopy is an invasive procedure that’s used to diagnose bronchogenic carcinoma, tuberculosis, interstitial pulmonary disease, and fungal or parasitic pulmonary infections. It can also be used to evaluate, manage, and treat numerous pulmonary processes. The procedure involves using a flexible fiber-optic scope connected to a light source to visualize the upper and lower airways. (See Features of the bronchoscope.) During the procedure, specimens can be collected from the tracheobronchial tree, foreign objects can be removed, and massive hemoptysis can be controlled.
The nurse who assists the doctor during a bronchoscopy must have knowledge of the technique, understand the complications associated with the procedure, and function according to the facility’s policy. Responsibilities may include patient preparation and monitoring, handling specimens, and postprocedure care and monitoring.
Equipment
Bronchoscope ▪ suction apparatus ▪ specimen container ▪ cytology brush ▪ bite block ▪ sterile gauze sponges ▪ topical anesthetic (viscous lidocaine, 1% lidocaine, and 1% lidocaine with epinephrine) ▪ syringes (5 mL and 30 mL) ▪ pulse oximeter ▪ nebulizer equipment ▪ cardiac monitor system ▪ blood pressure monitor ▪ oxygen delivery equipment ▪ emergency equipment (code cart with cardiac medications, defibrillator, intubation equipment) ▪ personal protective equipment ▪ 150-mL bottle of normal saline solution ▪ prescribed sedative and its reversal agent (to reverse adverse effects if necessary) ▪ Optional: ventilator, capnography monitoring equipment, intubation equipment, IV insertion equipment, ventilator adapter, prescribed medications.
Preparation of Equipment
Prepare intubation equipment if endotracheal intubation is necessary. Apply lidocaine to the gauze sponges for lubricating the bronchoscope. Fill five 30-mL syringes with normal saline solution, one 5-mL syringe with viscous lidocaine for local anesthesia, one 5-mL syringe with 1% lidocaine with epinephrine, and three 10-mL syringes with 1% lidocaine. Label all medications appropriately to prevent medication errors.1 Set up suction equipment and make sure it’s functioning properly. Fill specimen containers with normal saline solution. Make sure other emergency equipment, such as a defibrillator and crash cart with cardiac medications, are readily available in case complications arise.
Implementation
Verify the doctor’s orders.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Make sure that informed consent has been obtained and is documented in the patient’s medical record.6
Conduct a preprocedure verification process to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.7
Confirm that the patient has had nothing by mouth for at least 4 hours before the procedure.
Ensure that the patient and his family understand the procedure; answer any questions they may have to evaluate understanding of information previously given.
Make sure that the patient has patent IV access. Insert an IV catheter, if the patient doesn’t already have one in place. (See “IV catheter insertion and removal,” page 421.)
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