Bronchoscopy and Chest Tubes RC 275 Fiberoptic Bronchoscopy (F.O.B.)
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Transcript of Bronchoscopy and Chest Tubes RC 275 Fiberoptic Bronchoscopy (F.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
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