Bronchoscopy: A Nursing Perspective

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By Mary Shinn

Endoscopy professionals are often curious about what it's like to perform procedures outside of what they've already experienced. This overview is meant to introduce bronchoscopy procedures to those new to the field and to review the array of procedures for those who want a refresher.

During a bronchoscopy an endoscope is lowered into the airways through the mouth or nares to diagnose and treat lung diseases, infections and other abnormalities. Common bronchoscopy procedures include taking samples of possibly abnormal tissue or removing foreign objects.

Rigid or flexible fiberoptic scopes can be used. Rigid scopes are preferred for removing foreign objects or to treat bleeding and this may be completed under general anesthesia. Flexible bronchoscopy can be done under moderate sedation and is used for a variety of diagnostic, interventional and therapeutic reasons.

Within a bronchosopy suite nurses may rotate through different positions. They may work in a pre- or post-operation setting. Nurses may also administer sedative medications and monitor the patient during the procedure. Finally they may assist the bronchoscopist directly during the procedure by handling tools and medications.

These responsibilities require education in various areas, according to Henry Colt, MD, a pulmonologist with the University of California Irvine Medical Center and chair for the World Association for Bronchology and Interventional Pulmonology.

"Nurses should be well versed in all the elements of moderate and conscious sedation, emergency airway management, ACLS, and comfortable dealing with patients with chronic or acute lung and airway disorders of benign or malignant etiology," Colt said. The nurses should be comfortable providing reassurance, witnessing informed consent, and assuring that universal precautions are respected," Colt added. Nurses should also be able to conduct and implement procedure-specific and appropriate “time outs" to enhance patient safety.

"There have been few changes in how bronchoscopy is performed over the years, although instrumentation has improved considerably," Colt said. "Flexible bronchoscopy is usually performed in a procedure suite with patients in the seated or supine position. Patients are placed on oxygen and an electrocardiographic monitor. Intravenous sedation is usually offered, but is not always necessary."

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