In the article, we consider the algorithm for preparing for bronchoscopy.
This is a modern diagnostic and therapeutic method in which the internal surfaces of the bronchi and trachea are examined or treated. This procedure is carried out using a special optical device, which has the name "fibrobronchoscope." The device is a handset equipped with a video camera and a light source. The device is very similar to an endoscope, which examines the structure of the digestive system. The procedure is carried out by a doctor who is assisted by a specialist in nursing. Preparing the patient for bronchoscopy, the algorithm of the conduct are very important and can affect the patient's condition and the results of the manipulation.
Indications
This event is recommended for diagnostic purposes in the presence of the following pathological symptoms:
- persistent cough for no apparent reason;
- traces of blood in sputum;
- suspected pulmonary infections;
- respiratory failure;
- pathological changes due to x-ray examination - seals, nodules, inflammatory processes.
In addition, indications for bronchoscopy are:
- long smoking history for the purpose of preventive examination;
- bronchitis, obstructive pulmonary pathology of a chronic type;
- tuberculosis;
- lung atelectasis (a condition of lung tissue in which the alveoli lose airiness);
- suspected lung cancer.
A therapeutic bronchoscopy of the lungs is recommended for:
- removal of foreign bodies from the respiratory tract;
- removal of a benign or malignant neoplasm that blocks the airways;
- installing a stent in the respiratory tract if, for example, it is compressed by a tumor;
- removal of bronchial secretions or mucous plugs from the bronchial tree;
- the study of the characteristics of the tumor;
- elucidation of the intensity of bleeding, the degree of obstruction of the lumens of the bronchi, localization and nature of the foreign body;
- receiving a piece of tissue for microbiological and cytological studies to establish additional diagnostic information for tuberculosis, bronchogenic cancer, fungal infection, parasitic lung invasion, interstitial pneumonia.
The algorithm for preparing the patient for bronchoscopy and bronchography will be described below.
Contraindications to the procedure
Bronchoscopy is absolutely contraindicated in the following cases:
- myocardial infarction, which the patient suffered at least six months ago;
- intolerance to medications that are used for local anesthesia;
- heart rhythm disturbances;
- stenosis of the trachea or larynx;
- acute stroke;
- hypertonic disease;
- pulmonary heart or cardiovascular failure;
- exacerbation of bronchial asthma;
- soreness in the abdominal cavity;
- neuropsychic pathologies (epilepsy, schizophrenia, etc.);
- condition after traumatic brain injury;
- the patient’s serious condition when the diagnosis does not affect the treatment process.
Relative contraindications for bronchoscopy of the lungs are:
- menstruation period;
- the second half of the pregnancy period;
- ARI of the upper respiratory canals;
- coronary artery disease;
- chronic alcoholism;
- severe diabetes mellitus;
- an increase in the size of the thyroid gland (III degree).
Procedure for bronchoscopy
The study of the bronchi is carried out in a special room, where the rules of antiseptics and hygiene are observed. The procedure is carried out in a reclining position or sitting, so the patient can choose a comfortable position for him independently.
Before starting the study, a medical specialist introduces bronchodilators to the patient, thanks to which the spasms of the smooth muscles of the respiratory system stop. Lidocaine is also used, with the help of which the oral cavity is treated. This medication is necessary in order to reduce pain and the occurrence of vomiting reflexes in the patient. The medicine acts almost immediately after applying it to the mucous membranes of the oral cavity in the cavity. At the same time, the patient feels signs of numbness of the pharynx and palate, nasal congestion and difficulty while swallowing saliva are also observed.
Types of bronchoscope
The bronchoscope comes in two varieties: flexible and rigid. Most often, a flexible bronchoscope is used in medical practice, while a rigid one is used for patients who have a sense of anxiety and fear with bronchoscopy. This device is inserted through the nose or mouth, for which the patient needs to take a deep breath. The tube of the bronchoscope penetrates through the glottis and goes to the bronchi. The specialist through a video camera can monitor the process and monitor the further passage of the device. With the help of a bronchoscope, you can examine the following structures of the respiratory system:
Tissue Sampling
In the process of examining these organs, a specialist can take a tissue sample in order to conduct a detailed analysis in the future. Using a bronchoscope, you can examine the respiratory system and perform drug treatment by administering pharmacological agents. The bronchoscope allows the procedure for washing the bronchi from the accumulated mucus in them.
As soon as the study is over, and its duration is no more than 30 minutes, the doctor will remove the bronchoscope from the oral cavity. After the completion of the diagnostic study, the patient should be under the supervision of medical staff for approximately two to three hours, so the patient is placed in a special ward. During this time, it is possible to determine the absence of diseases.
Algorithm for preparing a patient for bronchoscopy
This is a very important stage, without which this study of the respiratory organs becomes impossible. The correct algorithm for preparing for bronchoscopy can significantly reduce the risk of complications, as well as significantly increase the veracity of the final result of the procedure. Before the study, the patient is prescribed the following manipulations:
- Take an x-ray of the lungs. An X-ray before the study allows the doctor to determine in advance the deviations that will need to be examined with bronchoscopy in the first place.
- Take blood tests: general and biochemical.
What else does the algorithm for preparing for bronchoscopy suggest?
To conduct a cardiogram, which is necessary so that a specialist can evaluate the correct functioning of the heart, which will exclude the development of sudden complications during the procedure from the cardiovascular system.
Before conducting bronchoscopy, a coagulogram analysis may be required, which allows you to evaluate the functioning of the patient's blood coagulation system.
These are the main types of studies that you need to provide to the doctor before examining the bronchi. The specialist may prescribe other types of diagnostics, which depends on the type of disease in an individual patient.
Taking drugs
If the patient takes certain medications, then you should inform your doctor in advance. He will tell you whether it is possible to take this or that drug on the day of the study or not. If a person has allergic reactions to drugs, then medical staff should also be informed about this in advance. If during the administration of anesthesia the patient develops allergy symptoms, this can lead to extremely negative consequences.
The algorithm for preparing for bronchoscopy is based on the fact that it is necessary to come to the procedure with an empty stomach, that is, on an empty stomach. Despite the fact that during this diagnostic measure, it is not the digestive system that is examined, but the respiratory organs, there should be no food in the stomach. This is necessary in order to reduce the severity of vomiting, and during their development - so that a person does not choke on the vomit.
To prepare the patient for bronchoscopy, eating for the last time before the study can be done within seven to eight hours. If the procedure is scheduled for the morning, then the last meal should be carried out in the evening, and if bronchoscopy is scheduled for afternoon, it is necessary to calculate whether it is possible to have a snack in the morning or not. Three days before the proposed study, it is not recommended to eat heavy foods, take alcoholic beverages and smoke, as this can lead to erroneous diagnostic results.
What does preparing a patient for bronchoscopy include ? The algorithm of the procedure involves a few more rules.
Bladder emptying
Upon arrival at the clinic, where bronchoscopy will be performed, it is necessary to empty the bladder. This is necessary so that during the study there are no unforeseen situations. Almost all patients before this procedure are very nervous, and in order to cope with anxiety, they are allowed to take any sedative drugs.
The algorithm for preparing for bronchography and bronchoscopy should be strictly adhered to.
Sensations after the procedure
Examination of the respiratory organs using a bronchoscope is a safe method, but it delivers a lot of unpleasant sensations. At the end of the procedure, the development of the following unpleasant symptoms is possible:
- numbness of the pharynx;
- difficulty swallowing;
- nasal congestion;
- a sensation of the presence of a foreign body in the larynx or esophagus;
- cough with mucus containing bloody streaks.
All these symptoms disappear, usually within two days after bronchoscopy. To avoid serious complications, it is forbidden to smoke, eat, drink and take medicine for some time, as this can aggravate the situation. If after this diagnostic study the unpleasant symptoms persist for more than two days, then you should visit the doctor who performed the bronchoscopy and get further recommendations.
If you do not follow the rules for preparing for bronchoscopy and the algorithm, severe consequences may develop.
Possible complications
If the patient neglects the preparation for the procedure, complications may occur. If the doctor determines in advance that the patient is not ready for bronchoscopy, he will transfer the procedure to another day. If this becomes known only during the course of the study, then the patient risks that the diagnostic result will not be entirely accurate and a repeated examination of the respiratory organs will be required.
There is always a risk of complications, even with proper and thorough preparation. You should contact the hospital if such symptoms occur:
- vomiting and nausea;
- feeling of shortness of breath;
- temperature rise;
- the presence of wheezing during the respiratory process;
- blood secretion during coughing.
These symptoms may indicate the development of pathological conditions such as bronchospasm, pneumothorax, or an allergic reaction.
Nursing with bronchoscopy
In preparation for bronchoscopy, the nurse should check the operation of the lighting system and sterilize the hooks, sight tubes, forceps and cotton holders. She carefully wipes the handle and light bulb with an alcohol solution, after which she covers the operating table with special sterile material. The bronchoscopy procedure is performed under local anesthesia (in exceptional cases, under general anesthesia). The nurse washes her hands, as before the operation, and helps the doctor by giving him all the necessary tools. The younger nurse supports the patient in the right position and monitors his condition.
We examined the algorithm for preparing the patient for bronchoscopy.