Nursing Responsibilities • Provide routine preoperative care as ordered. Bronchoscopy is an invasive procedure requiring conscious sedation or anesthesia. Care provided prior to the procedure is similar to that provided before many minor surgical procedures. • Provide mouth care just prior to bronchoscopy. Mouth care reduces oral microorganisms and the risk of introducing them into the lungs. • Bring resuscitation and suction equipment to the bedside. Laryngospasm and respiratory distress may occur following the procedure. The anesthetic suppresses the cough and gag reflexes, and secretions may be difficult to expectorate. • Following the procedure, closely monitor vital signs and respiratory status. Possible complications of bronchoscopy include laryngospasm, bronchospasm, bronchial perforation with possible pneumothorax or subcutaneous emphysema, hemorrhage, hypoxia, pneumonia or bacteremia, and cardiac stress. • Instruct to avoid eating or drinking for approximately 2 hours or until fully awake with intact cough and gag reflexes. Suppression of the cough and gag reflexes by systemic and local anesthesia used during the procedure increase the risk for aspiration. • Provide an emesis basin and tissues for expectorating sputum and saliva. Until reflexes have returned, the client may be unable to swallow sputum and saliva safely. • Monitor color and character of respiratory secretions. Secretions normally are blood tinged for several hours following bronchoscopy, especially if biopsy has been obtained. Notify the physician if sputum is grossly bloody. Grossly bloody sputum may indicate a complication such as perforation. • Collect postbronchoscopy sputum specimens for cytologic examination as ordered. Cells in the sputum may be examined if a tumor is suspected.  Client and Family Teaching • Fiberoptic bronchoscopy requires 30 to 45 minutes to complete. It may be done at the bedside, in a special procedure room, or in the surgical suite. • The procedure usually causes little pain or discomfort, because an anesthetic is given. You will be able to breathe during the bronchoscopy. • Some voice hoarseness and a sore throat are common following the procedure.Throat lozenges or warm saline gargles may help relieve discomfort. • You may develop a mild fever within the first 24 hours following the procedure. This is a normal response. • Persistent cough, bloody or purulent sputum, wheezing, shortness of breath, difficulty breathing, or chest pain may indicate a complication. Notify your physician if they develop.
Bronchoscopy is primarily used as a diagnostic tool. Abstract VOL: 99, ISSUE: 41, PAGE NO: 52 Julie Martin, BSc, RGN, Dip(Respiratory), is nurse bronchoscopist. South Manchester University Hospital NHS Trust
To continue reading this clinical article please log in or subscribe. Already have an account, click here to sign in Join NURSING.com to watch the full lesson now. Join NURSING.com to watch the full lesson now. Join NURSING.com to watch the full lesson now. Bronchoscopy is an invasive procedure that allows the direct examination of the larynx, trachea and bronchi using either a flexible fibreoptic bronchoscope or a rigid metal bronchoscope.1,2 Nurses perform an important role supporting patients undergoing bronchoscopy. In this article, we review the role of the bronchoscopy nurse in 3 surgical stages.
Ahead of the bronchoscopy procedure, the nurse’s role involves providing information on what to expect and what to avoid, helping relieve anxiety. The patient must be given a full explanation of the procedure, including risks, benefits and alternatives, as well as the preparation required.2 Other important tasks for nurses before the procedure include the following:1
During the bronchoscopy, intravenous sedation is given in incremental doses until the patient is adequately sedated. The patient must remain purposefully responding to the nurse, able to follow instructions and take deep breaths.2 The nurse must monitor the patient’s pulse, respirations and oxygen saturation levels using a pulse oximeter. Electrocardiography is not monitored routinely, unless the patient has a known history of severe cardiac disease. Any fall in oxygen saturation is treated with supplemental oxygen via a nasal cannula. The nurse must also look for any changes in breathing pattern, chest pain or any other signs of discomfort.2 Other responsibilities of the bronchoscopy nurse include:1
For an hour after the procedure, the patient’s vital signs must be monitored regularly according to their general condition. Changes in breathing pattern, chest pain or oxygen saturation levels should be reported.2 Other important tasks include:1
In conclusion, bronchoscopy is an invasive procedure that requires adequate patient preparation and cooperation. Nurse bronchoscopists play an important role before, during and after procedures to ensure patient safety.
My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management. This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.
The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger. |
What is the priority nursing action taken by the nurse before preparing the patient for bronchoscopy?
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