What Is a Bronchoscopy?
A bronchoscopy, or a "bronch", is a procedure that makes it possible to visualize the inside of the airways leading to the lungs using a specialized instrument called a bronchoscope. In addition to being able to see inside the respiratory pathways, it is also possible to take biopsy samples, remove secretions or foreign bodies and provide specialized treatments.
The most common type of bronchoscope is the flexible bronchoscope. A long, thin device that can be manipulated with hand controls, the bronchoscope uses fiber optics to allow a practitioner to view the inside of the airways, remove samples of tissue with tiny pinchers and remove secretions with suction.
The bronchoscope is easily manipulated, allowing the user to guide the scope through the airways, inspecting each in turn. A tiny but bright light on the end makes it possible to visualize the structures leading to the lungs.
The other type of bronchoscope is a rigid bronchoscope. Unlike the flexible type, the rigid scope is not easily manipulated and is primarily used for removing foreign bodies from the airways. It is rarely used without general anesthesia.
Why is a Bronchoscopy Performed?
There are many reasons why a bronchoscopy might be performed. Generally speaking, the bronchoscopy is performed to allow the physician to visualize the inside of the lungs and to look for any signs of disease or injury.
Some reasons that a physician might perform the procedure include:
Foreign body: An object is present in the lungs and should be removed. This is most common with children, often after accidentally inhaling a small object. It can also occur due to trauma. For some patients, the "foreign body" may be vomit, which can lead to a serious condition called aspiration pneumonia.
Secretions: For some people, coughing up secretions is not possible, and they continue to build up in the lungs. When severe, these secretions must be removed to allow the patient to get enough oxygen. For some patients it is difficult to cough properly after surgery, resulting in a large amount of secretions collecting in the lungs, which can make a bronchoscopy necessary in severe cases.
Infection: An infection may require a bronch to determine the source of the infection, or to remove secretions associated with the infection.
To monitor, treat or diagnose a tumor: In some cases, a tumor in the lungs can be treated by using a bronchoscope to place medications directly into the lesion. For other patients, a bronchoscopy may be performed to confirm a finding from a chest xray or CT scan.
To provide treatment: The placement of a stent, a small device designed to keep the airway open, is done using a bronchoscope. Some bronchoscopes are equipped with tiny pinchers that allow the physician to grasp the stent and properly place it within the airway.
Obtain a tissue sample: Your physician may suspect you have a condition that can be confirmed with a tissue biopsy. In this case, a bronchoscope with small pinchers is used to grasp a small sample of tissue, which is then examined under a microscope.
Investigate possible causes for a persistent cough: If your physician isn’t sure what is causing your cough or difficulty breathing, looking inside your lungs may be the best way to determine the exact nature of the problem.
Before a Bronchoscopy
Sedation, such as Versed, is typically given prior to a bronchoscopy if it isn't already being given as part of treatment. A numbing spray may also be given to numb the throat and the back of the mouth. These medications are necessary to help the patient tolerate the procedure. Without sedation, some patients feel like they are not getting enough oxygen while the bronchoscope is inserted. Numbing spray helps minimize the gag reflex when the bronchoscope is inserted.
When possible, the patient is advised not to eat prior to the procedure. This is to prevent vomiting if the patient gags while sedated, which can result in aspiration pneumonia. During Bronchoscopy
Once the sedative medications take effect, the bronchoscopy procedure can begin. If the patient is on a ventilator, the endotracheal tube stays in place and the bronchoscope is inserted into a port on the tubing. If the patient is breathing without assistance, the bronchoscope can be inserted into the nose or mouth and down the trachea to the branching airways of the lungs called the bronchus.
The bronchoscope allows the individual performing the procedure to look into the airways, they may also display the images on a video screen or take photos. If necessary, a sample can be taken (or foreign objects removed) with a small set of pinchers on the end of the scope.
If a sample of secretions is desired, sterile saline is injected via the bronchoscope and is then removed with suction and collected. This fluid can then be examined under a microscope for identification. This can help identify an infection, or to determine what antibiotics would be most effective in treating a known infection.
The procedure itself may last only a few minutes, but can be longer if necessary. The patient is given oxygen, or is able to breathe on their own, while the bronchoscopy is performed.
Recovery After Bronchoscopy
The recovery after a bronchoscopy is typically quick and is intended to allow the patient time to wake completely from the sedative medications that are given. For most, the side effect of the procedure is a sore throat, which resolves in a few days. For most, a bronch is an outpatient procedure and they are able to return home the same day. For patients who require a bronchoscopy who are also dependent upon a ventilator (typically ICU patients), the procedure may be done in the hospital room where they will continue to receive treatment after the procedure.
What is Bronchoscopy? Heart Lung and Blood Institute. Accessed August 2012. http://www.nhlbi.nih.gov/health/health-topics/topics/bron/