Transcript Bronchoscopy And Chest Tubes

Bronchoscopy and Chest
Tubes
RC 275
Fiberoptic Bronchoscopy
(F.O.B.)
Indications
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Therapeutic
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Remove mucus and/or foreign bodies
Diagnostic
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Identify tumors, inflammation, Lavage
sample for C & S, etc
Respiratory Therapist’s Role
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Patient Education
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Explain procedure
and answer
questions
Be reassuring and
put patient at ease
Administer prebronch anesthesia
Assist physician during
procedure
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Suction PRN
Monitor vitals (POx, EKG,
ETCO2, as well as TPR
and BP)
Instill lavage
Assist with specimen
collection
Monitor patient postbronch
Clean and maintain
bronchoscope and cart
Equipment
Bronchoscope and
fiberoptic light source
 Medications and lavage
solutions
 Monitoring equipment
including: EKG, POx,
ETCO2, etc
 Resuscitation supplies`
 Biopsy materials
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Forceps, brushes, slides
and fixative
Sampling Techniques
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Lavage with suction
trap
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Use non-bacteriostatic
lavage solution
Brush – minimal
hemorrhage
Forceps – excellent
sample but may cause
significant bleeding
Possible Complications
Hypoxia
 Arrhythmias
 Bronchospasm/Laryngospasm
 Hemorrhage
 Pneumothorax
 Infection
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Chest Tube Drainage
Indications: whenever there is significant
air or fluid in the pleural space
 Pneumothorax
 Pleural effusions
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Transudates or exudates
Chest Tube Placement
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For pneumothorax, 2nd
or 3rd intercostal space
at midclavicular line
For effusion, 5th
intercostal space at
mid-axillary line with tip
positioned posteriorly
Always go over the
top border of the rib
that is the lower
margin of the
intercostal space
Chest Tube Insertion
Drainage Setup: 1st “Bottle”
Water seal – prevents
air from getting into
pleura but allows it to
exit
 Water seal height is
usually 2 cm
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The water seal level
fluctuates with
respiration!
It bubbles as air exits
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Spontaneous breathing
during exhalation
Positive pressure
ventilation during
inspiration
2 bottle system
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Trap– it goes between
patient and water seal
and collects any fluid
that exits the pleural
space
It prevents fluid from
accumulating in the
water seal bottle (this
would increase
expiratory resistance)
3 Bottle System
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Suction– it measures
and controls suction
applied to pleural space
Comes AFTER the water
seal
Suction is determined
by the height of the
water
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Usually 10-20 cm
Should “bubble”
continuously
3 Chambered System
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Today, chest tube
systems are
disposable, three
chambered sets
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Trap, water seal,
and suction
chambers
Function the same
as “3 Bottle
System”
Chest Tube Care
Chest tube should
be sutured to chest,
and all connections
secure and taped.
 Do not allow any
gravity dependent
loops to form
 Never raise drainage
container above the
chest
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If transporting patient,
disconnect suction hose
(Don’t just turn it off!)
Check system operation
frequently
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Adequate fluid levels
Fluctuation in water seal
chamber
Continuous bubbling in
suction chamber
Follow hospital protocol
in regard to clamping
and milking tubes