Go deep into the airway and explore the "mirror" - Talk about bronchoscopy

Author: Chen Hui, head nurse of the First Affiliated Hospital of Naval Medical University

Reviewer: Wang Qin, deputy chief nurse, First Affiliated Hospital of Naval Medical University

Huang Haidong, deputy chief physician, the First Affiliated Hospital of Naval Medical University

1. What is bronchoscopy?

Bronchoscopy is an examination method that uses an endoscope with a light source and a lens (including flexible bronchoscopes and rigid bronchoscopes) through the oral cavity or nasal cavity and into the lower respiratory tract (i.e., through the glottis into the trachea, bronchi and beyond). This process is like an "endoscopic expedition" to the airway. Bronchoscopes can directly observe the internal conditions of the trachea and bronchi, helping doctors to find various lesions, such as tumors, interstitial lung disease, granulomatous diseases, and infectious diseases. Doctors can also use bronchoscopes to extract samples of diseased tissue or cells for pathological examinations, so as to more accurately diagnose the patient's condition. Bronchoscopes are not only used for examinations, but also have treatment functions. For some specific diseases, such as airway stenosis or bronchial foreign bodies, doctors can use bronchoscopes to perform high-frequency electrocoagulation, cryotherapy, balloon dilatation, and foreign body removal to help patients recover quickly.

2. Under what circumstances is bronchoscopy necessary?

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1. Unexplained cough: Cough that is difficult to explain or does not respond well to conventional treatments.

2. Unexplained hemoptysis: The cause of hemoptysis is difficult to determine, especially severe hemoptysis.

3. Atelectasis: It may be caused by obstruction such as tumors, inflammation, foreign bodies, etc.

4. Suspected tracheobronchial fistula: needs to be clarified.

5. If chest X-ray or CT examination shows lung shadows, lung masses, non-absorption of inflammation, diffuse lung lesions, hilar or mediastinal lymphadenopathy, etc., the nature of the lesion needs to be clarified.

6. Infectious diseases of the lungs or bronchus: Identify the pathogens through bronchoalveolar lavage and biopsy.

7. Remove foreign objects that have entered the airway.

8. Bronchoscopy interventional treatment of tracheal and bronchial obstruction and airway stenosis, such as metal or silicone stent implantation or laser, high-frequency electrocoagulation, freezing and other treatments.

3. Under what circumstances can bronchoscopy not be performed?

1. Within 4 to 6 weeks after acute myocardial infarction.

2. Continuous severe hemoptysis.

3. Abnormal coagulation function.

4. During pregnancy.

5. Severe cardiopulmonary insufficiency, etc.

4. What preparations should be made before bronchoscopy?

1. Complete preoperative examinations, including electrocardiogram (cardiac ultrasound if necessary), blood routine, coagulation function test, and chest CT, etc.

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2. The examination should be performed in a fasting state. Depending on the anesthesia method, fasting and drinking water should be avoided for 4 hours before local anesthesia examination and 6 to 8 hours before general anesthesia examination.

3. Drugs that may cause bleeding need to be discontinued for more than 5 days (such as aspirin and Plavix), and low molecular weight heparin needs to be discontinued for 12 hours.

4. Remove the dentures and hand them over to relatives for safekeeping to avoid accidental inhalation into the airway during surgery, which may cause suffocation.

5. For those with hypertension who take antihypertensive drugs regularly, take the antihypertensive drugs with about 20 ml of warm water before surgery.

6. Diabetics need to fast before surgery, so they need to stop using hypoglycemic drugs or insulin once according to their blood sugar level to avoid hypoglycemia. If you have symptoms of hypoglycemia such as hunger, palpitations, cold sweats, etc., you need to inform your doctor in time and supplement with glucose.

7. Patients with a history of asthma should use bronchodilators as needed before surgery.

8. Female patients should not wear nail polish, lipstick or colored lipstick, and should not wear pantyhose, jumpsuits or tights.

9. On the day of the examination, family members should accompany the patient throughout the examination and bring 1 to 2 packs of tissues.

5. Bronchoscopy process

The doctor inserts a bronchoscope through the person's nostrils or mouth and down the throat to the trachea and lungs.

During the examination, the doctor can observe the airway and use other accessories of the bronchoscope to collect tissue samples or perform other treatment procedures.

The entire examination process usually takes 10 to 30 minutes, and the specific operation time depends on the disease condition and whether other treatment operations are needed.

6. What should you pay attention to after bronchoscopy?

1. You can eat or drink water 2 hours after the examination and treatment. Drink a small amount of water first, and then eat after you stop choking. It is advisable to take warm or cool liquid or semi-liquid food, such as porridge, noodles, etc.

2. After the examination, talk less and rest more to facilitate the recovery of the vocal cords; avoid coughing and expectoration to prevent hemoptysis.

3. After the examination, the patient may experience a small amount of hemoptysis, mild cough, nasopharyngeal discomfort, pain, hoarseness, fever and other symptoms. No special treatment is required and they usually disappear on their own within 1 to 3 days. If breathing difficulties, worsening chest pain, and increased hemoptysis occur, seek medical attention immediately.

4. Those undergoing biopsy puncture should rest in bed as much as possible and avoid strenuous exercise to prevent increased tension in the bronchus and cause bronchial bleeding.

5. Patients under general anesthesia should not drive, work at heights, sign legal documents, or operate mechanical equipment within 24 hours after the examination.

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7. What are the possible complications of bronchoscopy?

Although bronchoscopy is very useful, there are some possible complications. The risk of these complications is very low, but they are still important to be aware of and prevent. They include: nausea, cough, vomiting; hypoxemia; allergic reaction to anesthetics; bleeding (such as blood in sputum); sore throat; laryngeal edema and laryngeal bronchospasm; and fever.

Although the above complications may exist, these symptoms can usually be alleviated and avoided with proper operation and good care. The doctor will explain the possible risks in detail before the examination and pay close attention to the patient's condition during and after the examination to ensure safety. I hope that every patient can understand this information and feel at ease to undergo bronchoscopy to protect their health.