Bronchoscopy and Chest Tubes RC 275

Fiberoptic Bronchoscopy (F.O.B.)

Indications Therapeutic Therapeutic Remove mucus and/or foreign bodies Remove mucus and/or foreign bodies Diagnostic Diagnostic Identify tumors, inflammation, Lavage sample for C & S, etc Identify tumors, inflammation, Lavage sample for C & S, etc

Respiratory Therapist’s Role Patient Education Patient Education Explain procedure and answer questions Explain procedure and answer questions Be reassuring and put patient at ease Be reassuring and put patient at ease Administer pre- bronch anesthesia Administer pre- bronch anesthesia Assist physician during procedure Suction PRN Monitor vitals (POx, EKG, ETCO2, as well as TPR and BP) Instill lavage Assist with specimen collection Monitor patient post- bronch 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 Forceps, brushes, slides and fixative

Sampling Techniques Lavage with suction trap Use non-bacteriostatic lavage solution Brush – minimal hemorrhage Forceps – excellent sample but may cause significant bleeding

Possible Complications Hypoxia Hypoxia Arrhythmias Arrhythmias Bronchospasm/Laryngospasm Bronchospasm/Laryngospasm Hemorrhage Hemorrhage Pneumothorax Pneumothorax Infection Infection

Chest Tube Drainage Indications: whenever there is significant air or fluid in the pleural space Pneumothorax Pneumothorax Pleural effusions Pleural effusions Transudates or exudates Transudates or exudates

Chest Tube Placement For pneumothorax, 2 nd or 3 rd intercostal space at midclavicular line For effusion, 5 th 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: 1 st “Bottle” Water seal – prevents air from getting into pleura but allows it to exit Water seal height is usually 2 cm The water seal level fluctuates with respiration! It bubbles as air exits Spontaneous breathing during exhalation Positive pressure ventilation during inspiration

2 bottle system 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 Suction– it measures and controls suction applied to pleural space Comes AFTER the water seal Suction is determined by the height of the water Usually cm Should “bubble” continuously

3 Chambered System Today, chest tube systems are disposable, three chambered sets Today, chest tube systems are disposable, three chambered sets Trap, water seal, and suction chambers Trap, water seal, and suction chambers Function the same as “3 Bottle System” Function the same as “3 Bottle System”

Chest Tube Care Chest tube should be sutured to chest, and all connections secure and taped. Chest tube should be sutured to chest, and all connections secure and taped. Do not allow any gravity dependent loops to form Do not allow any gravity dependent loops to form Never raise drainage container above the chest Never raise drainage container above the chest If transporting patient, disconnect suction hose (Don’t just turn it off!) Check system operation frequently Adequate fluid levels Fluctuation in water seal chamber Continuous bubbling in suction chamber Follow hospital protocol in regard to clamping and milking tubes