1. Fundamentals of Flexible Bronchoscopy Conventional Transbronchial Needle Aspiration EQUIPMENT

2. Equipment
bronchoscopy.org

3. History Conventional Transbronchial needle aspiration (cTBNA)
Originally described in Argentina by SCHIEPPATI E. “La punction mediastinal traves del espolon traquel” in Rev As Med Argent 1949, 663: Rigid bronchoscopy was used as a conduit for a rigid needle.
Expanded upon using flexible bronchoscopy in the 1970s
A new needle for transfiberoptic bronchoscope use. Oho K, Kato H, Ogawa I, Hayashi N, Hayata Y Chest 1979; 76: 492 (letter to the Editor).

4. Conventional TBNA today
Performed in outpatients in a bronchoscopy suite.
Performed using moderate sedation and topical anesthesia.
Rapid on site examination (histology or cytology) increases diagnostic yield.
Especially beneficial for level 7 and level 4R lymph nodes (yield is similar to EBUS - TBNA at these regions)

5. Training is essential in order to
Learn proper techniques and indications
Avoid procedure-related complications.
Learn to protect the equipment.
Avoid forced passage of the needle through the scope at ANY time, especially if the scope is flexed.
Avoid needle manipulation while it is inside the working channel of the bronchoscope.

6. Equipment : Examples of Cytology Needles
13 mm
22 G
13 mm
21 G
Bard MW 122
Olympus NA-1-C

7. Equipment: Examples of Histology Needles
BARD MW-319
EXCELON
19 mm
21 G
All 19 Gauge

8. Core samples can be obtained using histology needles
Photo courtesy A. Mehta
Photo courtesy S. Gasparini

9. Prepared with help from Udaya Prakash M. D. (USA), Atul Mehta M. D
Prepared with help from Udaya Prakash M.D. (USA), Atul Mehta M.D. (USA), Stefano Gasparini, and Wes Shepherd M.D. (USA)