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Bronchoscopy and Chest Tubes

Bronchoscopy and Chest Tubes. RC 275. Fiberoptic Bronchoscopy ( F.O.B .). Indications. Therapeutic Remove mucus and/or foreign bodies Diagnostic Identify tumors, inflammation, Lavage sample for C & S, etc. Patient Education Explain procedure and answer questions

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Bronchoscopy and Chest Tubes

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  1. Bronchoscopy and Chest Tubes RC 275

  2. Fiberoptic Bronchoscopy(F.O.B.)

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

  4. Patient Education Explain procedure and answer questions Be reassuring and put patient at ease 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 Respiratory Therapist’s Role

  5. 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

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

  7. Possible Complications • Hypoxia • Arrhythmias • Bronchospasm/Laryngospasm • Hemorrhage • Pneumothorax • Infection

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

  9. Chest Tube Placement • 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 marginof the intercostal space

  10. Chest Tube Insertion

  11. Drainage Setup: 1st “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

  12. 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)

  13. 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 10-20 cm • Should “bubble” continuously

  14. 3 Chambered System • Today, chest tube systems are disposable, three chambered sets • Trap, water seal, and suction chambers • Function the same as “3 Bottle System”

  15. 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 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 Chest Tube Care

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