Name of the Procedure:

Tracheobronchoscopy through Established Tracheostomy Incision
Common names: Tracheobronchoscopy, Bronchoscopy through Tracheostomy

Summary

Tracheobronchoscopy through an established tracheostomy incision is a medical procedure that allows a doctor to view the inside of the trachea and bronchi (airway passages) using a thin, flexible tube called a bronchoscope. This procedure is performed through an existing tracheostomy opening in the neck.

Purpose

The procedure is used to:

• Diagnose airway problems, such as blockages or injuries.
• Take tissue samples (biopsies).
• Remove foreign objects or mucus plugs.
• Evaluate the effectiveness of ongoing treatments for lung conditions.

Indications

• Persistent or unexplained cough.
• Difficulty breathing or suspected airway obstructions.
• Recurrent respiratory infections.
• Monitoring of known airway diseases, such as tracheal stenosis or tumors.
• Hemoptysis (coughing up blood).
• Need for airway clearance.

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications may need to be adjusted or paused.
• Pre-procedure diagnostic tests, such as chest X-rays or CT scans, may be required.

Procedure Description

1. Sedation/Anesthesia: The patient is usually given local anesthesia and may receive sedation.
2. Bronchoscope Insertion: A bronchoscope is inserted through the tracheostomy opening.
3. Visualization: The doctor examines the trachea and bronchi by guiding the bronchoscope through these airways.
4. Interventions: If necessary, tissue samples are taken, obstructions are removed, or therapeutic measures are performed.
5. Completion: The bronchoscope is carefully withdrawn once the examination and any interventions are complete.

Tools and Equipment:

• Flexible bronchoscope
• Suction device
• Tissue sampling tools (biopsy forceps)

Duration

The procedure typically takes 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Pulmonologist or thoracic surgeon
• Nursing staff
• Anesthesiologist or sedation nurse (if applicable)

Risks and Complications

• Bleeding
• Infection
• Allergic reactions to anesthesia
• Airway injury or perforation
• Respiratory difficulties

Benefits

• Accurate diagnosis of airway conditions.
• Ability to perform therapeutic interventions.
• Improved breathing and airway clearance.

Recovery

• Observation for a few hours post-procedure.
• Pain or soreness at the tracheostomy site may be managed with medication.
• Patients can typically return to normal activities within a day.
• Follow-up appointments may be necessary.

Alternatives

• Standard bronchoscopy (through the mouth or nose).
• Chest CT scan or imaging studies.
• Non-invasive respiratory treatments.

Pros and Cons:

• Standard bronchoscopy may be less suitable if the patient has a tracheostomy.
• Imaging studies provide less direct visualization but are non-invasive.

Patient Experience

During the procedure:

• Patients may feel some pressure and slight discomfort but should not experience pain due to sedation/anesthesia.

After the procedure:

• Mild sore throat or tracheostomy site discomfort.
• Temporary hoarseness or coughing may occur.
• Most discomfort is manageable with prescribed pain relief measures.