Name of the Procedure:

Bronchoscopy, rigid or flexible (with fluoroscopic guidance, when performed) with therapeutic aspiration of the tracheobronchial tree, initial.

Summary

A bronchoscopy involves inserting a thin tube with a camera (bronchoscope) into the airways through the nose or mouth to examine the trachea and bronchi. This procedure can be done with either a rigid or flexible bronchoscope and sometimes uses fluoroscopic guidance (real-time X-ray) to help visualize the area. In this therapeutic procedure, the bronchoscope is used to aspirate mucus or other blockages from the tracheobronchial tree.

Purpose

This procedure is used to clear blockages in the airways that may be caused by mucus, foreign bodies, or other obstructions. It helps to restore normal breathing, diagnose conditions of the airways, and provide therapeutic interventions.

Indications

• Persistent cough
• Unexplained wheezing or shortness of breath
• Obstruction in the airways
• Suspected infection in the lungs or airways
• Need to remove a foreign object
• Presence of an abnormal growth or lesion within the airways

Preparation

• Patients might be instructed to fast for 6-8 hours before the procedure.
• Medications that affect blood clotting may need to be adjusted.
• Diagnostic tests like blood work or imaging (e.g., CT scan) might be performed beforehand.

Procedure Description

1. The patient is positioned, typically lying flat.
2. Anesthesia or sedation is administered. General anesthesia is used for rigid bronchoscopy; for flexible bronchoscopy, local anesthesia with sedation may be employed.
3. The bronchoscope is inserted through the nose or mouth and gently guided into the airways.
4. Fluoroscopic guidance may be used for better visualization.
5. Therapeutic aspiration is performed to remove mucus, foreign bodies, or other blockages.
6. Instruments attached to the bronchoscope might also collect tissue samples if necessary.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, either in a specialized endoscopy suite or operating room.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist or Nurse Anesthetist
• Trained Nurses and Technicians

Risks and Complications

• Bleeding
• Infection
• Low oxygen levels during the procedure
• Reactions to anesthesia
• Perforation of the airway (rare)
• Pneumothorax (collapsed lung)

Benefits

• Immediate relief of airway obstruction
• Improved breathing
• Accurate diagnosis of airway conditions
• Removal of foreign bodies or harmful substances
• Rapid improvement in symptoms

Recovery

• Patients are monitored in a recovery area until sedation wears off.
• Throat soreness or hoarseness may occur temporarily.
• Normal activities can usually be resumed within a day, but strenuous activities might need to be avoided for several days.
• Follow-up appointments may be necessary to evaluate the outcomes and any further treatment needs.

Alternatives

• Medical management with bronchodilators or other medications
• Non-invasive imaging studies like CT scans for diagnostic purposes
• Surgical interventions if a more invasive approach is necessary

Patient Experience

During the procedure, patients under sedation typically do not feel discomfort. Post-procedure, there might be mild throat discomfort, coughing, or hoarseness. Pain management includes over-the-counter pain relievers and supportive care measures such as throat lozenges and rest.