1. Theoretical introductions to bronchoscopy
Critical Care Bronchoscopy Course – 19 Feb 2016
Theoretical introductions to bronchoscopy
Jonathan Ball
Consultant in General and Neuro Intensive Care

2. What do I need to think about before I do the procedure?
Critical Care Bronchoscopy Course – 19 Feb 2016
What do I need to think about before I do the procedure?
Jonathan Ball
Consultant in General and Neuro Intensive Care

3. The rule of P’s Planning a practical procedure?
Proper prior preparation and planning prevent piss poor performance

4. Assemble Toys The best available scope for the job in-hand
Suction valve / syringe cap
Suction (Dedicated?)
Light source
Camera?
Sterile jug + volume of 0.9% NaCl + 20ml syringe
Gauze
Lubricant
Topical anaesthesia? (1% lidocaine gel &/or liquid etc)
Sputum trap
Brush / forceps / other instruments
Cleaning solution / paraphernalia

6. Check Toys Work Can you see? - Light and focus
Does white look white? – White balance
Can you inject?
Can you suck?
Are you sticky?

7. Protect Yourself & Your Friends
Eyes
Nose and mouth
Gown and gloves
Be conscious of aerosols

8. Prepare your customer Consent? Coagulopathy?
Gastric distention / vomiting risk?
Sedation?
Monitoring?
Oxygen?
Ventilation?
Nose verses mouth verses tube?

9. Prepare your environment
Trolleys, trays, stacks and other hazards
Friends and runners?
Are you standing comfortably?
What can’t you reach?
What can’t you see?

10. Prepare for disasters Airway failure Hypoxia Hypercarbia
laryngospasm
tube displacement / obstruction
Hypoxia
Hypercarbia
Bradycardia / Hypotension
Bleeding
Pneumothorax
Sepsis / SIRS

11. Procedure What question(s) do you want to answer? Look
start with the normal?
look everywhere?
Remove proximal debris
Sample? (raw verses BAL verses brushings verses Bx)
Final check

12. Post Procedure Patient Scope and equipment Samples
Write an account +/- a plan