Page 510 - Clinical Application of Mechanical Ventilation

476 Chapter 14

transbronchial needle aspira- Transbronchial Needle Aspiration Biopsy. Transbronchial needle aspiration biopsy
tion biopsy (TBNAB): Tissue (TBNAB) is done where the lesion is located beyond the bronchial wall and there
specimens collected by applying
aspiration while moving the is no lesion in the bronchial lumen. This is done by pressing the tip of the broncho-
needle at the sample collection scope gently against the target puncture site. The tip of the needle is then firmly pro-
site.
jected through the mucosal wall. Aspiration (suction) is applied while moving the
tip of the insertion tube of the bronchoscope back and forth and from side to side.
The specimen (inside the needle) and the needle are retrieved from the broncho-
scope and a syringe is used to expel the specimen from the needle (Figure 14-10B).
Bronchial Brushing. Cytologic examination may be necessary when an area of patho-
bronchial brushing: Tissue or
loosened cell specimens collected logic change is encountered during bronchoscopy. A shielded small brush is used to
by a shielded small brush using a
brushing motion. brush along the bronchial mucosa and the loosened cells are adhered to the brush
(Figure 14-10C). The brush is then withdrawn into the shield and the entire appa-
ratus is removed from the channel outlet of the bronchoscope. A microscopic slide
may be made by fixing it with a suitable solution. An alternative is to cut off the
brush and send it for pathologic tests.
Complications

In vast majority of cases, bronchoscopy is a safe procedure. However, complications
Complications of bron- do occur and they range from infection to puncture of the lungs (Geraci et al.,
choscopy include infection,
hypoxemia, hemorrhage, and 2007; Pue et al., 1995).
pneumothorax.
Infection. There were reports of transmission and outbreak of Mycobacterium tuber-
culosis and Pseudomonas aeruginosa infections caused by the flexible bronchoscope
(Agerton et al., 1997; Michele et al., 1997; Spach et al., 1993; Srinivasan et al., 2003).
An increase in the frequency of Pseudomonas and other infections was also found to
be associated with bronchoscopy (Hanson et al., 1991). These experiences show the
need for diligent infection-control measures in the use of the bronchoscope.
Since the same bronchoscope is used to enter and explore different lung segments,
the incidence of cross-contamination of healthy lung segments by infected ones is
a possibility. Likewise, the saline solution used for lavaging the lung segments also
poses a threat of cross-contamination of healthy lung segments.
Hypoxemia. The bronchoscope decreases the size of the airway opening and may cause
partial airflow obstruction (Shakespeare et al., 2003). Ventilation/perfusion (V/Q) mis-
match and secondary hypoxemia may occur during and after bronchoscopy because of
the retained lavage solution, hypoventilation from premedication, mobilized and pooled
secretions, and excessive suctioning. Supplemental oxygen should be used to allevi-
ate the problem of secondary oxygen desaturation during bronchoscopy (Yildiz et al.,
2002). In most cases, oxygen therapy may be discontinued 4 hours after bronchoscopy.
Hemorrhage. Bleeding can occur during bronchoscopy. Most minor bleeding may
be stopped by saline lavage. When substantial bleeding occurs, a vasopressor (e.g.,
1 mL of 1:1000 epinephrine with 9 mL of normal saline given in 2-mL portions)
can be used to control bleeding from the biopsy site. Bleeding may also be stopped
by wedging the bleeding site with the distal end of the bronchoscope. If wedging
cannot be done because the airway is larger than the distal end of the bronchoscope,
a 6-Fr Fogarty embolectomy catheter with balloon tip may be inserted through the

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