Page 511 - Clinical Application of Mechanical Ventilation

Procedures Related to Mechanical Ventilation 477

channel. Wedging of the bleeding site may then be done by inflating the balloon tip
of the catheter. Bronchoscopes that have a built-in coagulation electrode may stop
hemorrhaging by using the coagulation mode (heat-induced coagulation).
Pneumothorax. Biopsy instruments are sharp and long enough to reach and puncture
the periphery of the lung. In extremely rare cases, pneumothoraces may occur during
bronchoscopy (Sun et al., 2003). Puncture of the lung while the patient is receiving
mechanical ventilation may lead to tension pneumothorax. The vital signs of the patient
must be monitored closely. Worsening cyanosis in spite of high oxygen concentration,
diaphoresis, tachypnea, tachycardia, and thready pulse are some signs of tension pneu-
mothorax. Chest tube is the treatment for tension pneumothorax and a complete chest
tube setup should be on the bronchoscopy supplies list.
Postbronchoscopy Complications. Incidence of serious complications and mortality as-
sociated with fiberoptic bronchoscopy is low. In one survey of over 24,000 proce-
dures, major complications occurred in 0.08% of all cases. The mortality rate was
0.1% to 0.2%, most of them secondary to hemorrhage and pneumothorax (Pue et
al., 1995). If sudden deterioration of the patient’s condition occurs, chest radiography
should be taken to rule out pneumothorax.
Hypoxemia and arrhythmias are the most common complications during and after
Hypoxemia and arrhyth- bronchoscopy (Yildiz et al., 2002). Oxygen therapy, proper use of topical anesthesia,
mias are the most common
complications during and and use of intermittent suction are useful techniques to minimize the occurrence of these
after bronchoscopy. complications. Continuous pulse oximeter should be used during the recovery period.

Postbronchoscopy Care

Following bronchoscopy, the patient’s vital signs are monitored for at least 2 hours
or until stable. During the recovery period, an aerosolized bronchodilator may be
used to treat bronchospasm. Oxygen is titrated to maintain a satisfactory SpO and
2
it may be provided via nasal cannula or continuous aerosol. Food and drink are
withheld from the patient until the gag reflex has returned.
Cleaning and Care of Equipment. All equipment and supplies used in bronchoscopy
must be cleaned, disinfected, or sterilized where indicated (Culver et al., 2003;
Alvarado et al., 2000; Weber et al., 2001). The bronchoscope must also be main-
tained on a regular basis (AORN, 2001). The portion of the bronchoscope that
comes in contact with the mucosal membrane must be sterilized. Bronchoscopes
used in examining patients with tuberculosis or hepatitis B should also be sterilized.
Ethylene oxide is used to sterilize delicate parts that cannot withstand steam auto-
clave. A checklist should be maintained to track delivery of equipment and supplies.
Restocking of the disposables and consumables in the cart should be documented.

TRANSPORT OF MECHANICALLY VENTILATED PATIENTS

Patients receiving mechanical ventilation are critically ill or have deficiencies in the
major organs or systems. They may also have difficulty in maintaining an adequate
level of ventilation and oxygenation to fulfill their metabolic needs. In an intensive
care setting, numerous resources are available to care for the mechanically ventilated

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