Overview

Bronchoscopy is an invasive procedure that allows the direct examination of the larynx, trachea and bronchi using either a flexible fibreoptic bronchoscope or a rigid metal bronchoscope.1,2 Nurses perform an important role supporting patients undergoing bronchoscopy. In this article, we review the role of the bronchoscopy nurse in 3 surgical stages.

A. Bronchoscopy Nurse - before the procedure

Ahead of the bronchoscopy procedure, the nurse’s role involves providing information on what to expect and what to avoid, helping relieve anxiety. The patient must be given a full explanation of the procedure, including risks, benefits and alternatives, as well as the preparation required.2 Other important tasks for nurses before the procedure include the following:1

  • Ensuring informed consent has been signed.
  • Collecting medical history, noting any known allergies.
  • Checking NPO status to reduce risk of aspiration.
  • Monitoring vital signs, including heart rate, blood pressure, respiratory rate and oxygen saturation.
  • Instructing on oral hygiene and remove dentures if appropriate.
  • Administering pre-operative medications as prescribed.
  • Preparing equipment required for the procedure, as well as emergency equipment that might be necessary.

B. Bronchoscopy Nurse - during the procedure

During the bronchoscopy, intravenous sedation is given in incremental doses until the patient is adequately sedated. The patient must remain purposefully responding to the nurse, able to follow instructions and take deep breaths.2
 
The nurse must monitor the patient’s pulse, respirations and oxygen saturation levels using a pulse oximeter. Electrocardiography is not monitored routinely, unless the patient has a known history of severe cardiac disease. Any fall in oxygen saturation is treated with supplemental oxygen via a nasal cannula. The nurse must also look for any changes in breathing pattern, chest pain or any other signs of discomfort.2
 
Other responsibilities of the bronchoscopy nurse include:1
 
  • Positioning the patient in a sitting or supine position and administer supplemental oxygen as prescribed.
  • Providing assistance with the procedure, including collection of tissue specimen for testing, removal of foreign body, bronchoalveolar lavage, placement of a bronchial stent, and aspiration of retained secretions.

C. Bronchoscopy Nurse - after the procedure

For an hour after the procedure, the patient’s vital signs must be monitored regularly according to their general condition. Changes in breathing pattern, chest pain or oxygen saturation levels should be reported.2 Other important tasks include:1

  • Noticing any haemorrhage, observing the patient’s sputum and report for any excessive bleeding. 
  • Assessing respiratory status. Watching for signs of bronchial spasm or bronchial perforation such as facial crepitus, hypoxemia, haemorrhage, and chest tightness.
  • Monitoring vital signs, including heart rate, respiratory rate, blood pressure and oxygen saturation.
  • Positioning the patient assuring safety and comfort; reassuring them that a hoarse voice, loss of voice and sore throat may occur temporarily. 

Conclusion

In conclusion, bronchoscopy is an invasive procedure that requires adequate patient preparation and cooperation. Nurse bronchoscopists play an important role before, during and after procedures to ensure patient safety.

About the author

My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.

This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.

    

The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.

  • 1. Martin, P. (2019) Bronchoscopy. Nurse Labs. Available at https://nurseslabs.com/bronchoscopy/

  • 2. Martin, J. (2013) Preparing and supporting patients undergoing a bronchoscopy. Nursing Times. Available at https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/preparing-and-supporting-patients-undergoing-a-bronchoscopy-14-10-2003/

  • 3. National Heart, Lung, and Blood Institute. Bronchoscopy. Available at https://www.nhlbi.nih.gov/health-topics/bronchoscopy