Bronchoscopy procedure note template

Bronchoalveolar lavage BAL is a procedure in which a bronchoscope is passed through the mouth or nose into the lungs to obtain cells and other components from bronchial and alveolar spaces for diagnostic purposes. Bronchoalveolar lavage is a diagnostic procedure similar to flexible bronchoscopy in which a bronchoscope is wedged into a bronchus.

In addition to the insertion of a bronchoscope, BAL involves pumping of sterile saline into the broncho-alveolar pathway which is then retrieved along with the fluid and cells to be analyzed. Bronchoalveolar lavage has an important diagnostic role in clinical pulmonary medicine.

The fluid obtained through this procedure can be used for cytology examination, Gram staining, and culture and sensitivity. In addition, many other biomarkers can be analyzed from BAL fluid, thereby helping the clinician in making a diagnosis. The right middle lobe RML and lingula of the lung are more easily accessible and are likely to allow a good return of lavage fluid with patients placed in a supine position.

Traditionally, these sites have been used for performing BAL. However, with the use of high-resolution computed tomography HRCTimages of the lung can be obtained which show specific areas having a prominent change especially areas with ground-glass attenuation. Lavaging these areas increases the chances of obtaining diagnostic material.

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Bronchoalveolar lavage is distinguished from segmental or whole lung lavage WLL which is a therapeutic procedure usually employed in pulmonary alveolar proteinosis to wash out the proteinaceous material occluding the airspaces. It is an infrequently done procedure carried out only in a few tertiary care centers. Bronchoalveolar lavage is different from bronchial lavage.

In the latter, saline is instilled into the large airways or bronchial tubes and then aspirated for fluid analysis. This results in the sampling of larger airways. It is carried out to detect cancer or to identify infectious pathogens involving the larger airways. In contrast, during BAL, the bronchoscope is directed into a smaller airway to minimize sampling from the large airways. BAL may be focused on specific regions of the lung, and multiple lavages may be performed during the same procedure.

BAL is mostly done under conscious-sedation anesthesia as an outpatient procedure. However, it can be carried out even in critically ill patients. The patient should be fasting overnight so as to reduce the risk of aspiration.

Bronchoscopy Procedure Note Sample

Medical conditions such as COPD or other should be stabilized before the procedure is done. To avoid contamination of the specimen, BAL should be performed prior to any other bronchoscopic procedure. The majority of the patients show no major adverse effect or complication during or after the procedure.A bronchoscopy is a test that allows your doctor to examine your airways.

Your doctor will thread an instrument called a bronchoscope through your nose or mouth and down your throat to reach your. SewArt 1. Stewart for mac download free.

bronchoscopy procedure note template

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Image processing tools and a step-by-step wizard. Even though SewArt for Mac is not available on the market, there are several alternative Mac apps that might be helpful. Bronchoscopy is most commonly performed using a flexible bronchoscope. However, in certain situations, such as if there's a lot of bleeding in your lungs or a large object is stuck in your airway, a rigid bronchoscope may be needed.

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Common reasons for needing bronchoscopy are persistent cough, infection and something unusual seen on a chest X-ray or other test. Bronchoscopy can also be used to obtain samples of mucus or tissue, or to remove foreign bodies or other blockages from the airways or lungs.

Why it's done Bronchoscopy is usually done to find the cause of a lung problem. For example, your doctor might refer you for bronchoscopy because you have a persistent cough or an abnormal chest X-ray.

In people with lung cancer, a bronchoscope with a built-in ultrasound probe may be used to check the lymph nodes in the chest. This is called endobronchial ultrasound EBUS and helps doctors determine the appropriate treatment. EBUS may be used for other types of cancer to determine if the cancer has spread. Bronchoscopy can also treat some medical problems.

It can be used to remove obstructions or tumors from the air passages or lungs, or to place a small tube to hold open an airway stent. In these instances, special devices may be passed through the bronchoscope, such as a laser or electrocautery probe for controlling bleeding.Flexible bronchoscopy. Right muscle-sparing lateral thoracotomy with complete decortication of the lung with drainage of right lower lobe lung abscess.

After satisfactory induction of general endotracheal anesthesia, a flexible Olympus bronchoscope was passed through the endotracheal tube, visualizing the distal trachea, carina, right and left main stem bronchus with primary and secondary divisions. No evidence of any endobronchial tumor was noted. What I did see was some crowding involving the right middle lobe and right lower lobe bronchi. The scope was then withdrawn. A double-lumen endotracheal tube was then positioned by the anesthesiologist.

The patient was placed in the left lateral decubitus position and prepped and draped in the usual sterile fashion. A right muscle-sparing lateral thoracotomy was made. We entered via the fifth intercostal space. Careful exploration was carried out and findings were as stated above. The gelatinous material present in the right pleural space was completely evacuated.

Adhesiolysis was carried out freeing up the entire right lung. Decortication was next carried out, being careful not to injure the underlying lung parenchyma. The patient had a very thick pleural rind. While performing the decortication, I unroofed a 2 x 2 cm right lower lobe lung abscess. The contents were evacuated. I sent cultures of the abscess cavity as well as of the empyema cavity in separate containers to microbiology for examination.

All decorticated tissue was also sent to pathology for examination as well. Excellent lung expansion was noted. I irrigated the entire region using several liters of warm antibiotic saline solution until the effluent came back clear and then I irrigated with several more liters.

Attention was then directed at closing. Two French chest tubes were placed, 1 anteriorly and 1 posteriorly, and these were brought out through inferior stab wounds.

bronchoscopy procedure note template

The ribs were approximated using heavy Vicryl sutures.Acute respiratory failure. Obstructing tumordistal left main stem bronchus. Postobstructive pneumonia. Obstructing tumor, distal left main stem bronchus. Flexible bronchoscopy with debridement and ablation of distal left main bronchial tumor at the secondary carina.

Therapeutic aspiration of the airways. He underwent a right hemicolectomy. In the postoperative period, he developed respiratory failure. He had abnormal ventilator mechanics. A bronchoscopy had been performed by the ICU service and this revealed an obstructing lesion in the distal left main stem bronchus. This lesion arose from the secondary carina and this mushroomed out and obstructed the lumen to both the left upper lobe and left lower lobe bronchi.

bronchoscopy procedure note template

This was given sequentially throughout the procedure to those total doses. Flexible thoracoscopy was performed. The distal trachea, right main stem bronchus, right upper lobe, right middle lobe, and right lower lobe bronchi were all normal.

The proximal left main stem bronchus was normal. The distal left main bronchus was obstructed by a polypoid lesion projecting from the secondary carina. We could squeeze the bronchoscope past the lesions superiorly and inferiorly and then through this compressed area, opened up into the obstructed bronchi.

The bronchoscope was pulled back. Once the tumor was debrided back to the base of the lesion in the thickened area of carina, the base of the lesion was coagulated with the Argon plasma coagulator cauterizing tissue back to allowing a fully patent proximal left upper lobe and left lower lobe bronchi.

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As the purulent mucus was aspirated from the left upper lobe and left lower lobe bronchi, it was then irrigated and aspirated clear. There was good hemostasis. A significant amount of mucus was aspirated from the upper lobe and lower lobe bronchi. The patient tolerated the procedure well without incident. The bronchoscope was removed, and the patient remained in the ICU in satisfactory condition.

We should note that a time-out was held prior to the procedure confirming the correct patient and the correct procedure. Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website.

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Patients on beta-blockers present a special problem, because epinephrine has both alpha-activity and beta-activity. Therefore, using epinephrine in the setting of beta-blockage yields unopposed alpha-activity that could result in hypertensive crisis.

It is advisable for patients to stop beta-blockers before the procedure, if epinephrine is to be used. The patient findings and explanations about the procedure given to the patient need to be documented in the chart prior to the procedure. The physical examination and history need to rule out other potentially serious diseases, as well as evaluate the primary lung problem. Chest x-ray and oxygen saturation are done prior to the procedure.

Respiratory depression can be a major problem with these agents. The agent of choice is midazolam, titrated to effect 0. Reversal of the midazolam effect should be considered in high-risk patients at the completion of the procedure.

Local Anesthesia Transoral Dentures are out. Electrocardiogram EKG monitor and nasal oxygen are on; liter flows recommended by the bronchoscopist; standard flow is 5 LPM per nasal prongs, unless physician orders otherwise.

Bronchoalveolar Lavage (BAL)- Procedure, Indications and Diagnostic Tests

Spray on inspiration to aid distribution of the anesthetic. More or less of the spray may be used, depending on the patient. This effectively blocks the internal branch of the superior laryngeal nerve by transmucosal absorption, knocking out the gag reflex. Anesthesia can be checked by inserting fingers into the patient's mouth to the back of the tongue to check for gag reflux.

If anesthesia is effective, the patient is ready for the initial insertion of the bronchoscope. With the patient sitting, the flexible bronchoscope can be placed orally and gently slide over the back of the tongue to view the vocal cords. This works best with the patient making panting respirations. Glassware and metalware should be cleaned in the scope washer. Overdose is manifested by CNS symptoms tremor, shivering, weakness. Spray by pointing atomizer tip straight back, not up the nares.

The patient is often uncomfortable until some anesthesia has been accomplished. Have the patient lie back on the table and squirt 0. Have the patient sniff through each nostril to determine which is the most patent.

Procedure Notes: Endotracheal Intubation

Let anesthesia take effect five minutes before proceeding.Flexible bronchoscopy. Cervical mediastinoscopy with biopsy and thyroid isthmusectomy.

bronchoscopy procedure note template

The procedures were explained to the patient. All risks, benefits, and options were discussed. The risks include but were not limited to bleeding, infection, and pneumothorax.

All of her questions were answered, and she wished for us to proceed with the surgery. No evidence of any endobronchial mass was noted. Mediastinoscopy revealed several firm pretracheal and right paratracheal masses.

Frozen section analysis revealed this to be a non-small cell carcinoma, most likely squamous cell carcinoma. After satisfactory induction of general endotracheal anesthesia, a flexible Olympus bronchoscope was passed through the endotracheal tube visualizing the distal trachea, carina, and right and left main stem bronchus with the primary and secondary divisions. No evidence of any endobronchial tumor was noted. We did see some blunting of the carina. The scope was then withdrawn.

The patient was then prepped and draped in the usual sterile fashion. A small curvilinear incision was made above the suprasternal notch in the line of the skin crease. Dissection was carried down through the subcutaneous tissue down through the platysmal muscle. The strap muscles were next identified and laterally retracted. We continued our dissection down to the pretracheal fascia. A thyroid isthmusectomy was done without any problems with excellent hemostasis being obtained.

A pretracheal plane was next developed. A mediastinoscope was then placed.

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Careful exploration was carried out, and findings were as stated above. Multiple right paratracheal and pretracheal lymph nodes were encountered after first aspirating these nodes to make sure they were not vascular in nature.

Generous biopsies were taken and sent to pathology for examination. Frozen section analysis revealed this to be a non-small cell carcinoma, most likely squamous cell. Excellent hemostasis was obtained. The wound was then closed in layers using Vicryl sutures.Procedure and the complications including complication of anesthesia, pneumothorax requiring chest tube, bleeding complication, arrhythmia, hypoxia, need for ventilation was explained to the patient and he consented for the procedure.

The patient was brought to the operating suite. Under general anesthesia, endotracheal tube was placed by anesthesiologist. Bronchoscopy was done through endotracheal tube. Distal trachea is normal. Main carina is sharp. Bronchoscope was advanced to the left lung. Left upper lingula and lower lobe were visualized up to subsegmental level. All subsegments are patent.

No endobronchial or mucosal lesions were seen. The bronchoscope was further advanced to the right lung. Right upper, middle and lower lobe were visualized. No endobronchial obstructing or mucosal lesions were seen. Right lower lobe bronchoalveolar lavage and brushing was done. It was sent for cytology. Right upper lobe bronchoalveolar lavagebrushing and biopsies were done. Biopsies sent for pathology. Bronchoalveolar lavage sent for cytology.

Brushing sent for cytology. The patient tolerated the procedure well. Postprocedure chest x-ray to rule out pneumothorax. Cervical mediastinotomy with frozen section. There was no evidence of endobronchial pathology.


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