Endoscopy is a non-surgical medical technique used to examine a person's internal organs and vessels. This lesson will focus on two types of endoscopic studies: bronchoscopy and thoracoscopy.

Bronchoscopy

Description

Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due to its flexibility, small size, and excellent optical system, which allows for increased visualization of the peripheral airways.

Purpose

Diagnostic bronchoscopy serves to visualize tissues, determine the nature, location, and extent of the pathologic process, collect secretions for analysis, obtain tissue samples for diagnosis, and determine whether a tumor can be resected surgically. Therapeutic bronchoscopy removes foreign bodies or secretions from the tracheobronchial tree, controls bleeding, treats postoperative atelectasis, destroys and excises lesions, provides brachytherapy, and inserts stents to relieve airway obstruction.

Procedure

The patient must abstain from food or drink for at least 6 hours before the procedure to decrease the risk of aspiration. Medications such as atropine for dry secretions and a sedative or narcotic to depress the vagus nerve are administered before the procedure. The bronchoscope is introduced through the nose, mouth, tracheostomy, or artificial airway.

Nursing Responsibilities

Before the procedure, ensure that informed consent has been obtained and explain the procedure to the patient to alleviate fear and anxiety. The patient must abstain from food or drink for at least 6 hours before the bronchoscopy to decrease the risk of aspiration.

After the procedure, the patient should take nothing by mouth (NPO) until the cough reflex returns. Monitor the patient's respiratory status and watch for complications like hypoxia, hypotension, tachycardia, arrhythmias, hemoptysis, and dyspnea. Report any abnormalities promptly.

Thoracoscopy

Description

Thoracoscopy is a diagnostic procedure that allows for examining the pleural cavity. An endoscope is inserted through small incisions into the pleural cavity through an intercostal space.

Purpose

This procedure is performed to evaluate pleural effusions and pleural disease, for the staging of tumors, and for obtaining fluid and tissue samples for analysis. Future potential exists for laser treatment of pulmonary nodules and other growths.

Procedure

The location for the incision is selected based on clinical and diagnostic findings. If fluid is present, it is aspirated and sent for culture and cellular studies. A chest tube may be inserted following the procedure for re-expansion of the lung.

Nursing Responsibilities

Preoperatively, the nurse should ensure informed consent is obtained and that the patient remains NPO(nothing by mouth)for 6 hours before the procedure. Postoperatively, vital signs, pain level, and respiratory status should be monitored. The nurse should look for signs of bleeding and infection at the incisional site. Shortness of breath may indicate a pneumothorax and should be reported immediately.

Bronchoscopy and Thoracoscopy are valuable endoscopic procedures for diagnosing and treating various lung and pleural diseases. Proper nursing care before and after these procedures is vital for patient safety and recovery.