Bronchoscopy

Bronchoscopy is a procedure that helps the healthcare provider look directly at the airways in the lungs using a thin, lighted tube (bronchoscope). The bronchoscope is put in the nose or mouth. It is moved down the throat and windpipe (trachea), and into the airways. A healthcare provider can then see the voice box (larynx), trachea, and large and medium-sized airways.

There are two types of bronchoscopes: flexible and rigid. Both types come in different widths.

A rigid bronchoscope is a straight tube. It’s only used to view the larger airways. It may be used within the bronchi to:

• Remove a large amount of secretions or blood
• Control bleeding
• Remove foreign objects
• Remove diseased tissue (lesions)
• Do procedures and other treatments

A flexible bronchoscope is used more often. Unlike the rigid scope, it can be moved down into the smaller airways (bronchioles). The flexible bronchoscope may be used to:

• Place a breathing tube in the airway to help give oxygen
• Suction out secretions
• Take tissue samples (biopsy)
• Put medicine into the lungs

A bronchoscopy may be done to diagnose and treat lung problems such as:

• Tumors or bronchial cancer
• Airway blockage (obstruction)
• Narrowed areas in airways (strictures)
• Inflammation and infections such as tuberculosis (TB), pneumonia, and fungal or parasitic lung infections
• Interstitial pulmonary disease
• Causes of persistent cough
• Causes of coughing up blood
• Spots seen on chest X-rays
• Vocal cord paralysis

Diagnostic procedures or treatments that are done with bronchoscopy include:

• Biopsy of tissue
• Collection of sputum
• Fluid put into the lungs and then removed (bronchoalveolar lavage or BAL) to diagnose lung disorders
• Removal of secretions, blood, mucus plugs, or growths (polyps) to clear airways
• Control of bleeding in the bronchi
• Removing foreign objects or other blockages
• Laser therapy or radiation treatment for bronchial tumors
• Placement of a small tube (stent) to keep an airway open (stent placement)
• Draining an area of pus (abscess)

Your healthcare provider may also have other reasons to advise a bronchoscopy.

Give your healthcare provider a list of all of the medicines your child takes. This includes prescription and over-the-counter medicines, vitamins, herbs and supplements. Your child may need to stop certain medicines before the procedure. Follow any directions you're given for not eating or drinking before the procedure.

You will be asked to sign an informed consent document. This document explains the benefits and risks of the procedure. Make sure all of your questions are answered before you sign it.

Your child may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. A bronchoscopy can take 15 minutes to 1 hour. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, a bronchoscopy will follow this process:

• Your healthcare provider may ask your child to remove their clothes. If so, they will give you a hospital gown to wear. They may ask your child to remove jewelry or other objects
• Your child will lie down on a procedure table with the head raised up slightly
• Your healthcare provider may put an IV (intravenous) into your child's arm or hand
• Your healthcare provider may give your child antibiotics before and after the procedure
• Your child may be awake during the procedure. Your healthcare provider will give your child medicine to help you relax (sedative). They will also give your child a liquid medicine to numb their nose and throat. For a rigid bronchoscopy, they will give your child general anesthesia. This is medicine that prevents pain and lets them sleep through the procedure
• Your healthcare provider may give your child oxygen through a nasal tube or face mask. They will watch your child's heart rate, blood pressure and breathing during the procedure
• Your provider will spray numbing medicine into the back of your child's throat. This is to prevent gagging as the bronchoscope is passed down the throat. The spray may have a bitter taste to it. Once the tube passes down the throat, the gagging feeling will go away
• Your child won’t be able to talk or swallow saliva during the procedure. Saliva will be suctioned from the mouth as needed
• Your provider will move the bronchoscope down the throat and into the airways. Your child's airway will not be blocked, and they can breathe around the bronchoscope. They will be given extra oxygen if needed
• As the bronchoscope is moved down, the lungs will be examined. Your provider may take tissue samples or mucus for testing. They may do other procedures as needed. This may include giving medicine or stopping bleeding
• When the exam and other procedures are done, the bronchoscope will be taken out

After the procedure, your child will spend some time in a recovery room. Your child may be sleepy and confused when they wake up from general anesthesia or sedation. Their healthcare team will watch vital signs, such as heart rate and breathing.

A chest X-ray may be done right after the procedure. This is to make sure your child's lungs are OK. They may be told to gently cough up and spit your saliva into a basin. This is so a nurse can check your child's secretions for blood.

Your child may have some mild pain in your throat. Your child won't be allowed to eat or drink until their gag reflex has returned. They may notice some throat soreness and pain with swallowing for a few days. This is normal. Using throat lozenges or gargling may help.

If they had an outpatient procedure, you will go home when your healthcare provider says it’s OK.

At home, your child can go back to normal diet and activities if instructed by their healthcare provider. They may need to limit any physical activity for a few days.

You may notice a low-grade fever. This is common.

Call your healthcare provider if your child has any of these:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider
• Redness or swelling of the IV site
• Blood or other fluid leaking from the IV site
• Coughing up significant amounts of blood
• Chest pain
• Severe hoarseness
• Trouble breathing

Your healthcare provider may give you other instructions after the procedure.