Consent and Pre-Screening
- Explain the procedure to the patient and allay his anxieties. Patients may have
heard about the distress associated with a rigid bronchoscope. Explain that the fiberoptic
bronchoscope has made the procedure much easier.
- Assure the patient that there is sufficient room for air to go through.
- Instruct the patient that he should not talk during the procedure to avoid the
likelihood of injury to the vocal cord. However, we'll establish some mechanism of
communication. Instruct him to raise his fist whenever he is uncomfortable. If a
transbronchial biopsy is planned, he will be asked to take a deep breath and expire
slowly. Should he develop a sharp chest pain at any time during the procedure, make a
- Inform him not to expect the results immediately. It normally takes two days
before the pathological exam is complete. Besides, the patient is under sedation and may
misinterpret what you say. Once the patient is relaxed, the procedure will go smoothly.
Pre-screening: Check for the following:
- History of allergic reactions to local anesthetic
- Platelet count, PT and PTT
- BUN and creatinine
- Evidence for recent MI or irritable heart
- If there is a focal lesion present, make an assessment as the most probable
- If there is history of asthma, prepare the patient with 200 mg of IV
hydrocortisone prior to the procedure. Give him a bronchodilator by inhaler prior to
starting the topical anesthesia.
- If the patient has a history of chronic obstructive pulmonary disease or is short
of breath, obtain baseline blood gases. If the patient has CO2 retention, be absolutely
sure of the indication. Be certain that the diagnosis cannot be made by another means. Do
a test run with oxygen to assess the sensitivity of his respiratory centers. Do not use
respiratory depressants to premedicate the patient. Rely primarily on local anesthesia.