Consent and screening: We need to obtain a consent and pre-screen laboratory
data to make sure that a bronchoscopy can be performed safely.
- Pre-Procedure Screening:
NPO-The patient should abstain from food and liquids since midnight if the procedure is
planned for the morning. He can have a liquid breakfast if the bronchoscopy if planned for
the afternoon. The stomach should be empty during the procedure to prevent aspiration. As
a general rule, food and liquids should be withheld five to six hours prior to the
- Assess the Need for Fluoroscopy:
In general, all of the peripheral lesions and transbronchial lung biopsies require fluoro
guidance and should be planned for. If you are fortunate enough to have a C-arm in your
bronchoscopy room, it is not necessary to schedule the procedure with the Radiology
- Plan Ahead for Tests:
Anticipate your needs and gather all of the necessary material ahead of time. It is very
frustrating to find that you do not have all the appropriate tubes or accessories in the
middle of the procedure.
I routinely give demerol and 1 mg of atropine intramuscularly thirty minutes prior to the
procedure. You can give them combined together. Atropine dries up the bronchial secretions
and blocks the vasovagal reflex.
The dose of demerol has to be adjusted
according to the age and weight of the patient. 25-50 mg may suffice if the patient is
small and elderly. You may want to give 100 mg to an anxious, young, larger patient.
Patients with COPD and CO2 retention should not be given any demerol.
- Oxygenation and monitors:
Start the patient on 3-4 liters of oxygen by nasal cannulation. There is an approximate
drop of 10-20 mg Hg PO2 during the procedure. Providing supplemental oxygen prevents
hypoxemia during the procedure. You can monitor the patient's oxygenation status easily by