Complications

The following lists possible bronchoscopy complications:

• Bacteremia:
  Bacteremia can follow any endoscopic procedure and cause fever. Most of the time, it is transitory and does not require antibiotics. This is of special concern in patients with artificial valves. There is no consensus of opinion for prophylaxis for this situation. Prospective studies have demonstrated the absence of bacteremia following a bronchoscopy. While it seems logical to provide antibiotic prophylaxis for patients with valvular disease for bronchoscopy, it is not supported by scientific evidence.

  References:

  1. Kane, RC, et al. Absence of bacteremia after fiberoptic bronchoscopy. Amer Rev of Resp Dis 111:102-4, 1975.
  2. Pereira, W, et al. Fever and pneumonia after flexible fiberoptic bronchoscopy. Amer Rev of Resp Dis 112:59-64, 1975.
• Pneumonia:
  Fortunately, post bronchoscope pneumonia is rare. Transitory infiltrates with fever have been observed in one study in 6% of patients following a bronchoscopy. Rarely has fatal pneumonia been reported following a bronchoscopy. Pseudomonas pneumonia has been traced to contaminated bronchoscopes. The procedure is not sterile and, surprisingly, pneumonia is rare following the procedure. There is a tendency on the part of the clinician to be too casual regarding the sterile technique during the procedure. We should strive to accomplish as clean a procedure as possible.

  References:

  1. Suratt, PM, et al. Absence of clinical pneumonia following bronchoscopy with contaminated and clean bronchofiberscopes. Chest 71:52-4, 1977.
  2. Beyt, BE, et al. Fatal pneumonitis and septicemia after fiberoptic bronchoscopy. Chest 72:105-7, 1977.
  3. Hsu, JT, et al. Lung abscess complicating transbronchial biopsy of a mass lesion. Chest 80:230-4, 1981.
• Tuberculosis:
  The spread of tuberculosis to patients by a contaminated bronchoscope is rare. However, it has been reported. It is important to follow the guidelines for chemical disinfection of the bronchoscope. The spread of tuberculosis to the bronchoscopist is also of concern. In suspected cases, be sure to have negative sputums prior to the actual procedure.

  While it is possible to diagnose tuberculosis by bronchoscope, it should be discouraged. Bronchoscopy for the diagnosis of tuberculosis should be reserved to selected cases where multiple sputum smears are reported negative. The mask does not offer complete protection and the aerosolized particles can reach the operator's lungs.

  References:

  1. Nelson, KE, et al. Transmission of tuberculosis by flexible fiberbronchoscopies. _______97-100, 1982.
  2. Leers, W. Disinfecting endoscopes: How not to transmit mycobacterium tuberculosis by bronchoscopy. CMA Journal 123:275-83, 1980.
• Hypoxemia:
  The arterial PO2 drops by 10-20 mm of mercury routinely during a bronchoscopy. The worst drop occurs during saline lavage. This complication can be prevented with routine use of supplemental oxygen therapy.

  References:

  1. Kleinholz, EJ, et al. Arterial blood gas studies during fiberoptic bronchoscopy. Amer Rev Resp Dis 108: ____-1014, 1973.
  2. Albertini, R, et al. Management of arterial hypoxemia induced by bronchoscopy. Chest 67:134-5, 1975.
• Pneumothorax:
  A pneumothorax can occur if a transbronchial lung biopsy or brushing of the lung was done during the bronchoscopy. This is uncommon with bronchoscopy alone. However, it can occur with a bronchoscopy alone when the procedure is done in a patient who is on a ventilator.

  With an endotracheal tube, the airway resistance increases during bronchoscopy and the resulting barotrauma can lead to a pneumothorax. To minimize this complication, use either larger ET tubes or smaller bronchoscopes. Minimize the duration of the procedure and inspect the bronchial tree intermittently.

• Respiratory Failure:
  
• Anesthetic Reaction:
  
• Hemoptysis:
  Bleeding and hemoptysis can occur following a biopsy or brushing. A bronchoscopy pierce should not lead to this complication. Excessive suction can injure mucous membranes and cause bleeding. Be gentle with suction. Use suction intermittently and sparingly.

  Do not perform the biopsy if the endobronchial appearance of a lesion is suggestive of a bronchial adenoma. Adenomas are vascular and severe hemorrhaging can following a biopsy.

  The bleeding that follows a brushing or transbronchial biopsy usually stops because the biopsy is at the capillary level and the pressures are at venous level. Use of 1 in 1000 adrenaline solution prior to the biopsy is recommended to minimize the amount of bleeding.

  Patients with a coagulation defect should not be biopsied. I have witnessed fatal bleeding in a uremic patient who had underwent a transbronchial biopsy. In my experience, the brushing causes more bleeding than the actual biopsy! Be satisfied with BAL in patients with a coagulation defect.

  References:

  1. Sansone, S, et al. Severe hemorrhage complicating endoscopic biopsy of bronchial adenoma. Report of a case. Disease of Chest 51:208-10, 1967.
• Arrhythmia:
  Fear of arrhythmias and ischemic changes were studied. The finding report that risks are minimal.
• Aspiration from Lung Abscess: