Title: Fiberoptic Bronchoscopy in ICU
Purpose: To establish clear guidelines for desired clinical outcomes and improved patient care b
- Standardization of the procedure
- Enhanced competency should achieve
- Optimal specimens for higher diagnostic yield
Definition: Fiberoptic Bronchoscopy in ICU is done for highly specific conditions:
- Difficult intubation (trained staff only): not used as aid to failed endotracheal intubation.
- Persistent lobar collapse that is refractory to physiotherapy.
- Blood clots, thick mucus plugs or foreign bodies compromising the ventilation.
- Diagnostic bronchoalveolar lavage (BAL) i.e. if Hospital acquired pneumonia (HAP)/Ventilator associated pneumonia (VAP) suspected.
Policy:
- This policy applies to all personnel in the pulmonogy and ICU division.
- This is only to be used by skilled personnel and authorized by the duty consultant.
- Expertise with the bronchoscope takes time:
- Registrars are recommended to attend all bronchoscopic procedures in ICU by the consultant intensivist to become familiar with the
- Anatomy of the tracheobronchial tree
- Use of the flexible fiberoptic bronchoscope.
- Bronchoscopy in ICU is available 24 hours/day 7 days/week to aid in the management of eligible patients requiring diagnostic or therapeutic intervention.
- Sources of admission can be:
- Medical ICU
- Surgical ICU
- Coronary Care unit (CCU)
- Emergency Room (ER)
- Any critically ill patient in KFHU who requires bronchoscopic intervention but can not be shifted to ICU for any reason.
Procedure:
- Equipment
- Flexible bronchoscope with its accessories
- Suction machine
- Light Source
Bronchoscopy Procedure reports are completed by physician and must include
- Date and time
- Finding and impression
- Mention all that is sent for analysis
- Name and Signature of physician
- Tolerance and condition of patient
- Nature of specimen collected
- Signature of nurse
- Post procedure instructions
Procedure : As per Guidelines
Responsibility:
- Consultant on duty
- Endoscopy staff
- Respiratory therapist is responsible for the assistant during the procedure.
