A fiberoptic bronchoscopy is a medical procedure that allows a doctor to look directly into the airways of the lungs. This examination uses a specialized instrument called a bronchoscope, which is a long, thin, and flexible tube made of fiber optic material with a small light and camera at its tip. The flexible nature of the bronchoscope allows it to navigate the smaller, branching airways within the lungs. The images captured by the camera are transmitted to a video screen, allowing the physician to visualize the internal structure of the lungs and airways in real-time. This procedure is generally performed in an outpatient setting and is considered safe and well-tolerated by patients.
Why a Bronchoscopy is Performeda
Physicians order a bronchoscopy for both diagnostic and therapeutic reasons. Diagnostically, the procedure is frequently used to investigate persistent, unexplained symptoms such as a chronic cough, coughing up blood, or shortness of breath. It is also used to evaluate abnormal findings seen on imaging tests like chest X-rays or CT scans, such as suspicious nodules or lung collapse.
The bronchoscope is equipped with a working channel that allows the doctor to pass small instruments through it for sample collection. These samples may include tissue (biopsy) to check for cancer cells or inflammation, or fluid collected through bronchoalveolar lavage (BAL) to test for infection or other diseases. Therapeutically, the scope is used for several purposes:
- To remove foreign objects that have been accidentally inhaled.
- To clear thick mucus plugs and excessive secretions that are blocking the air passages.
- To assist in placing a stent, which is a small tube used to keep a narrowed airway open.
- To help stop active bleeding within the lungs.
Preparing for the Procedure
Preparation for a fiberoptic bronchoscopy begins well before the day of the procedure. Patients are instructed not to eat or drink anything (NPO) typically for six to twelve hours before the procedure to ensure the stomach is empty. This fasting is important to prevent the accidental aspiration of stomach contents into the lungs during the procedure.
A discussion about all current medications is necessary, especially concerning blood thinners, such as aspirin or warfarin, which may need to be stopped several days in advance to minimize the risk of bleeding. Diabetes medications, including insulin, are often adjusted or held on the morning of the procedure because of the fasting requirement. Patients must sign a consent form before the procedure begins. Since sedation is used, patients must also arrange for a responsible adult to drive them home afterward, as the lingering effects of the medication make it unsafe to operate a vehicle.
Understanding the Steps of the Bronchoscopy
When the patient arrives in the procedure room, they are positioned comfortably on a bed or table, and an intravenous (IV) line is placed in an arm vein. This IV line is used to administer the sedative medication, which helps the patient relax and may induce a drowsy, twilight state. Continuous monitoring of vital signs, including heart rate, blood pressure, and oxygen saturation, is maintained throughout the procedure to ensure patient stability.
A local anesthetic spray is applied to the back of the throat and nasal passage to numb the area, which helps suppress the natural gag and cough reflexes that would otherwise interfere with the insertion of the scope. Once the area is numb and the sedation has taken effect, the physician gently inserts the lubricated bronchoscope, usually through the nose or mouth, past the vocal cords, and into the trachea. The doctor then guides the scope down into the branching bronchial tubes, using the controls to navigate and visualize the airway walls.
If a sample is needed, a small brush or forceps can be passed through the working channel of the bronchoscope to collect cells or tissue from a suspicious area. A common technique involves washing the airways with a sterile saline solution, which is then suctioned back into a collection trap to retrieve cells for testing (BAL). The entire procedure typically lasts between 30 minutes to one hour, depending on the complexity of the examination and whether samples are taken. Once the examination is complete, the physician withdraws the bronchoscope.
What to Expect During Recovery
Following the procedure, the patient is moved to a recovery area where a healthcare team continues to monitor their vital signs until the effects of the sedation begin to subside. A sore throat, hoarseness, and a mild cough are common temporary side effects that usually resolve within 24 to 48 hours. If a biopsy was performed, it is normal to cough up small amounts of bloody saliva for several hours after the procedure.
The local anesthetic spray numbs the throat and suppresses the gag reflex, meaning the patient cannot safely eat or drink immediately after the procedure. The patient must remain fasting until the gag reflex has fully returned, which is typically checked about one to two hours after the scope is removed, to prevent aspiration. Upon discharge, patients are advised to take it easy for the remainder of the day and to avoid strenuous activity until the next day. Immediate medical attention is necessary if the patient experiences severe chest pain, worsening shortness of breath, or coughs up more than a few tablespoons of blood.