A device used to perform bronchoscopic procedures. Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs: biopsies, fluid (bronchoalveolar lavage), or endobronchial brushing. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible fiberoptic instruments with real time video equipment.
A rigid bronchoscope is a straight, metal tube with an inner diameter of up to one centimeter. It is inserted through the mouth, the patient lying in a supine position and the neck hyperextended. The procedure causes significant discomfort and is performed under general anesthesia.
Rigid bronchoscopy is less often used today, but it remains the procedure of choice for removing foreign materials, as the greater diameter of the rigid bronchoscope allows instruments to be more easily inserted through it. Rigid bronchoscopy also becomes useful when bleeding interferes with viewing the examining area, and allows for more interventions, such as cauterize to stop the bleeding.
A flexible bronchoscope is longer and thinner than a rigid bronchoscope. It contains a fiberoptic system that transmits an image from the tip of the instrument to an eyepiece or video camera at the opposite end. Using Bowden cables connected to a lever at the handpiece, the tip of the instrument can be oriented, allowing the practitioner to navigate the instrument into individual lobe or segment bronchi. Most flexible bronchoscopes also include a channel for suctioning or instrumentation, but these are significantly smaller than those in a rigid bronchoscope.
Flexible bronchoscopy causes less discomfort for the patient than rigid bronchoscopy and the procedure can be performed easily and safely under local anesthesia. It is the technique of choice nowadays for most bronchoscopic procedures.
In the Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes, by the Society of Gastroenterology Nurses and Associates (SGNA), the society recommends that leak testing occur before the scope is submerged inside a patient.
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