Abstract
Use of flexible bronchoscopy in an intensive care unit can serve many purposes. This chapter outlines bedside bronchoscopy for the advanced practice provider. It is meant to serve as a general guideline for performing diagnostic and therapeutic flexible bronchoscopy. The primary focus of the chapter is to provide bedside clinicians with a step-by-step reference for performing bronchoalveolar lavage on mechanically ventilated patients in the intensive care unit.
Flexible bronchoscopy is not without its risks and complications which are discussed in detail, but the relative safety of the procedure is also well highlighted. Adjunctive use of bronchoscopy with difficult intubations and bedside percutaneous tracheostomy has also shown to provide added safety and success in these procedures. This chapter is unique as it provides brief discussions on billing and coding which can be confusing and is often overlooked. Training is often on the job, and simulation courses with high-fidelity training are needed. Credentialing, certification, and competence can also be nebulous; finding ways to better assess clinicians skills other than numbers of procedures performed is now being recommended.
As with all critical care skills and procedures, knowing one’s limitations and working interdependently with the intensive care unit team will ultimately contribute to success.
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Additional Resources
Hands on course provided by CHEST for in depth training for all providers including ACPs, MDs, RNs, RTs. https://www.chestnet.org/Education/Advanced-Clinical-Training/Certificate-of-Completion-Program/Bronchoscopy
British Thoracic Society Guidelines of Flexible Bronchoscopy in Adults https://thorax.bmj.com/content/68/Suppl_1/i1.long
There are multiple online bronchoscopy simulator programs, as well as, hands on simulators that are very beneficial. YouTube also has good videos
Book titled “Introduction to Bronchoscopy” 2nd Edition. Edited by Armin Ernst and Flex J.F. Herth
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Lowe, J., Singh, J. (2021). Diagnostic and Therapeutic Bronchoscopy. In: Taylor, D.A., Sherry, S.P., Sing, R.F. (eds) Interventional Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-64661-5_9
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