Respiratory Diagnostic Procedures Detailed Notes

Endoscopic Examinations
- Laryngoscopy
- A tube for visualization is inserted into the larynx.
- Purpose:
  - To assess the function of the vocal cords.
  - To remove foreign bodies in the larynx.
  - To obtain tissue samples for biopsy or culture.
- Mediastinoscopy
- Procedure: Insertion of a tube through the chest wall just above the sternum into the area between the lungs.
- Conducted in the operating room under anesthesia.
- Uses: To obtain tumors or tissue samples for biopsy or culture.
- Complications: Related to anesthesia and bleeding.
- Bronchoscopy
- Most commonly used invasive procedure.
- Procedure: Insertion of a tube into airways to view airway structures and obtain tissue samples.
- Uses:
  - Diagnose and manage pulmonary diseases.
  - Evaluate the airway, place/change endotracheal (ET) tube.
  - Collect specimens and diagnose infections.
  - Stage lung cancer and remove secretions.
- Types:
  - Rigid Bronchoscopy: General anesthesia in the operating room.
  - Flexible Bronchoscopy: Performed in the ICU or endoscopy suite with low-dose sedation.

Preparation for Procedure:
- Explain the procedure to the patient and verify that consent has been signed.
- Document any allergies and perform tests including:
- Complete Blood Count (CBC)
- Platelet count
- Prothrombin time
- Electrolytes
- Chest X-ray
- Patient must be NPO (nothing by mouth) for 4-8 hours before the procedure to prevent aspiration.
- Premedication: As ordered, potentially including benzodiazepines or opioids.
- Topical Anesthesia: Benzocaine may be used.
- Important Consideration:
- Methemoglobinemia: Condition where hemoglobin is converted to methemoglobin, which cannot transport oxygen.
  - Symptoms: Cyanosis unresponsive to oxygen, chocolate-brown blood.
  - Reversal Treatment: With oxygen and IV injection of 1% methylene blue (1-2 mg/kg).

Monitoring:
- Patient must be monitored until sedation has worn off.
- No eating/drinking until the gag reflex returns.
- Vital signs (VS) and breath sounds should be monitored every 15 minutes for the first 2 hours.
- Complications to Assess:
- Bleeding
- Infection
- Hypoxemia

Definition: Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes.
Indications:
- To relieve respiratory distress caused by conditions such as cancer, empyema, tuberculosis, or pleurisy.
- Medications can be instilled into the pleural space during the procedure.

Patient Preparation:
- Inform about the expected stinging sensation from local anesthesia and pressure from the needle.
- Stress importance of not moving, coughing, or taking a deep breath during the procedure to avoid lung or pleura puncture.
- Verify any allergies to local anesthetic and ensure informed consent is signed.
- If necessary, clip chest and back hair to facilitate the procedure.
- Correct Position:
- Positioned to access spaces between ribs easily; a pillow can be used for comfort.

Execution:
- Performed at the bedside with CT (Computed Tomography) or US (Ultrasound) guidance.
- Usually, no more than 1000ml of fluid is removed at one time.
- Thorough documentation is required regarding procedure, patient tolerance, puncture site, fluids removed, and their characteristics.
- Follow-Up Assessments:
- Chest X-ray to rule out pneumothorax and mediastinal shift.
- Monitor vital signs (VS) and listen for absent or reduced lung sounds on the affected side.
- Assess the puncture site for bleeding, leaking, fluid reaccumulation, subcutaneous emphysema, infection, and tension pneumothorax.

Teaching for Patients:
- Symptoms of potential pneumothorax can develop within the first 24 hours after the procedure.
- Signs include:
- Pain on the affected side, worsening with inhalation/exhalation.
- Rapid heart rate.
- Rapid, shallow breathing (respirations).
- Air hunger or difficulty breathing.
- Prominence of the affected side that remains still during respiration.
- Trachea deviating towards the unaffected side.
- New onset of a persistent cough.
- Cyanosis of skin and mucus membranes.

Definition: Includes various types such as Transbronchial Biopsy (TBB), Transbronchial Needle Aspiration (TBNA), and Transthoracic Needle Aspiration.
Purpose: For culture or cytology to diagnose:
- Cancer
- Infection
- Inflammation
- Lung diseases

Positioning: Patient should be in a side-lying position.
Guidance: Procedure is usually performed with CT guidance to visualize the area effectively.
Follow-Up Care:
Vital signs (VS) and breath sounds should be monitored every 4 hours for 24 hours.
Complications to Monitor For:
- Pneumothorax, indicated by reduced or absent lung sounds.
- Hemoptysis (coughing up blood).
- Bleeding at the biopsy site.