Bronchoscopy Consent ๐Ÿซ

๐Ÿ” Procedure

  • Bronchoscopy โ€“ direct visualisation of the tracheobronchial tree using a flexible or rigid endoscope inserted via the nose or mouth.

๐Ÿ’ก Indications

  • Investigation of persistent cough, haemoptysis, or abnormal chest imaging
  • Diagnosis of suspected lung cancer or infection
  • Foreign body removal or airway obstruction evaluation
  • Bronchoalveolar lavage or tissue biopsy
  • Evaluation and sampling of known or suspected lung pathology using techniques such as BAL, brushings, biopsies, or needle aspiration

๐Ÿงพ Procedure Walkthrough

  • Performed under conscious sedation with local anaesthetic to nose/throat.
  • A flexible or rigid bronchoscope is inserted via the nose or mouth into the tracheobronchial tree.
  • Visual inspection is followed by diagnostic procedures if indicated: washings (BAL), brushings, endobronchial biopsy, transbronchial biopsy, or needle aspiration.
  • Procedure duration is typically 15โ€“30 minutes.
  • Post-procedure monitoring includes vitals, oxygenation, and return of gag reflex. CXR if biopsy performed.

โš ๏ธ Risks & Complications

  • Common (>5%): Low oxygen levels (may require supplemental oxygen), collapsed lung (pneumothorax) possibly requiring chest drain and longer hospital stay, especially after trans-bronchial biopsy or brushings. Obese patients have increased risk of infection, heart/lung complications, and thrombosis.
  • Uncommon (1โ€“5%): Heart strain or arrhythmias, nasal or post-biopsy bleeding (especially with anticoagulants), asthma-like bronchospasm managed with inhalers.
  • Rare (<1%): Laryngospasm (brief narrowing of vocal cords), fever (usually self-limiting with paracetamol), death (very rare).

๐Ÿ’ฌ Common Patient Questions

  • Will I be asleep? โ€” Youโ€™ll be sedated and made comfortable but usually remain semi-awake.
  • Will it be painful? โ€” It may be uncomfortable, but local anaesthetic and sedation reduce this.
  • Can I go home after? โ€” Usually, yes โ€” once fully recovered from sedation.
  • Will I be able to eat afterwards? โ€” Yes, after your gag reflex has returned (typically ~1 hour).
  • Will I be able to talk afterwards? โ€” Yes, but you may feel hoarse for a short while.

โœ… Benefits

  • Direct visualisation of airways and access for diagnostic sampling
  • Early detection and investigation of lung pathology
  • Minimally invasive with quick recovery

๐Ÿ”„ Alternatives

  • CT chest โ€“ useful for visualising anatomy but not suitable for sampling
  • Sputum culture/cytology โ€“ less sensitive
  • No investigation โ€“ not typically recommended due to diagnostic delay

๐Ÿง  Special Considerations

  • Check coagulation status and anticoagulation โ€“ may need to pause DOACs/warfarin
  • Ensure recent imaging available (e.g. CT chest)
  • Assess for allergies (especially to local anaesthetic or sedatives)
  • Nil by mouth 4โ€“6 hours pre-procedure
  • Post-procedure chest X-ray if biopsy or deep sampling performed to rule out pneumothorax
  • Ensure interpreter or cultural liaison if communication barriers present

๐Ÿ—ฃ๏ธ Example Consent Script

  • "We are recommending a bronchoscopy to examine your airways and possibly take samples to help with diagnosis."
  • "Youโ€™ll receive sedation and numbing spray, and weโ€™ll pass a thin camera into your lungs via your nose or mouth."
  • "Risks include sore throat, coughing, mild bleeding or rarely more serious problems like lung collapse."
  • "Youโ€™ll be monitored afterwards and can usually go home the same day. Do you have any questions?"

๐Ÿ”— External Resources