6.6
Examens Endoscopiques I : Bronchoscopie et Thoracoscopie
L'endoscopie est une technique médicale non invasive, utilisée pour explorer les organes internes et les vaisseaux d'un patient. Cette leçon portera s…
La bronchoscopie est une procédure diagnostique qui permet de visualiser le larynx, la trachée et les bronches.
La bronchoscopie diagnostique permet la visualisation et l’évaluation des tissus, l’analyse des sécrétions et le prélèvement d’échantillons de biopsie.
La bronchoscopie thérapeutique élimine les obstructions, gère les saignements, traite l’atélectasie, enlève les lésions et administre la curiethérapie.
Les responsabilités des infirmières avant l’intervention comprennent l’explication de l’intervention, l’obtention du consentement et la garde de l’OBNL du patient pendant 6 heures.
Après l’intervention, les infirmières doivent surveiller les signes vitaux et garder le patient NPO jusqu’à ce que le réflexe de toux revienne.
Ensuite, la thoracoscopie est une procédure diagnostique qui consiste à examiner la cavité pleurale en insérant un endoscope à travers de petites incisions.
Il aide à évaluer les épanchements pleuraux et les tumeurs et recueille des échantillons de liquide et de tissu pour le diagnostic.
Un drain thoracique peut être inséré après l’intervention pour la réexpansion du poumon.
Les responsabilités des infirmières avant l’intervention comprennent l’obtention du consentement et la garde de l’OSBL du patient.
Après l’opération, les infirmières doivent surveiller les signes vitaux, vérifier le site de l’incision pour détecter les saignements ou les infections, et surveiller le drain thoracique et le système de drainage.
View the full transcript and gain access to JoVE Core videos
Q1: What structures does a bronchoscopy allow a nurse to visualize?
Bronchoscopy enables direct visualization of the larynx, trachea, and bronchi using a flexible fiber-optic or rigid bronchoscope. The fiber-optic bronchoscope is preferred due to its flexibility, small size, and excellent optical system, allowing increased visualization of peripheral airways. This visualization supports both diagnostic assessment and therapeutic interventions.
Q2: What are the main differences between diagnostic and therapeutic bronchoscopy?
Diagnostic bronchoscopy visualizes tissues, determines pathologic processes, collects secretions for analysis, and obtains tissue samples for diagnosis. Therapeutic bronchoscopy removes foreign bodies and secretions, controls bleeding, treats atelectasis, destroys lesions, provides brachytherapy, and inserts stents to relieve airway obstruction. Both procedures use the same equipment but serve distinct clinical purposes.
Q3: Why must patients remain NPO before bronchoscopy?
Patients must abstain from food and drink for at least 6 hours before bronchoscopy to decrease the risk of aspiration. After the procedure, patients should remain NPO until the cough reflex returns, ensuring airway protection during recovery. This precaution prevents aspiration of gastric contents during sedation and the procedure.
Q4: What post-procedure complications should nurses monitor for after bronchoscopy?
Nurses should monitor for hypoxia, hypotension, tachycardia, arrhythmias, hemoptysis, and dyspnea following bronchoscopy. Vital signs and respiratory status require continuous assessment, with abnormalities reported promptly. These complications can indicate adverse reactions to sedation, airway trauma, or bleeding during the procedure.
Q5: How does thoracoscopy differ from bronchoscopy in terms of procedure and access?
Thoracoscopy examines the pleural cavity by inserting an endoscope through small incisions in an intercostal space, whereas bronchoscopy visualizes airways through the nose, mouth, tracheostomy, or artificial airway. Thoracoscopy evaluates pleural effusions, tumors, and collects fluid and tissue samples. A chest tube may be inserted post-thoracoscopy for lung re-expansion.
Q6: What are the key post-operative nursing responsibilities after thoracoscopy?
Postoperatively, nurses must monitor vital signs, pain level, and respiratory status. The incisional site requires assessment for bleeding and infection. Shortness of breath may indicate pneumothorax and should be reported immediately. Chest tube monitoring and drainage system assessment are essential for proper lung re-expansion and patient safety.
Q7: What diagnostic purposes does thoracoscopy serve in respiratory assessment?
Thoracoscopy evaluates pleural effusions and pleural disease, stages tumors, and obtains fluid and tissue samples for analysis. If fluid is present, it is aspirated and sent for culture and sensitivity testing. Future applications include laser treatment of pulmonary nodules and other growths, making thoracoscopy valuable for comprehensive respiratory diagnosis.