Bronchoscopy is a diagnostic and therapeutic procedure used to visualize the larynx, trachea, bronchi, and deep lung structures. It is performed using a flexible scope passed through the nose, mouth, or endotracheal tube to assess, diagnose, or treat respiratory conditions.
For nurses, understanding the indications, preparation, and post-procedure care is critical to prevent complications and ensure patient safety.
What is a Bronchoscopy?
A bronchoscopy allows direct visualization of the airway structures using a thin, flexible tube with a light and camera. This enables healthcare providers to:
- Examine abnormal areas in the airway
- Remove blockages or secretions
- Obtain tissue samples for biopsy
Common Indications for Bronchoscopy
The procedure is typically performed for three primary reasons:
1. Biopsy of tissue
- To check for cancer, infections, or other abnormal growths.
2. Lavage (lung washing)
- To flush out mucus, fluid, or infection from the lungs.
- To remove thick sputum or foreign objects lodged deep in the airway.
Preparation Before Bronchoscopy
Mild Sedation:
- Administered to keep the patient calm, reduce anxiety, and slow vital signs.
Topical Anesthetic:
- Agents like lidocaine are applied to the throat to suppress the gag reflex and prevent laryngospasm during insertion.
Nursing Role Before the Procedure:
- Verify informed consent
- Ensure the patient is NPO (nothing by mouth) for 6–8 hours before the procedure
- Remove dentures or oral prosthetics
- Provide emotional reassurance
Post-Procedure Care
Normal and Expected Findings:
- Low respiratory rate (RR) and low oxygen saturation (due to sedation)
- Absence of gag reflex immediately after the procedure due to numbing agents
Key Nursing Action:
- Maintain NPO status until the gag reflex returns to prevent aspiration.
Priority Complications to Report Immediately
Some post-procedure findings require urgent provider notification:
1. Laryngospasm / Stridor
- High-pitched wheezing sound on inspiration
- Indicates possible airway obstruction and requires immediate intervention
2. Bright Red Blood-Tinged Sputum / Hemoptysis
May signal airway trauma or active bleeding
Kaplan NCLEX Tip:
Select all that apply:
- Blood-tinged sputum (bright red)
- Stridor with increased dyspnea
Nursing Care After Bronchoscopy
- Monitor airway and breathing: Watch for respiratory distress or reduced oxygen saturation
- Assess for bleeding: Small amounts of blood-tinged sputum may be normal, but bright red bleeding is a red flag
- Check vital signs: Every 15–30 minutes until stable
- Ensure gag reflex returns before offering food or drink
- Provide oxygen if needed
Patient Education
Before the procedure:
- Explain the purpose and what the patient might feel (mild discomfort, pressure)
- Inform about the need for NPO status
After the procedure:
- Avoid eating or drinking until cleared by the nurse or provider
- Report any chest pain, shortness of breath, heavy bleeding, or fever immediately
Quick Reference Table – Bronchoscopy Nursing Guide
| Stage | Nursing Role | Priority Concerns |
|---|---|---|
| Pre-procedure | NPO, sedation, topical anesthetic, consent, vitals | Risk of aspiration |
| During procedure | Monitor O₂, assist provider, manage sedation | Laryngospasm |
| Post-procedure | NPO until gag reflex returns, airway monitoring | Stridor, hemoptysis, respiratory distress |
NCLEX & Exam Tips
- Gag reflex must return before allowing oral intake
- Stridor = emergency → prioritize airway management
- Bright red hemoptysis requires immediate provider notification
- Mild sedation effects (low RR, low O₂) can be expected post-procedure but must be closely monitored
Frequently Asked Questions (FAQs)
Q1. Is coughing up blood normal after bronchoscopy?
Slight blood-tinged sputum is normal, but bright red bleeding should be reported immediately.
Q2. Why must patients be NPO before bronchoscopy?
To prevent aspiration during the procedure, as sedation and anesthesia suppress the gag reflex.
Q3. How long does sedation last after bronchoscopy?
Usually a few hours; patients should avoid driving or operating machinery for 24 hours.
Q4. What is the biggest airway risk after bronchoscopy?
Laryngospasm and airway obstruction.
