Medical Surgical Bronchoscopy #4

Question

The provider would like to schedule a bronchoscopy for a client due to an abnormal lung x-ray. Which in the client’s past medical history would contraindicate a fiberoptic bronchoscopy?

Answers

  1. A client who had a myocardial infarction 7 years prior.
    • Rationale:

      This answer is not correct because the heart attacked occurred 7 years prior and not recently. Studies confirm that blood pressure and cardiac output increases during fiberoptic bronchoscopy, which increases oxygen demand on the heart.

  2. A client who has recovered from a concussion.
    • Rationale:

      This answer is not correct because the client has recovered from the concussion. Those with recent head trauma who are prone will be at risk for increased intracranial pressure.

  3. A client with Von-Willebrand disease.
    • Rationale:

      This answer is correct because a major risk for bronchoscopy is bleeding. Von Willebrand disease is a clotting disorder. Clients with uncorrectable coagulopathy are not candidates for fiberoptic bronchoscopy. Virtual bronchoscopy is an option for clients with clotting disorders since it is non-invasive and there is no risk of bleeding.

  4. A client in chronic respiratory failure.
    • Rationale:

      This answer is not correct because clients with respiratory failure with hypercapnia are not candidates for bronchoscopy. This is because they are unable to tolerate high flow oxygen interruption.

Overview

Contraindications for a bronchoscopy include anything that can cause a serious complication or make it impossible for the scope to pass. Examples would include clients who are uncooperative, clients with coagulopathy issues, those in severe respiratory failure, post-recent myocardial infarction, or recent head trauma. Von-Willebrand disease causes the client’s blood not to clot well resulting from low amounts of von-Willebrand factor, which is a protein that assists in clotting.

Explanation

Learning Outcomes

A fiberoptic bronchoscopy is an invasive procedure which involves inserting the respiratory tract with a fiberoptic scope for direct visual examination of the larynx, trachea, and bronchi. The major risk for bronchoscopy is bleeding. Bleeding with bronchoscopy can be catastrophic and result in a fatal outcome. A small amount of blood can fill the trachea and bronchi quickly and lead to respiratory failure. For this reason, clients with clotting disorders or a risk for bleeding are not ideal candidates for fiberoptic bronchoscopy. Bronchoscopy increases blood pressure and cardiac output, so clients with recent heart attacks are also contraindicated. Clients who cannot lay prone, such as with head injuries, should not have a fiberoptic bronchoscopy due to the risk of increased intracranial pressure. The client going through fiberoptic bronchoscopy will be unable to receive high flow oxygen, so clients who require oxygen support in that manner are also contraindicated.

Test Taking Tip

If the student thinks about the major risks of fiberoptic bronchoscopy (bleeding), this will help answer this question.

Video Rationale