Bronchoscopy - foreign body
Considerations
Pre-operative evaluation
History - witnessed aspiration, clinical course consistent with aspiration
Physical - auscultation
Imaging - order XR airway foreign body protocol, look for air trapping
Plan with Pediatric Anesthesia
Maintain spontaneous respiration throughout case
Preparation
OR setup
Pediatric bronchoscopy tray
Pediatric bronchoscopy cart
Video tower
Topical local - 1% Lidocaine (max 4 mg/kg), 1% Lidocaine with 1:100,000 (max 7 mg/kg) - draw up in syringe with long atomizer tip
Ask Anesthesia for the topical so that the circulating nurse does not need to exit the room
Procedure
Laryngoscope
Pediatric Miller/Mac
Setup your bronchoscope and backup - Storz ventilating rigid bronchoscope
2 sizes shown: 3.5, 3.7 - age appropriate - use chart on cart
3 lengths: 18.5 cm, 26 cm, 30 cm
Choose your endoscope - Hopkins 0 degree
2 sizes: 2.9 mm, 4 mm
Choose the length that matches the length of the bronchoscope with/without the extender
Choose a flexible suction - size 5 Fr, 6 Fr (7 and 8 Fr are available on request)
Be aware: The suction catheter can shear into small pieces if damaged by placing a tightly fitting endoscope into the bronchoscope with the suction in place
Choose an extraction device
Optical forceps - setup with separate Hopkins scope
Wire baskets - Boston Mechanics or Cook from the Urology supplies