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

Post-op

High-Yield

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