Where are your bronchoscopys perfromed and what is the protocol.

[nlhnurse1982]

I was wondering where bronchoscopys are performed in your hospitals and what the protocol is. At my facility they are performed in the patient rooms and usually a nurse is not present just the MD and the RT. Well the other day I hear the code button go off and when I get to the room there was a patient being scoped that coded during the procedure went into respiratory failure lost her pulse the whole 9 we got her rhythm back tubed and to the unit. What I find odd is that the patients are not monitored during the procedure. I would think at the very least if they are going to be doing this in the room a nurse should be present to advocate for the patient and vitals should be monitored, pulse ox, maybe even put them on telemetry for the procedure. There was a poor student watching the procedure who said although she never saw one before she knew something was wrong when the patient started making agonal noises and turning blue. Any thoughts would be great.

[GilaRRT]

The respiratory therapist was not monitoring the patient? Seems strange as an RT is more than up to the task of monitoring vitals and ensuring adequate ventilation, oxygenation, and maintaining a patent airway.

[CABG patch kid, BSN, RN]

I can't believe that patients are getting bronched without being on a monitor, at the very least. Granted, I've only worked at 1 hospital so I don't have much to compare to, but in my limited experience I've seen a few patients brady down to the 20's and 30's requiring atropine, as well as pts desat.... is there any type of monitoring at all in place? BTW I work in CCU so we do bedside bronchs but any pts out on the floor (even the tele pts) have to go somewhere else to get it done.

[Rose_Queen, BSN, MSN, RN]

Bronchs are done at the bedside in ICU and step down only. All other patients go to the endoscopy suite.

[nurse_mo1986]

Does your facility not require a nurse ABS for con. sedation? At my hospital bronch's are done only in special services unit or ICU. and either one requires an RN abs for monitoring. But our policy also calls for versed usage during a routine bronch...

[nlhnurse1982]

Thanks for your answers I just don't feel that a med-surg floor is the place to have this done. Granted they don't happen very often. I just think that especially since the person is on the floor as the nurse we are still in charge of their care and should be present for bedside procedures so we can advocate for the patient and ensure proper monitoring. In additon nurses should receive education on the procedures that are being performed on the floor so we can intervene to the best of our abilities. I hope after this it is mandatory that the patients be sent to the unit or down to surgical services for the procedure.

[Jarnaes]

Scary situation. In my book, anyone who gets a bronch deserve a little versed/fentanyl cocktail and proper monitoring.

[meandragonbrett]

Outside of ICU: Done in the GI Lab

ICU: at bedside.

We require RN, RT, and provider at bedside. RT assists the provider and the RN does the patient monitoring. All are on tele, o2, etc.

In GI lab it's provider and RN x2.