The following lists possible bronchoscopy complications:
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While it is possible to diagnose tuberculosis by bronchoscope, it should be discouraged. Bronchoscopy for the diagnosis of tuberculosis should be reserved to selected cases where multiple sputum smears are reported negative. The mask does not offer complete protection and the aerosolized particles can reach the operator's lungs.
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With an endotracheal tube, the airway resistance increases during bronchoscopy and the resulting barotrauma can lead to a pneumothorax. To minimize this complication, use either larger ET tubes or smaller bronchoscopes. Minimize the duration of the procedure and inspect the bronchial tree intermittently.
Do not perform the biopsy if the endobronchial appearance of a lesion is suggestive of a bronchial adenoma. Adenomas are vascular and severe hemorrhaging can following a biopsy.
The bleeding that follows a brushing or transbronchial biopsy usually stops because the biopsy is at the capillary level and the pressures are at venous level. Use of 1 in 1000 adrenaline solution prior to the biopsy is recommended to minimize the amount of bleeding.
Patients with a coagulation defect should not be biopsied. I have witnessed fatal bleeding in a uremic patient who had underwent a transbronchial biopsy. In my experience, the brushing causes more bleeding than the actual biopsy! Be satisfied with BAL in patients with a coagulation defect.
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