Pitfalls in the Use of the Flexible Bronchoscope in Pediatric Patients: BRONCHOALVEOLAR LAVAGE
Bronchoalveolar lavage is often used in adult patients for a variety of diagnostic purposes. In children, standards for technique, as well as normal values, have yet to be defined. There are several potential pitfalls. If the tip of the bronchoscope is not wedged into an airway, much of the saline solution instilled through the suction channel may be distributed into adjacent or proximal airways, leading to coughing, aspiration of fluid into other areas of the lungs, and loss of specimen volume. The suction channel (in Olympus bronchoscopes) is located at 2 o’clock from the marker on the circumference of the bronchoscope image which identifies the plane of flexion. The lumen of the airway into which the tip of the instrument is wedged should be positioned to the upper right of the image. Total lavage volumes must be sufficient to permit the necessary diagnostic studies, but should not be excessive, as this may lead to respiratory compromise.
Summary
Flexible bronchoscopy is an important diagnostic technique for study of pediatric patients with pulmonary problems. Many pitfalls await the unwary, but with experience and care, most can be overcome or circumvented. kamagra soft tablets
