Pitfalls in the Use of the Flexible Bronchoscope in Pediatric Patients: EVALUATION OF INFECTION/INFLAMMATION
Bronchoscopy may be very helpful in the evaluation of a patient with lower airway infection, especially if there are unusual features of the clinical picture or if the patient cannot produce sputum. However, just as expectorated material may not be representative of the lower airways, or may be contaminated with upper airway or oral secretions, specimens obtained with a bronchoscope must be subjected to serious scrutiny. Pediatric flexible bronchoscopes are too small to use currently available protected microbiology specimen brushes, so bacteriologic specimens must be obtained by aspiration, with or without saline solution lavage. Great care must be taken to avoid contamination of the instrument with nasal or oral secretions; this is not always possible. Excessive use of topical lidocaine solution can wash oral secretions into the lower airways, and lidocaine can be bacteriostatic itself. It is useful to compare a specimen obtained from the oropharynx with bronchial washings (nonbacteriostatic saline solution must be used for washings), and also to use quantitative cultures. The cytology of the washings should be studied; a polymicrobial specimen containing few polymorphonuclear leukocytes does not likely indicate lower airway infection.
When larger bronchoscopes are used, with protected microbiology brushes, there is still great potential for diagnostic error. Once the larynx has been anesthetized, patients may aspirate oral secretions, especially if they are in a Fowlers or reverse Trendelenburg’s position. Thus, it is quite possible to obtain a specimen which is contaminated with oral secretions which have been aspirated during the procedure or in preparation for the procedure. Specimens obtained by brushing should be cultured quantitatively and should be transported to the microbiology laboratory in nonnutritive media. canada drugs online
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Tags: Flexible Bronchoscope, Pediatric Patients, Pitfalls