Ryder Practice Guidelines for ICU Bronchoscopy

• Timeout to confirm consent, monitoring, ventilator settings, medication plan, and precautions to avoid introduction of pathogens to respiratory tract

• Continuous cardiac monitoring
• Continuous pulse oximetry and end-tidal CO2, activate audible SpO2 monitoring
• Continuous arterial line or q2min blood pressure cuff monitoring

100% FiO2, A/C volume control adjusted for predicted decrease in ventilation. Adjust high pressure limit alarms to maximum (105 cmH2O)

• Vent settings to be adjusted per attending if thought to not tolerate mode change

At provider discretion and based on patient clinical condition, may use bronchoscope administered local anesthesia (2 or 4% lidocaine) alone to minimize sedation and/or combination of sedation and neuromuscular blockade.

The bronchoalveolar tree is not sterile, but precautions should be taken to avoid iatrogenic introduction of pathogens during bronchoscopy. These should include:

• Placing swivel adapter with attention to avoiding contamination to the portion of adapter where bronchoscope will enter.
• Positioning of sterile drape over patient to create a field where bronchoscope may be placed without contamination.
• Use of sterile gloves by any provider manipulating the bronchoscope.
• Use of sterile saline for irrigation if needed.