Rigid Bronchoscopy for Retrieval of Foreign Bodies in Children

Overview

What is Rigid bronchoscopy?

Rigid bronchoscopy is a procedure used to visualize the airways and retrieve foreign bodies in children. It requires specialized equipment and expertise. It is a type of endoscopy that uses a rigid tube with a light source and camera to visualize the airways.

Epidemiology

Foreign body aspiration is a common problem in children, particularly in those under the age of 3.

Indications

1. Foreign body aspiration:

Rigid bronchoscopy is indicated for the retrieval of foreign bodies from the airways.
2. Airway obstruction:

Rigid bronchoscopy can be used to relieve airway obstruction caused by foreign bodies or other conditions.

Contraindications

1. Severe respiratory distress:

Rigid bronchoscopy may not be suitable for children with severe respiratory distress.
2. Cardiac instability:

Children with cardiac instability may not be good candidates for rigid bronchoscopy.

Instruments and Accessories

1. Rigid bronchoscope:

A rigid tube with a light source and camera.
2. Telescope:

A thin, flexible or rigid scope used to visualize the airways.
3. Forceps:

Used to grasp and remove foreign bodies.
4. Suction catheter:

Used to clear secretions and debris.

Process

Step-by-Step Procedure

1. Selection of bronchoscope size:

The size of the bronchoscope is selected based on the child's age and size.
2. Assembling the bronchoscope and accessories:

The bronchoscope and accessories are assembled and checked for proper function.
3. Anesthesia:

General anesthesia is typically used for rigid bronchoscopy in children.
4. Positioning the patient:

The child is positioned in a supine position with the head extended.
5. Introducing the bronchoscope:

The bronchoscope is introduced through the oropharynx and advanced through the vocal cords into the trachea.

Calculating Bronchoscope Size

Age-based estimation:

The size of the bronchoscope can be estimated based on the child's age:

Infants (0-6 months): 2.5 – 3.5 mm bronchoscope
Infants (6-12 months): 3.5 – 4.0 mm bronchoscope
Toddlers (1-2 years): 4.0 – 5.0 mm bronchoscope
Children (2-5 years): 5.0 – 6.0 mm bronchoscope
Children (5-10 years): 6.0 – 7.0 mm bronchoscope

Weight-based estimation:

Some clinicians use a weight-based estimation:

< 5 kg: 2.5-3.0 mm bronchoscope
5-10 kg: 3.0-4.0 mm bronchoscope
10-20 kg: 4.0-5.0 mm bronchoscope
> 20 kg: 5.0-6.0 mm bronchoscope

Considerations

Individual variation

These are general guidelines, and the actual size of the bronchoscope needed may vary depending on the individual child’s anatomy.

Type of bronchoscope

The size of the bronchoscope may also depend on the type of bronchoscope being used (e.g., rigid vs. flexible).

Final Determination

The final determination of the bronchoscope size should be made by an experienced clinician, taking into account the child's age, size, and individual anatomy.

Visualizing the airways

Passing the bronchoscope through the vocal cords requires careful technique and visualization.

Preparation

1. Visualization:

The vocal cords should be visualized using a laryngoscope or a video laryngoscope.
2. Relaxation:

The patient should be adequately relaxed and anesthetized to minimize coughing and movement.

Technique

1. Alignment:

The bronchoscope should be aligned with the glottic opening, ensuring that the tip of the bronchoscope is in line with the vocal cords.
2. Gentle advancement:

The bronchoscope should be gently advanced through the vocal cords, using a smooth and controlled motion.
3. Visualization of the vocal cords:

The vocal cords should be visualized throughout the procedure, and the bronchoscope should be advanced between the cords.
4. Avoidance of trauma:

Care should be taken to avoid traumatizing the vocal cords or the surrounding tissues.

Tips

1. Use of a telescope:

A telescope can be used to visualize the vocal cords and guide the bronchoscope through the glottis.
2. Coordination with anesthesia:

Close coordination with the anesthesiologist is essential to ensure that the patient is adequately relaxed and anesthetized.
3. Gentle manipulation:

The bronchoscope should be manipulated gently to avoid causing trauma to the vocal cords or surrounding tissues.

By following these steps and tips, the bronchoscope can be safely and effectively passed through the vocal cords.

4. Retrieving the foreign body:

Forceps are used to grasp and remove the foreign body.
5. Bronchial lavage:

Saline solution may be used to lavage the airways and clear secretions.

Postoperative Monitoring

1. Vital signs:

The child's vital signs are monitored closely after the procedure.
2. Oxygen saturation:

Oxygen saturation is monitored to ensure adequate oxygenation.
3. Respiratory status:

The child's respiratory status is monitored for any signs of distress.

Complications

1. Bleeding:

Bleeding can occur during or after the procedure.
2. Airway trauma:

The airway can be traumatized during the procedure.
3. Respiratory distress:

The child may experience respiratory distress after the procedure.

Rigid bronchoscopy is a valuable procedure for retrieving foreign bodies in children. It requires specialized equipment and expertise, and careful monitoring is necessary to prevent complications.

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