Bronch 101

So one of my friends Andrea asked me today precisely what a bronch entails. I thought since I talk about them so often here, an explanation might be a good idea. So here we go.

Basically a bronch is a way of seeing what's really going on inside the lungs. A basic bronch is with "lavage," which is a fancy way of saying they squirt a lot of saline in there to loosen up secretions and suction out some for sampling. It's kind of like a lung car wash. They take about 45 minutes. A bronch w/ biopsy also involves lavage, but the 'biopsy' part involves the taking of a bunch of small pieces of tissue to test for rejection and stuff like that. So we check secretions and tissue pieces to get a full picture of what is going on down there. Post-tx, they are done at 1 month, 3 months, 6 months, 9 months, and 1 year, with yearly ones after that, and whenever one is warranted. I've had three in the past two months, so it's a good thing I like them. As far as testing goes, they are not bad.

You are NPO (Latin for nil per oram(l), "nothing by mouth") at midnight before the exam. This can be tricky if they randomly decide to do one, but they basically just tell you not to eat or drink from that point forward. You want your stomach empty so it doesn't, um, "empty" itself during/after the procedure. It's a 23-hour admit, so if it's scheduled you end up going to Admission around 7 am, check in, and go to a room to wait for them to come get you. Blood is taken ( for my drug levels and such), a pregnancy test is done, and usually around 9, 10:00 one of the RTs or the nurse on the floor takes you down to the bronch suite. Now we have a brand-spankin' new suite, which I wrote about in a post below. It is awesome. (Note: now they might just admit us to the bronch suite, since there are pre/post procedure rooms. Not sure.)

A bronch involves a lot of personnel: 3 RTs (respiratory therapists), a nurse (or two--usually now it's just Julie), Dr. A, and the pulmonary fellow or someone else (this time, it's been the fellow, named Steve. He and I are getting very chummy.). And, of course, I'm there.

The procedure starts with the RTs attaching little monitoring probes to your chest: one for your heart, and the others monitoring reps per minute and breathing. You get a SAT monitor on your finger and a blood pressure cuff which measures your BP every 5 minutes. This information is broadcast on two little TV screens at the foot of the gurney. You get a nasal cannula with about 2L of oxygen running through it to start, although sometimes during the procedure I've gone up to 4, depending on coughing and stuff like that.

Once you're all rigged up, you're strapped to the table, arms and legs, so you don't move or try to remove the scope or anything fun like that. You kind of feel like Frankenstein's monster. After that, the fellow has usually arrived, as well as the nurse, and the fun parts begin. The fellow starts to numb your throat with a very nasty-tasting spray so that you can't feel the bronchoscope as it goes through. There are about 4-5 sprays of about 5-10 seconds each, and it's kind of nasty. Sometimes, though, they do this once you're sedated, so it's all good. Concurrently Julie will be giving me fentanyl and versed through my port. The first is for pain (I usually get about 300 mg) and the versed is so you don't remember the procedure (6 mg). It's a great cocktail, let me tell you. I like to be out, or out soon after, my throat is numb, because it's a very odd/panic-inducing feeling to not be able to feel yourself swallow. Do not recommend it. The "happy drugs" are not administered all at once--it's about 3 or 4 separate injections, so you nod off gradually, which is nice. I usually feel pretty loopy. For a bronch they don't want you completely out, because you have to be able to follow commands when they give them, but they don't really want you conscious, either. I believe it's called the "twilight" state. But I'm usually pretty easy to sedate, so I go to sleep very nicely. I also bare my soul during bronchs and say some interesting things, so it pays to be present for them. :) Considering that all bronchs at Children's are taped, I bet there's some pretty interesting stuff on my tapes....scary thought.

Anyway, once I'm out, they start the actual procedure. I may or may not have seen Dr. A before we start, usually not. It takes about an hour, and then you go to one of the post-procedure rooms to kind of wake up. When you've waken up a bit they take you to the floor where you continue to shake it off. Once you're coherent enough, you have to swallow to prove your gag reflex is back, and usually eat something. After all that, they will discharge you, unless there were problems, but I've never had any. You can't drive for 24 hours post-bronch, and it usually takes me about 36-8 hours to totally shake off everything. You sleep really, really well following this procedure, let me tell you.

So that, everyone, is how a bronch works. Great test--happy drugs, you get to sleep, and you get good samples for testing. So yay!