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Aim: to assess nurses’ knowledge and practice for patients undergoing bronchoscopy procedures and design suggested nursing care guidelines for those nurses. Design: descriptive research design was utilized in this study. Setting: The study was conducted on 40 nurses at bronchoscopy unit of the chest department, at Assiut University hospital. Tools: A structured interview questionnaire sheet for nurses. Including: Demographic data, an observation checklist for nurses and develop suggested nursing care guidelines. Results: Fifty two of studied nurses had poor knowledge score, and regarding the total score of nurses' practice, (87.5%) of them was satisfactory. In addition, there was no correlation between nurses' knowledge and practice total scores and their demographic data except between good knowledge level score and their ages and marital status. Conclusion: the studied nurse practice levelwas satisfactory while their knowledge scores were not in the same line.

Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt. Objective This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience. Patients and methods This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018. Results The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor non-life-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA. Conclusion Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

SETTING In high-risk areas (sputum collection room in a tuberculosis [TB] clinic, patient rooms in a TB ward, the emergency department and the bronchoscopy unit) in seven health care facilities located in central Thailand. OBJECTIVE To detect airborne Mycobacterium tuberculosis complex and other environmental parameters using the liquid impinger and real-time quantitative polymerase chain reaction (real-time qPCR) technique in high-risk areas. DESIGN Cross-sectional study. RESULTS M. tuberculosis was detected in 3 of 99 (3.0%, 95%CI 0.6-8.6) areas: one sputum collection room and one TB in-patient room in one facility and one sputum collection room in another facility. In these three areas, the M. tuberculosis copy number/m³ ranged from 9.6 to 1671. Lower air change rate ( 65%), and contact with coughing patient(s) were more common in airborne M. tuberculosis-positive areas than in M. tuberculosis-negative areas. CONCLUSIONS Air sampling using a liquid impinger followed by real-time qPCR is effective for quantitative detection of airborne M. tuberculosis in high-risk areas. Our findings indicate TB risk among health care workers, and suggest that improved ventilation, enhanced appropriate cough etiquette and respiratory protection are needed to mitigate M. tuberculosis transmission. .

Introductions and Methods: the ultrathin bronchoscope (UB) is a tool that has proven its usefulness in the diagnosis of distal lung lesions. Descriptive analysis of the bronchoscopic explorations performed with UB due to suspected neoplasm between October 2016 and November 2019 Results: we performed 67 procedures, 6 (9%) of them in the operating room (under fluoroscopic guidance) and 61(91%) in the bronchoscopy room. All patients had a previous chest CT and 41 of those showed an endobronchial route to the lesion and which was also identified during the exploration in 29 cases (43.2%). The figure below summarizes the characteristics of patients and samples, and the diagnosis achieved by the use of UB in 21 patients (31.3%). A conventional bronchoscopy was previously done, which had been diagnostic in only 5 cases; meaning that with the UB we diagnosed 16 additional cases (23.9%) avoiding other procedures. Conclusions: The global rentability of UB has been 31.3%, taking into account that in most of the patients the technique was performed in the bronchoscopy room, without radioscopic control and that 50% of the lesions were located in upper lobes. The UB used as a complementary exploration technique after a conventional bronchoscopy proved to be diagnostic on respect of this latter one performed alone in 76.2%. The procedure was performed safely, with a low complication rate.

Background: Pulmonary nodules are one of the most common thoracic imaging abnormalities. A revised estimate of over 1 million nodules are detected each year as an incidental finding, either on chest radiographs or thoracic computed tomography (CT) scans However, an accurate diagnosis from these small, peripheral lung lesions can still be challenging with the use of conventional procedures.The lung point navigation bronchoscopy seems safe and effective. Navigation support with fluoroscopic guidance more successful in sampling small Solitary Pulmonary Nodules, increasing the likelihood of a diagnosis and decreasing the need for surgical biopsy . Aim of the work: To detect the role of the lung point navigation bronchoscopy in diagnosis of pulmonary nodule. PATIENTS AND METHODS: This study was performed between January 2019 and October 2019 in the bronchoscopy unit of Chest hospital of Military Kobri Al-Kobba medical Complex, It was prospective cross-sectional analytic study conducted on 30 patients to detect the role of the lung point navigation system in diagnosis of pulmonary nodule. Conclusion: Diagnosis of pulmonary nodule by navigated bronchoscopy with the lung point system seems safe and effective. Navigation support with fluoroscopic guidance may be more successful in sampling small and peripherally located pulmonary nodule, increasing the likelihood of a diagnosis and decreasing the need for surgical biopsy.

This paper presents three ventilation scenarios for a bronchoscopy unit using a numerical study. A Fire Dynamics Simulator (FDS) is employed for this purpose. The results obtained are visualized using Smokeview (SMV), which is a program for displaying FDS results. The numerical results are compared with experimental ones from Cheong and Phua's research study. This study was chosen because it investigates ventilation strategies in hospital isolation rooms using a tracer gas technique. In the present work, six points of measurements are utilized to evaluate the concentrations of contaminants and air velocity. The results show that the concentrations estimated by FDS are inferior to the experimental results given by Cheong and Phua . For example, in the SP1 point of measurement, the concentrations estimated by FDS and by Cheong and Phua are 20 and 28.9 ppm, respectively, while in the SP5 point, the concentrations estimated by FDS and by Cheong and Phua are 28.6 and 32.9 ppm, respectively. The error percentages between FDS estimates and experimental measurements made by Cheong and Phua range between 1 and 32%.

Introduction: We hypothesise that management of tracheal stenosis (TS) following intubation due to cardiogenic shock is particularly difficult. Methods: Retrospective study of patients with TS and history of intubation submitted to bronchoscopic procedures in a Bronchoscopy Unit, from 2014 to 2018. Patients were divided in 2 groups: I – intubation due to cardiogenic shock; II – intubation due to other causes. Clinical data was reviewed. Results: From a total of 55 patients with benign TS, 48 (87.3%) had history of intubation. Three were excluded due to missing cause of intubation. Out of 45 included patients (27 men, median age 58 years, 18 with smoking history), 13 (28.9%) matched group I and 32 (71.1%) group II. Patients’ characteristics and procedures are shown in Table 1. Group I was submitted to significantly more rigid bronchoscopies (6 vs 2, p 0.031) and mechanical dilations (5 vs 2, p 0.031) compared to group II. Discussion: Almost 30% of patients with TS were intubated due to cardiogenic shock. These patients required a higher number of endoscopic procedures, reflecting a more complex management. It would be important to identify risk factors and implement preventive strategies of tracheal injury in these at risk patients. Data: median (IQR), no. of patients (%) or no. of procedures

Background Mycobacterium fortuitum survive in different environmental conditions, biofilm formation and resistance to chlorinated disinfectants makes its isolation frequent in hospital environments, even being involved in outbreaks by contamination of medical equipment such as bronchoscopes. We describe a pseudo-outbreak by M fortuitum isolated in samples from 9 patients who underwent bronchoscopy in the pneumology bronchoscopy unit of the University Hospital Complex of the Canary Islands from December 2016 to March 2017. Methods We proceeded to investigate the pseudo-outbreak with a combination of epidemiologic, environmental, and molecular typing data. Results The source/reservoir of pseudo-outbreak was the hospital water used by the bronchoscope automatic washing machine (without antibacterial filter), so control measures were taken. Molecular typing was performed on 7 strains from 7 patients, and a sample of water was collected from a tap in the pneumology bronchoscopy unit: all of which had the same pattern. Conclusions Our study demonstrates the presence of nontuberculous mycobacteria in the hospital water supply, and thus the need to take measures against them because they compromise patients’ health. We also suggest the need for hospital water quality guidelines in which methods to control and/or eliminate them are established.

Introduction We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and methods The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Result The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusions Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Rapid on-site evaluation (ROSE) of samples obtained by transbronchial needle aspiration during flexible bronchoscopy or endobronchial ultrasound has been practised for more than two decades. Earlier studies evaluating its role have reported a magical impact on improving the diagnostic yield and the adequacy of samples produced by transbronchial needle aspiration. Subsequent studies with more rigorous methodologies failed to find a significant increase in sensitivity with ROSE but consistently demonstrated a trend toward performing shorter procedures with fewer complications when ROSE is utilized. There are new exciting fronts for ROSE, such as using it to direct molecular testing for lung cancer. In the future, we expect more centers to apply ROSE, now that pulmonologists have succeeded in doing so and telecytopathology has become reality.

Objective To assess the incidence of bacteremia following bronchoscopy to determine whether the use of prophylactic antibiotics is warranted in patients at risk of endocarditis. Design Prospective nonrandomized clinical study. Settings Bronchoscopy Unit of Chest Department and Thoracic Surgery Department, and Microbiology Laboratory of Ain Shams University Hospitals, Cairo, Egypt. Patients Forty-five patients undergoing diagnostic and therapeutic bronchoscopy. Interventions Blood samples for culture were obtained before and immediately after the procedure. Results There were no documented cases of bacterial growth in blood. Two culture bottles yielded contaminant. Conclusion Bronchoscopy is a low-risk procedure for the development of bacteremia. This may bear on present practice regarding perioperative antibiotic prophylaxis for endocarditis in the high-risk groups.

Background: The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. Methods: We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. Results: Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. Conclusions: EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

At the bronchoscopy unit in Mater Dei Hospital there is a wide variation among respiratory teams regarding the use of sedatives and local anaesthesia (LA) during flexible bronchoscopy (FB). An ideal sedative should result in improved safety, as well as enhancing patient tolerance and comfort., N/A

The purpose of this study was to investigate the occurrence of free-living amoebae in the water system of a teaching hospital in Johannesburg (South Africa). Water and biofilm samples were collected from the theatres, theatre sterilisation service unit, central sterilisation service unit and endoscopy/bronchoscopy unit. The samples were filtered and seeded on non-nutrient agar spread with heat-killed Escherichia coli. Of the 71 samples collected, 63 (88.7%) were positive for free-living amoeba. Acanthamoeba spp., Balamuthia spp. and Hartmanella spp. were identified by morphology. The presence of free-living amoeba in the hospital water network may be a potential health risk.

ObjectiveForceps biopsy is the standard method to obtain specimens in endoscopically visible lesions. It is common to combine forceps biopsy with cytology methods to increase the diagnostic yield. Although the flexible cryoprobe has been established for bronchoscopic interventions in malignant stenosis, the obtained biopsies, called “cryobiopsies,” have not been investigated in a large cohort of patients. The aim of this feasibility study was to prospectively evaluate the diagnostic yield and safety of cryobiopsy and forceps biopsy.MethodsDuring a 6-year period, 296 patients with visible endoluminal tumor lesions were included in the study at the bronchoscopy unit of a university hospital. In the first consecutively conducted 55 cases, both techniques, forceps biopsy and cryobiopsy, were applied simultaneously. Pathologic and quantitative image analyses were performed to evaluate the size and quality of the obtained specimens. We evaluated the safety and diagnostic yield to describe the feasibility of cryobiopsy.ResultsComparative analysis of the first conducted and randomly assigned 55 cases revealed a significantly higher diagnostic yield for cryobiopsy compared with forceps biopsy (89.1% vs 65.5%, P < .05). In this cohort, quantitative image analysis showed significantly larger biopsies regarding size and artifact-free tissue sections for cryobiopsy compared with forceps biopsy (P < .0001). The overall diagnostic yield of cryobiopsy was 89.5%. Mild bleeding occurred in 11 cases (3.7%), moderate bleeding occurred in 3 cases (1.0%), and severe bleeding occurred in 1 case (0.3%).ConclusionCryobiopsy is safe and increases the diagnostic yield in endobronchial tumor lesions. The method also is feasible under routine conditions.

Background Tranexamic acid (TA) is a synthetic antifibrinolytic substance used for short-term control of bleeding. However, control of pulmonary bleeding with endobronchial administration of TA in more than 2 cases has not been attempted earlier. Objective We tested the feasibility of endobronchial administration of TA for controlling pulmonary bleeding. Methods This was a 2-year prospective observational trial of endobronchial TA in consecutive patients presenting with hemoptysis to our bronchoscopy unit. Patients were initially treated according to the recommendations of the Spanish National Guidelines using ice-cold saline and adrenaline. Endobronchial administration of TA was attempted in patients with uncontrolled hemoptysis before proceeding with further interventions (balloon occlusion or embolization). Results Forty-eight patients (37 male; mean age: 64±13 y) were treated with endobronchial TA. The causes of bleeding were divided into iatrogenic (n=28) and noniatrogenic (n=20). Among patients with noniatrogenic bleeding, malignancies (11 patients) and bronchiectasis (10 patients) were the most frequent causes of hemoptysis. In this patient group, endobronchial TA successfully controlled the bleeding in 11 subjects (39.2%). Nonresponders to endobronchial TA suffered more frequently from bronchiectasis (58.3% vs. 18.8%, P=0.039) and less frequently from malignancies (16.7% vs. 56.3%, P=0.040) as compared with responders. All patients with iatrogenic bleeding were treated successfully with endobronchial TA. No subject in either of the patient groups suffered from thrombotic events or other adverse events related to endobronchial TA administration. Conclusions Patients with acute pulmonary bleeding may benefit from endobronchial instillation of TA. Further double-blinded controlled studies are necessary to confirm our results.

Background: A significant part of the budget of our bronchoscopy unit represents repair costs for damaged bronchoscopes. Objectives: The purpose of this study was to determine the frequency, type and cause of damage to the bronchoscope as well as the repair costs. Methods: Frequency, type and cause of bronchoscope damage and repair costs of 13 new bronchoscopes that were used between August 1, 2001, and December 31, 2006, were retrospectively studied. Results: We recorded 47 instances of bronchoscope damage during the study, which is 1 instance of damage/141.6 procedures. Six instances of damage (12.7%) were potentially preventable. The most frequent wear and tear damage was to the rubber sheath on the distal bending portion of flexible bronchoscopes, and the most frequently preventable damage was that of the suction channel of the bronchoscope. The repair costs totaled 34,950.00 EUR or 5.25 EUR/procedure. 17,781.00 EUR (50.9%) can be attributed to preventable damage. The use of bronchoscopes for educational purposes was not associated with a higher rate of bronchoscope damage at our institution. Conclusions: Only a small number of occurrences of bronchoscope damage in our unit are potentially preventable, but they still represent an important expense. The relatively low occurrence of preventable damage is a result of the successful bronchoscopy training program.

The prevalence of lung cancers with epidermal growth factor receptor (EGFR) mutations in South Africa is not known. In the absence of the routine availability of laboratory assays to test for the presence of EGFR mutations, certain demographic and clinical features might be used to predict a response to treatment with a tyrosine kinase inhibitor in patients with lung cancer. These features include East-Asian ethnicity, female gender, non-smokers, and those with adenocarcinoma.

Bronchoscopy unit design has become a topic of interest as interventional pulmonology is being recognized throughout the world and dedicated bronchoscopy suites are being created. The challenges faced are to provide for current volume and types of procedures and to have flexibility in the design to accommodate for future growth. Specific area design must be considered as well as efficient flow throughout the unit.

In December 2008, bronchoalveolar lavage fluid samples obtained from 3 patients were positive forBurkholderia cepaciacomplex on culture. Samples obtained from bronchoscopes and rinse-water samples obtained from the washer-disinfector were found to be positive forB. cepaciacomplex. The cause of this pseudo-outbreak was that the washer-disinfector was installed without the required antibacterial filter.

Study objective: To evaluate the extent to which high-resolution CT (HRCT) can predict the clinical outcome of bronchoscopic treatment with curative intent in patients with intraluminal typical bronchial carcinoid tumors. Design: An observational study. Setting: Bronchoscopy unit and radiology department of a university hospital. Patients and interventions: Eighteen patients with intraluminal typical bronchial carcinoid tumors in the absence of nodal and distant disease were treated with bronchoscopic electrocautery or Nd-YAG laser as an alternative to surgical resection. Prior to treatment, HRCT was performed. Results: In 10 patients, HRCT showed no peribronchial tumor extension, and 9 of these patients were found to be tumor free after bronchoscopic treatment. So far during follow-up, none of these patients has had a recurrence of the tumor. The median duration of follow-up was 33 months (range, 13 to 68 months). In five patients, HRCT showed signs of peribronchial tumor extension. In three of these patients, specimens taken from biopsies performed after bronchoscopic treatment showed residual tumors, and salvage surgery was carried out. In three patients, HRCT was unable to assess peribronchial tumor extension: in two because of insufficient connective tissue contrast between the hilar structures and in one patient because of suboptimal scan technique. Conclusion: HRCT findings were complementary but not conclusive in patients with intraluminal typical bronchial carcinoid tumors treated with bronchoscopic therapy. However, in a category of patients in whom HRCT showed strictly intraluminal tumors, bronchoscopic resection as an alternative for surgical resection seems justified. (CHEST 2000; 117:125‐128)

Setting: Contamination events with Mycobacterium chelonae in 7 patients undergoing bronchoscopy, out of a total of 100 patients in a 5-month period, were analysed. Objective: To identify and assess the importance of factors thought to be relevant in the aetiology of these contamination events and by removing these factors, to eradicate the problem of continuing M. chelonae contamination. Design: A retrospective analysis of the frequency of M. chelonae isolates from bronchoalveolar fluid, assessing the contribution of the following measures to the eradication of M. chelonae : (1) changes to the bronchoscopy unit's water supply; (2) insertion of bacterial filters; (3) installation of a new semi-automated cleaning machine incorporating an ultrasound cycle; (4) staff training in correct use of the new equipment. Results: Following the discontinuation of using tapwater in the cleaning process, the above changes resulted in complete eradication of contamination events, with no further events occurring in the following 12 months. Conclusion: Insertion of bacterial filters into the water supply, with the addition of a more sophisticated semiautomatic cleaning machine involving an ultrasound cycle in addition to conventional cleaning methods currently used, will help reduce or eradicate contamination events with M. chelonae in bronchos copy units.