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BTS guidelines
British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE
  1. I A Du Rand1,
  2. J Blaikley2,
  3. R Booton3,
  4. N Chaudhuri4,
  5. V Gupta2,
  6. S Khalid5,
  7. S Mandal6,
  8. J Martin4,
  9. J Mills7,
  10. N Navani8,
  11. N M Rahman9,
  12. J M Wrightson9,
  13. M Munavvar7,
  14. on behalf of the British Thoracic Society Bronchoscopy Guideline Group
  1. 1Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
  2. 2The University of Manchester, Manchester, UK
  3. 3The University of Manchester, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
  4. 4University Hospital of South Manchester, Manchester, UK
  5. 5Royal Blackburn Hospital, Lancashire, UK
  6. 6Lane Fox Unit, St Thomas’ Hospital, London, UK
  7. 7Lancashire Teaching Hospitals NHS Trust, Preston, UK
  8. 8University College London Hospital and MRC Clinical Trials Unit, National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
  9. 9Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
  1. Correspondence to Dr Ingrid Du Rand, Worcestershire Royal Hospital, Aconbury East, Charles Hastings Way, Worcester, WR5 1DD, UK; ingrid.durand{at}nhs.net

https://doi.org/10.1136/thoraxjnl-2013-203618

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    Summary of recommendations

    Monitoring, precautions and complications

    • All patients undergoing bronchoscopy should have heart rate, respiratory rate, blood pressure and oxygen saturation recorded repeatedly, including before, during and after the procedure. (Grade D)

    • All bronchoscopy units should undertake periodic audit of bronchoscopic performance, including efficacy, complications and patient satisfaction surveys. (Good practice point (√))

    • All Trusts should have a ‘safe sedation policy’, and ensure all bronchoscopy unit staff, including trainees, receive appropriate training. (√)

    Hypoxaemia

    • Patients should be monitored by continuous pulse oximetry during bronchoscopy. (Grade C)

    • Oxygen supplementation should be used when desaturation is significant (pulse oximeter oxygen saturation (SpO2)>4% change, or SpO2<90%) and prolonged (>1 min) to reduce the risk of hypoxaemia-related complications. (Grade D)

    • The risks of hypoxaemia-related complications are associated with baseline arterial oxygen saturation (SaO2) and lung function, comorbidity, sedation and procedural sampling. Fitness for bronchoscopy should incorporate an assessment of these elements, and appropriate monitoring and preprocedure optimisation. (Grade D)

    Cardiac arrhythmias

    • Continuous ECG monitoring should be used when there is a high clinical risk of arrhythmia. (Grade D)

    • When there is a high risk of arrhythmia, oxygen saturations, pulse rate and blood pressure should be optimised. Appropriate aftercare monitoring and instructions should be given. (Grade D)

    • Resuscitation equipment should be readily available. (√)

    • Intravenous access should be established before sedation is given and maintained until discharge. (√)

    Bleeding complications

    • Perform coagulation studies, platelet count and haemoglobin concentration when there are clinical risk factors for abnormal coagulation. (Grade D)

    • Bronchoscopy with lavage can be performed with platelet counts >20 000 per μL. Liaise with the local haematology team regarding the need for platelet transfusion before bronchoscopy if endobronchial biopsy (EBB) or transbronchial lung biopsy (TBLB) is planned. (Grade D)

    • Discontinue clopidogrel 7 days prior to consideration of EBB and TBLB. Low-dose aspirin alone can be continued. (Grade C)

    • Anticoagulants should be managed according to published …

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