TY - JOUR T1 - British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE JF - Thorax JO - Thorax SP - i1 LP - i44 DO - 10.1136/thoraxjnl-2013-203618 VL - 68 IS - Suppl 1 AU - I A Du Rand AU - J Blaikley AU - R Booton AU - N Chaudhuri AU - V Gupta AU - S Khalid AU - S Mandal AU - J Martin AU - J Mills AU - N Navani AU - N M Rahman AU - J M Wrightson AU - M Munavvar AU - on behalf of the British Thoracic Society Bronchoscopy Guideline Group Y1 - 2013/08/01 UR - http://thorax.bmj.com/content/68/Suppl_1/i1.abstract N2 - 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 … ER -