Iatrogenic bleeding during flexible bronchoscopy: risk factors, prophylactic measures and management

Bernasconi, Maurizio ; Koegelenberg, Coenraad F.N. ; Koutsokera, Angela ; Ogna, Adam ; Casutt, Alessio ; Nicod, Laurent ; Lovis, Alban (2017)


Significant iatrogenic bleeding during flexible bronchoscopy is fortunately rare and usually self-limiting. Life-threatening bleeding, however, can occur, especially after conventional or cryoprobeassisted transbronchial biopsy. The aim of this review is to provide the practising pulmonologist with a concise overview of the incidence, severity and risk factors for bleeding, to provide sensible advice on prophylactic measures and to suggest a plan of action in the case of significant bleeding. Bronchoscopy units should have a standardised approach and plan of action in the case of life-threatening haemorrhage. Wedging the bronchoscope in the bleeding segment, turning the patient in an anti-Trendelenburg position and onto the side in order for the bleeding lung to be in the dependent position, installing vasoconstrictors and using a tamponade balloon early are the recommended first-line strategies. Involving a resuscitation team should be considered early in the case of massive bleeding, desaturation and haemodynamic instability.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/104337
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