Functional Characteristics of Flexible Fiber Optic vs Single Patient Use Bronchoscopes

Abstract

Background:

Bronchoscopy is a common procedure in the ICU setting (1). It is often performed for airway inspection/visualization and secretion removal. While the procedure is among those of low to moderate risk, the question of cross contamination of patients by use of fiber optic scopes remains, with some reports of cross contamination as high as 20%(2). Single patient use disposable bronchoscopes have recently become available, but have received mixed reviews by users. Our study sought to determine the functional ability of a disposable versus a flexible fiber optic bronchoscope.

Methods:

A bench study involving direct comparison of two commercially available bronchoscopes (Olympus America, Southborough MA; Ambu Inc., Colombia MD). Each manufacturer offers a scope with a channel size of slim, standard, and therapeutic. Picture quality was not directly addressed, but was deemed adequate for routine work in the ICU. Suction capability was assessed by attempting aspiration of three solutions. 0.9% Saline was used to simulate thin liquids, Clorhexadine Gluconate 2% solution represented a medium thickness secretion, and “honey” consistency barium sulfate suspension (29% w/w) comprised a thick/tenacious secretion. Suction was applied at two settings (150 mm Hg and Full) for either 10 or 20 seconds. Solution(s) acquired were weighed on a scientific scale to an accuracy of 0.1 g (Tree Instruments, China). Findings of mass were converted to liquid volume by weighing a measured quantity (1 mL) in a 10 mL syringe. Scope choice and solution tested were randomized throughout.

Results:

Table 1 details our findings. There was no statistical difference in terms of scope tested against the same solution. There was statistical significance between solutions (P < .0005), and time of suction applied (P < .05) when results were placed in a predictive multiple regression model.

Conclusions:

In instances where the enhanced picture quality of a flexible fiber optic scope is not required, the functional ability of single patient use bronchoscopes is equal to that of the flexible fiber optic. The eliminated risk of cross contamination and the reduced cost of acquisition/maintenance of single patient use scopes should be among the deciding factors for ICU bronchoscopic procedures. References: (1) BJA Education 17;2:48-56. (2) Infect Control Today, August 10, 2018 Disclosures: The authors claim no conflict(s) of interest in this research.