Chest
Volume 90, Issue 3, September 1986, Pages 403-405
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Clinical Investigations
The Safety of Outpatient Transbronchial Biopsy

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Fiberoptic bronchoscopy (FOB) is an accepted outpatient procedure, but transbronchial biopsy (TBB) is generally reserved for hospitalized patients. Over a three-year period, we performed fluoroscopically guided TBB in 14S of 688 outpatients undergoing FOB. Following the procedure, fluoroscopy was used to screen for possible pneumothorax in those patients who had had TBB. All patients were observed for one hour and then discharged if stable. Three patients (2.02 percent) were admitted and observed for acute hemoptysis following TBB. Bleeding ceased spontaneously in each. The remaining 145 patients were discharged after one hour of observation. One patient (0.68 percent) required Heimlich tube treatment for a delayed pneumothorax. Our experience indicates a low incidence of delayed complications in patients who are asymptomatic for one hour following TBB. We conclude that patients do not require hospitalization solely for TBB.

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MATERIALS AND METHODS

From Jan 1, 1982, to Dec 31, 1984, we performed 1,942 FOB in the department of pulmonary disease at The Cleveland Clinic Foundation (CCF). Of these patients, 688 underwent FOB on an outpatient basis. Fluoroscopically guided TBB was performed in 148 of these 688 patients, ranging in age from 23 to 80 years. Each had a normal prothrombin time, activated partial thromboplastin time, and platelet count; and none had renal or immune compromise. The presence of pulmonary function impairment

RESULTS

Table 2 lists the procedures performed in the 688 outpatients undergoing FOB. The 148 patients who had TBB on an outpatient basis also underwent other procedures (Table 3). Table 4 describes the five complications that occurred in the 688 patients undergoing outpatient FOB. The only complication (0.18 percent) in the 540 patients who did not have TBB was a presumed transient bacteremia that did not require hospitalization. Four patients (2.7 percent) who underwent outpatient TBB had

DISCUSSION

In addition to confirming the conclusions of Donlan et al10 and Ackart et al11 that FOB is a safe outpatient procedure, our study indicates that TBB also can be performed safely on an outpatient basis. In our patients who underwent this procedure, three of the four complications we encountered occurred well within the one hour observation period. A single complication, a pneumothorax, was manifested after the patient had been discharged from the bronchoscopy area. The treatment was

REFERENCES (17)

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Presented at the 51st Annual Scientific Assembly, American College of Chest Physicians, New Orleans, Oct 29, 1985.

Manuscript received January 31; revision accepted March 3.

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