Division of Pulmonary & Critical Care Medicine

As of 3/16/2020 Due to the significant and dramatic change in the environment regarding COVID-19, all Bronchoscopy and IP procedures were reviewed for the next 2 weeks. Each case was classified and in cases of Non-Urgent and Routine, patients were contacted, and intervention discussed with them. Bronchoscopic procedure Classification and Prioritization standardized.

Inclusion: Ex-smokers (≥4 months)  PFT:  Post BD FEV1 15 – 45%  TLC ≥100%  RV ≥150%  6MWD  ≥ 100 – <500 meters after pulmonary rehabilitation program BMI <35 Kg/m2 Completed pulmonary rehabilitation program (or is enrolled and completed 6-8 sessions)  ABG: PaCO2 <60  Stable on prednisone <20mg/day  Exclusion:  Any contraindication to bronchoscopy and/or general anesthesia  Lung findings:  […]

 LAST DOSE BEFORE BRONCHOSCOPY< TIME TO RESTART MEDICATIONS AFTER BRONCHOSCOPY WITH BIOPSIES Heparin SubQ No Need to stop Not applicable Enoxaparin 1mg/Kg SubQ BID > 24 hours > 12 hours Enoxaparin 1.5mg/Kg SubQ QD > 24 hours > 12 hours Warfarin (Coumadin) 5 days (confirm INR < 1.5) immediately Heparin IV > 4 hours (check […]

Inpatient The GPU residents/staff will order diagnostic/therapeutic thoracentesis through EPIC. Arrangements have been made through EPIC, so that every time a thoracentesis order is typed, there will be 2 options: Thoracentesis-Pulmonary and Thoracentesis (radiology).   Once Thoracentesis-Pulmonary is selected, the name of the patient will go to a workqueue in the bronchoscopy suite.   If […]

  INR Less than 2.0 for Therapeutic Thoracentesis (includes the use of drainage catheter-6.0 Fr from the Thoracentesis Kit) Less than 2.5 for Diagnostic Thoracentesis (includes the use of NEEDLE ONLY, but no catheter). Average amount drained with needle is 20mL (depends on the procedure staff)   Platelet Count More than 50,000 for Therapeutic Thoracentesis […]

In this article and its corresponding editorial, there are 5 questions that can take the place of ordering coagulation studies prior to every bronchoscopy. These five clinical risk factors are as follows history of anticoagulant therapy history or physical evidence of liver disease, eg, hepatitis, cirrhosis, hepatomegaly, ascites, or jaundice history, family history, or physical evidence of bleeding tendencies, […]