AK asks:
Wondering how many people out there do blind TBB's or if fluoro is pretty routine. Do people favor a particular protocol? I've seen people try to have the patient exhale, others just check if the forceps cause pain then let her rip. Would be curious to hear different techniques used out there.
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I tend to always use fluoro.
I use fluoro, but think that even with fluoro a lot of it is done "by feel." We tend to extend the wire until we feel (not see) some resistance, then back up, opent the forcepts, and again advance until I feel some resistance. Then I wait for exhalation (or a cough), and use the "grip it and rip it" approach.
Fluoro is the default but sometimes you run into special situations where it's not feasible. (for example an ICU patient or other patient where a portable bronch is needed. You measure the wire on the outside of the chest to where you want the biopsy, then make note of that when you do the bronch; go out to that area max or until you hit resistence.
I personally don't feel comfortable without fluoro, but it is not entrely unreasonable in the right circumstances...
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