Few situations elevate the BP or tighten the sphincter tone of a pulmonologist more than bleeding after transbronchial biopsy (TBB). One or two drops of blood mixed with a small volume of sputum appear through the bronchoscope to be a raging river. We all know the drill: occlude the bleeding orifice and wait. And wait. Suction a bit, but don’t disturb the forming clot. And wait.
Some of you may have learned a few tricks along the way. One mentor advocated instilling a little topical epinephrine to stem the tide (where is the evidence-based medicine proving the efficacy of that technique?). Others tamponade the offending orifice by inflating the balloon of a pulmonary artery catheter or Fogarty catheter. Rarely, surgical control of bleeding via thoracotomy is necessary. Fortunately, the old adage “all bleeding eventually stops” usually holds true.