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Editorials |

Bleeding Risk and Bronchoscopy: In Search of the Evidence in Evidence-Based Medicine

Kenneth Chinsky, MD, FCCP
Author and Funding Information

Affiliations: Erie, PA
 ,  Dr. Chinsky practices with Chest Diseases of Northwestern Pennsylvania, Erie, PA.

Correspondence to: Kenneth Chinsky, MD, FCCP, 3580 Peach St, Suite 103A, Erie, PA 16508; e-mail: lchinsky@aol.com



Chest. 2005;127(6):1875-1877. doi:10.1378/chest.127.6.1875
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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.

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