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Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

While the usually thin, watery esophageal and

gastric secretions, if free from food, are readily aspirated through a

drainage canal, the secretions of the bronchi are often thick and

mucilaginous and aspirated with difficulty. Further-more, bronchial

secretions as a rule are not collected in pools, but are distributed

over the walls of the larger bronchi and continuously well up from

smaller bronchi during cough. The a
pirating bronchoscopes should be

used whenever their very slight additional area of cross-section is

unobjectionable. In most cases, however, the most advantageous way to

remove bronchial secretion has been found to be by introducing a gauze

swab on a long sponge carrier (Fig. 14), so that the sponge extends

beyond the distal end of the bronchoscope, causing cough. Then

withdrawal of the sponge carrier will remove all of the secretion in

the tube just as the plunger in a pump will lift all of the water

above it. By this maneuver the walls of the bronchus are wiped free

from secretions, and the lamp itself is cleansed.

[FIG. 14.--Sponge carrier with long collar for carrying the small

sponges shown in Fig. 15. The collar screws down as in the Coolidge

cotton carrier. About a dozen of these are needed and they should all

be small enough to go through the 4 mm. (diameter) bronchoscope and

long enough to reach through the 53 cm. (length) esophagoscope, so

that one set will do for all tubes. The schema shows method of

sponging. The carrier C, armed with the sponge, S, when rotated as

shown by the dart, D, wipes the field, P, at the same time wiping the

lamp, L. The lamp does not need ever to be withdrawn for cleaning

during bronchoscopy. It is protected in a recess so that it does not

catch in the sponges.]

[FIG 15.--Exact size to which the bandage-gauze is cut to make

endoscopic sponges. Each rectangle is the size for the tubal diameter

given. The dimensions of the respective rectangles are not given

because it is easier for the nurse or any one to cut a cardboard

pattern of each size directly from this drawing. The gauze rectangles

are folded up endwise as shown at A, then once in the middle as at B,

then strung one dozen on a safety pin. In America gauze bandages run

about 16 threads to the centimeter. Different material might require a

slightly different size and the pattern could be made to suit.]

[32] The gauze sponges are made by the instrument nurse as directed in

Fig. 15, and are strung on safety pins, wrapped in paper, the size

indicated by a figure on the wrapper, and then sterilized in an

autoclave. The sterile packages are opened only as needed. These

bronchoscopic sponges are also made by Johnston and Johnston, of New

Brunswick, N. J. and are sold in the shops.