Mediastinoscopy
Norm of Mediastinoscopy
Normal mediastinal structure and lymph nodes; no evidence of disease process.
Usage of Mediastinoscopy
To detect lymphoma (such as Hodgkin's disease), lung metastasis to mediastinal lymph nodes, granulomatous infection, mediastinal tuberculosis, sarcoidosis; to obtain biopsy specimen of mediastinal lymph nodes or intrathoracic lesions; to determine staging of bronchogenic carcinoma; and to evaluate tumor spread or intrathoracic diseases. Used when fine-needle aspiration biopsy of the thoracic structures has not yielded a diagnosis.
Description of Mediastinoscopy
Mediastinoscopy is a surgical endoscopic procedure performed with the client under general anesthesia. A small incision is made at the suprasternal notch, and a mediastinoscope is inserted into the mediastinum. The purpose of this procedure is to visualize the mediastinal structure and lymph nodes and to obtain biopsy sample of lymph nodes or other lesions. The lymph nodes in the mediastinum receive lymphatic drainage from the lungs. A mediastinoscopy is usually performed when radiographs, sputum cytologic evaluation, and lung scans (CT and nuclear) have not confirmed a diagnosis. Mediastinoscopy is an invasive procedure and is performed with the client under general anesthesia because of the pain and coughing that result from the manipulation of the trachea.
Professional Considerations of Mediastinoscopy
Consent form IS required.
Risks
Perforation of the trachea, esophagus, aorta, or other blood vessels; pneumothorax; laryngeal nerve damage; and infection.
Contraindications
Previous mediastinoscopy (caused by adhesions); clients who are not candidates for general anesthesia.
Preparation
- See Client and Family Teaching.
- Complete preoperative checklist, and perform routine preoperative care, which is the same as with any other surgical procedure. Check if the client's blood needs to be typed and cross-matched.
- Measure and record baseline vital signs.
- Ask the client if he or she is allergic to any anesthetic medicine.
- Encourage the client and family members to express concerns about the procedure. Answer questions and refer those that you cannot answer to appropriate health care professionals.
- Administer preprocedural medication approximately 1 hour before the test, as prescribed.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- The client is transported to an operating room and general anesthesia is administered.
- A small incision is made in the suprasternal fossa, and a mediastinoscope is passed through this neck incision, along the anterior course of the trachea, and into the superior mediastinum.
- The area is visualized. Photographs of specific areas and structures may be taken. Biopsies of the lymph nodes may also be performed.
- The mediastinoscope is withdrawn, and the incision is sutured.
Postprocedure Care
- Assess vital signs every 15 minutes × 2, then every 30 minutes × 2, then hourly × 4, and then every 4 hours until 24 hours after the procedure. Report changes in vital signs (such as increase in pulse rate or respiratory rate, decrease in blood pressure).
- Auscultate lung sounds, and assess for any respiratory abnormalities, such as dyspnea.
- Check for bright red blood or increased blood on the dressing. Observe the wound for symptoms of infection.
- Provide comfort measures as needed (such as position change, medication).
- Send biopsy specimens to the pathology laboratory immediately.
Client and Family Teaching
- Refrain from eating or drinking for 8–12 hours before the procedure.
- Void before the surgical procedure.
- This procedure will take approximately 1 hour and is performed by a surgeon.
- You will be asleep during the procedure.
Factors That Affect Results
- Phenytoin hypersensitivity may result in a “pseudolymphoma,” causing false-positive cytologic results.
Other Data
- Thoracotomy is advisable in the instance of negative cytologic characteristics in lesions likely to be malignant.
