Techniques used for transbronchial wall penetration during TBNA*

Jabbing method

The needle is thrust through the intercartilaginous space with a quick, firm jab to the catheter, while the scope is fixed at the nose or mouth.

Hub against the wall method

With the needle in the retracted position, the distal end of the catheter (the metal hub) can be placed directly in contact with the target and held firmly while the needle is pushed out of the catheter for its spontaneous penetration through the tracheobronchial wall.

Piggyback method

Once the needle is advanced and locked in position, the catheter is fixed against the proximal end of the insertion port using the index finger in a single port scope or the little finger in a dual port scope to prevent recoil when resistance is met. The bronchoscope and catheter are then pushed forward as a single unit, until the entire needle penetrates the tracheobronchial wall.

Cough method

While the jabbing or piggyback technique is applied, the patient is asked to give a hard cough for the spontaneous penetration of the needle.

Bronchial_wall_puncture.htm

* These techniques may be used alone or in combination for successful penetration of the needle through the tracheobronchial wall.

Reproduced with permission from Minai, OA, Dasgupta, A, Mehta, AC. Transbronchial needle aspiration of central and peripheral lesions. In: Bolliger, CT, Mathur, PN (Eds), Progress in Respiratory Research-Interventional Bronchoscopy. Karger, Basel, Switzerland, 1999.

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Techniques used for transbronchial wall penetration during TBNA*