1. PATIENT IMMOBILIZATION

• Secure patient on procedure table to minimize movement per hospital protocol.

2. ANESTHESIA

• Administer Lidocaine until patient’s throat is adequately numb.

3. LUNGVISION^® REGISTRATION

• A revised respiration protocol is necessary due to the effect of sedation medications on respiratory volume. A larger breath hold may increase the difficulty of accurately navigating to the lesion location.  
• Perform all steps of LungVision^® registration prior to sedation:
• Main Carina Registration – Perform per Procedure Workflow instructions.
• Lesion Registration – 
• Instruct patient to perform 3 large breaths in and out.
• Instruct patient to take 1 small inspiratory breath and to hold this breath.
• Perform C-arm spin per Procedure Workflow to register lesion.
• Repeat to register each lesion of interest.

4. SEDATION

• Administer small doses of Versed and Fentanyl.
• Insert scope into airway utilizing Lidocaine.
• Administer and titrate Lidocaine in 3-5cc doses until coughing subsides. 
• Administer sedation medications per hospital protocol to help patient with anxiety and discomfort during procedure.

5. TOOL-IN-LESION CONFIRMATION

• Attempt a breath hold by waking patient and repeating breath hold protocol described above for “Lesion Registration” (This may not be possible depending on sedation level).
• Perform C-arm spin per Procedure Worfklow to visualize tool and lesion.

6. PERFORM REMAINDER OF LUNGVISION^® PROCEDURE