Figure 1.

Stepwise assembly of closed bronchoscopy system. A, Pulmonary artery catheter sheath that is cut on either end. B, Pulmonary artery catheter sheath is advanced over the bronchoscope and secured at the proximal end with a heavy silk suture and tape to create a seal. C, Swivel elbow is connected to the endotracheal tube at the distal end and allows passage of the bronchoscope through the diaphragm on the proximal end. D, View of the 5.8-mm bronchoscope as it passes through the diaphragm of the swivel elbow. A tight seal is created that prevents air leakage and maintains airway pressure. E, Slit required on the pulmonary artery catheter sheath to fit over the elbow. The distal end of the sheath with the slit is then secured to the proximal end of the swivel elbow using heavy sutures and tape, creating a seal. F, Final assembly of closed circuit that is ready to be attached to the endotracheal tube and used throughout the procedure to limit the escape of particles and protect users from handling the contaminated part of the bronchoscope after it enters the airway.