Bronchoalveolar lavage
Sampling protocol
- Plan to perform the BAL preceding any other planned bronchoscopic procedure to avoid specimen contamination
- Minimize use of topical anesthesia as there may be bacteriostatic effects of lidocaine
Preparation an anesthesia
- Obtain informed consent
- If outpatient: the patient should be accompanied by a designated person to be driven
- BAL should be planned to be performed prior to any other bronchoscopic procedure
- Review Chest X-ray to determine ideal site ol alveolar lavage (in diffuse infiltrates, the right middle lobe or the lingula in the supine patient is preferred)
- Prepare bronchoscope, collection trap and tubing
- Prepare supplemental oxygen and monitoring equipment
- Premedicate with bronchodilatators and/or warm the saline solution for those at risk for bronchospasm
- Position patient, preferably in supine position when approaching RML or lingula
- Apply monitors and supplemental oxygen
- Sedation with a benzodiazepine and a narcotic will allow patient comfort and minimize cough reflex
- Perform preparatory steps and obtain adequate sedation
- Advance bronchoscope until wedged in a desired subsegmental bronchus at the desired location
- Infuse 20mL of saline with a syringe, observing the flow of saline at the distal tip of the bronchoscope
- Maintaining wedge position, apply gentle suction (50-80 mmHg), collecting the lavage specimen in the collection trap
- Repeat these steps up to 5 times as needed (total 100-120 mL), to obtain an adequate specimen (40-60 mL – usually 40-70% recovery of total instillate)
- Flexible bronchoscope
- Sterile collection trap
- Suction tubing
- Sterile saline
- Vacuum source
- Syringe
- Optional 3 ways stop-cock
- Lidocaine 1-2%
- Sedation medication (according to local guidelines)
Microbiology requires at least 3mL in a sterile container (add more if other specific request)