Clinical Procedure
Aliases:
Topic aliases are alternate phrasings for a particular topic.
Bronchopulmonary lavage (BPL)
BAL
Non-bronchoscopic BALs are done by anaesthetists at RCH.
Bronchoscopic BALs are done by respiratory physicians with an anaesthetist faciliting the anaesthetic.
BALs in ICU are performed using a significantly more involved and sterile technique with a combicath to avoid sampling colonising organisms on the wall of the ETT which have typically had more time for colonisation than a theater patient.
Bronchoscopic BALs are done by respiratory physicians with an anaesthetist faciliting the anaesthetic.
BALs in ICU are performed using a significantly more involved and sterile technique with a combicath to avoid sampling colonising organisms on the wall of the ETT which have typically had more time for colonisation than a theater patient.
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Feb 06, 2016
Procedure for obtaining bronchial washing samples for microscopy and culture. This can be done with or without bronchoscopic guidance.
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Feb 06, 2016
If performing the BAL with another procedure, consider performing the BAL first to give the patient's airway some time to recover before extubation.
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Apr 30, 2012
BRONCHOALVEOLAR LAVAGE GUIDELINE (Frank Shann)
Equipment
Combicath, simple dressing set, 10ml syringe, sterile saline, drawing-up needle, sterile scissors, mask, gloves, hat.
Measure the distance from the patient's xiphisternum to the tragus (ear), then to the end of the endotracheal tube. If the total distance is less than 35cm, use a Combicath 58223.19 (short), and if it is 35cm or more use a Combicath 58229.19 (long).
Procedure
1. Use a sterile technique (scrub, gloves, mask, hat).
2. Pre-oxygenate the patient.
3. Insert the Combicath through the endotracheal tube until it is gently wedged.
4. While keeping the white outer protective sheath wedged, pull back the clear inner cannula 0.5 cm so you can remove the 5cm grooved tube that is between the end of the white protective sheath and the end of the clear inner cannula.
5. Push the inner cannula back in so it is gently wedged in the airway, and hold it wedged while pulling the white protective sheath out about 5cm (until it meets the Luer fitting on the end of the inner cannula).
6. While keeping the inner cannula gently wedged, inject 1ml/kg (maximum 10ml) of sterile saline over 5 seconds, then aspirate gently for 10 seconds using the 10ml syringe.
7. Stop aspirating. To avoid contamination with tracheal secretions, ONLY ASPIRATE WHILE THE INNER CATHETER IS WEDGED.
8. After you have stopped aspirating, hold the outer protective sheath still and pull the inner cannula back about 5cm until you can see the end of the metal tube that is inside the inner cannula.
9. Pull out the whole Combicath (protective sheath and inner cannula).
10.Wipe the end of the protective sheath with a sterile swab, then cut off the distal 1cm of the protective sheath with sterile scissors.
11.Push the Luer fitting of the inner cannula back into the Luer fitting of the outer protective sheath so that the end of the inner cannula that was inside the patient is poking out of the protective sheath.
12.Inject 1ml of sterile saline through the inner cannula into a sterile sampling bottle.
13.Label the bottle and send it for a Gram stain, culture and any other tests needed.
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Mar 27, 2013