Bronchoalveolar Lavage

Bronchoalveolar Lavage



Basic Information image



Synonym(s)




Lung wash



Overview and Goal(s)


It is commonly agreed that tracheal wash cytology, endoscopy, and radiography are not sufficient diagnostic techniques for the diagnosis of inflammatory airway disease (IAD) in horses; bronchoalveolar lavage (BAL) provides the “gold standard” diagnosis. The goal of the BAL is to obtain a representative sample of lower airway respiratory secretions to diagnose diseases that diffusely affect the lower airways, such as IAD and exercise-induced pulmonary hemorrhage (EIPH).



Indications




• Indications for BAL include


image Diffuse lung disease such as IAD

image Alveolar hemorrhage such as EIPH

image Nonresolving pneumonia

image Diffuse lung infiltrates

image Alveolitis

image Nonresolving bronchitis

image Silicosis, other dust exposure

image Research


Contraindications




• BAL is relatively contraindicated in patients with borderline oxygenation.


• Care should be used in animals with tachypnea, tachycardia, or dysrhythmias.


• Should not be performed within 24 hours of anticipated exercise.



Equipment, Anesthesia




• Bronchodilator (360 µg of albuterol or 84 µg of ipratropium bromide) using an aerosol delivery device (AeroHippusR, Trudell Medical International, London, Ontario, Canada) 15 minutes before BAL


• Sedation (xylazine hydrochloride 0.5–0.75 mg/kg IV or detomidine 0.005–0.01 mg/kg IV). The addition of butorphanol tartrate (0.02–0.04 mg/kg IV) to the sedation will decrease coughing


• Twitch


• Bivona tube (VBAL30) with outside diameter 11 mm, 244 cm length, Smith Medical or a long (2–3 m) endoscope


• 30 mL of warmed lidocaine to inject on the glottis and additional 30 mL for anesthesia of the trachea


• 2 × 250 mL bolus of warmed sterile saline in bottle or large syringes that can be prefilled


• Administration set with pressure bulb and three-way stopcock


• Ice for chilling sample


• Tubes with EDTA or other fixative only if sample cannot be refrigerated


• Table top centrifuge or cytocentrifuge


• Transfer pipette


• Slides


• Fan for drying slides


• Diff-Quik or similar stain if staining in-house


• Toluidine blue if staining in-house

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Bronchoalveolar Lavage

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