A Blind BAL can be undertake between 0400Hrs and 2000Hrs only and should be dispatched to the labs between 0800Hrs and 2000Hrs seven days a week as they will not be analysed out with this time period. Specimens undergoing a prolonged period of storage prior to examination decrease show a reduced yield. The sample will need to be analysed within 12 hours of collection. If the sample is taken overnight please store in the PICU “lab fridge” for routine morning sample pick-up or send to Microbiology from 0800Hrs in the pneumatic tube system.
Blind BAL equipment - see picture 1. (all stocked in labelled tray in PICU store room) |
1 Sterile drape |
2 Sterile gloves & plastic apron |
3 Two tracheal suction traps (Ref 24006182) |
4 10ml syringe |
5 Normal saline |
6 Sterile green needle |
7 3-way tap (Ref 876.20) |
8 Male-male connector (Ref 893.00) |
9 Luer lock suction connector (Ref 801.00) |
10 Argyle suction catheter 6, 8 or 10Fr gauge (use the largest size that will fit the ET Tube) |
11 Blind BAL trolley |
12 Spare suction catheter for after Blind BAL |
Picture 1: Blind BAL trolley
Picture 2: Blind BAL equipment laid out on trolley
Picture 3: Equipment assembled
Action |
Rationale |
At the bedspace prepare the sterile field on top of the cleaned Blind BAL trolley:
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There is a risk of introducing infection if asepsis is not maintained. |
Draw up saline using the green needle with an air “chaser” to flush in saline:
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The “air chaser” is required to flush in all the saline |
Assemble the Blind BAL equipment (picture 2 & 3):
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It is important not to suction tracheal secretions from the ETT while performing BBAL. This would make the interpretation of the result difficult. |
Give sedation (if required) and pre-oxygenate for 2 minutes (unless balanced cardiac physiology) |
Pre-oxygenation is mandatory for all patients except balanced cardiac conditions |
Advance the Argyle suction Blind BAL catheter gently until resistance is met ensuring that it is advanced beyond the length of the ETT |
This will mean Catheter is normally wedged down right main stem bronchus. |
Inject the saline with the syringe held vertically down the ETT so the air “chaser” is last down the ETT |
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Keep the Argyle suction catheter in the same position and open the three-way tap to the suction & suction for 2-4 seconds pulling the Blind BAL catheter up a maximum of 2cm |
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After the sample has been collected, close the three-way tap to suction to ensure that no tracheal secretions are collected and pull out the Argyle catheter |
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Do not aspirate through the catheter once the catheter has been removed from the ETT. Routine ETT suction may be needed after a Blind BAL is undertaken |
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If enough sample decant half the sample into a 2nd plain container and send this to Virology for extended respiratory virus PCR. If not enough sample then repeat the process using a clean argyle suction catheter to get the sample for Virology |
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Order investigations as per trakcare plan – see below the label & send to the microbiology or virology lab:
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We do not now routinely gram stain Blind BAL’s or perform TB culture The sample will need to be analysed within 8 hours of collection or 12 hrs if sample taken overnight and stored in fridge |
Document event on CIS under “event” as Blind BAL |
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