What is a Bronchoalveolar Lavage?

Bronchoalveolar lavage is a surgical procedure used to obtain samples of fluid washings from the lining of the respiratory tract, specifically around the alveolar and bronchial spaces. The bronchi are structures in the lungs which act as a passageway for air going in and out of the lungs. Alveoli are small sacs in the lungs where gas exchange takes place. Doctors normally perform this procedure to diagnose lung conditions, including infections, cancer and lung disease.

The procedure is done with minimum invasion to the lung tissues, and is often helpful to physicians in confirming a diagnosis. A bronchoalveolar lavage is commonly performed to check for the presence of malignancy or bleeding, and to confirm the presence of opportunistic microorganisms, such as fungi, in patients with immune system problems. It is also indicated in patients on ventilators, or breathing machines, who are suspected of suffering from pneumonia, a condition characterized by inflammation of the lung tissues.

Pulmonologists, doctors specializing in lung disorders, are generally the ones performing bronchoalveolar lavage. One of the instruments used during the procedure is a bronchoscope, which is a slender, flexible, tube-like instrument equipped with a small flashlight and eyepiece. It is often utilized for viewing and examining the internal structures in the respiratory tract, such as the trachea and bronchi. Other instruments needed in bronchoalveolar lavage are tubes for suction, a vacuum source and a sterile specimen trap.

An electrocardiogram (ECG), blood pressure apparatus and pulse oximeter, an instrument which measures oxygen levels in the blood, are usually attached to the patient for continuous monitoring as the procedure is performed. After sedation and administration of a local or general anesthesia, the bronchoscope is inserted in the mouth or nose of the patient until it reaches the affected lung. Saline solution is then flushed into the lung area to irrigate the alveoli. Sample fluids are then suctioned and collected in a sterile specimen trap and sent to the laboratory for analysis, with particular attention paid to any presence of microorganisms. The number of white blood cells in the fluid sample are also counted as well as its protein content.

After the procedure, a chest x-ray is usually taken to determine the lung status of the patient, as suctioning may sometimes cause injury to the cells. To prevent risk of aspiration, patients are usually not allowed to take anything by mouth until a normal gag reflex is elicited. Careful and thorough evaluations pertaining to the respiratory status of the patient are also done regularly until he recovers.