Bronchoalveolar Lavage Procedure
1. Obtain bronchoscope from Special Procedures (GI Endoscopy) Unit.
2. Inspect instrument for any defects or damages prior to removing from the unit. If
any damage noted, record on paper in endoscopy unit
3. Sign out the scope in the log book with instrument serial number, your name, date
and time and record condition of endoscope.
4. Procedure should be performed with sterile drape, betadine prep of bodi
5. Anesthesia: medicate patient prior to procedure with appropriate analgesia
(morphine IV) and sedation (versed). Consider Nimbex for procedure if necessary
1) Suction ETT before starting bronchoscopy
2) Insert bronch, avoid suctioning secretions through bronch channel
3) Wedge tip of bronchoscope into a subsegmental bronchus and inject 20ml
of saline, aspirate and discard. (This should not be sent for quantitative
4) Inject additional aliquots of 20-60 ml and aspirate back after each flush
into a Lukey tube. At least 4-5 cc BAL fluid is needed for adequate
analysis for quantitative culture. Usually about 100 – 140 cc is needed to
inject to obtain 4-5 cc BAL fluid
5) Send BAL fluid to micro lab, mark the request with “Quantitative Culture
7. Bal should be done between the hours of 8am and 4pm so that the quantitative
culture is processed the same day in micro lab and the bronch can be returned and
cleaned the same day.
Care of Bronchoscope:
At the end of the procedure flush through the scope with saline and wipe
outside. Do not drop endoscope on floor or leave on counters where it can be
• Return immediately to Special Procedure Unit. If after hours place in
dirty utility room. During regular working hours (8-4pm) give to
Endoscopy technician for cleaning.
• Note condition of instrument at return and document this on paper.
Sign instrument back in log book with date, time and your name.