A-Z of BALs

Presenter – Adam Bell BSc BVSc CertVC CertSAM MRCVS of Calder Vets, and Nick Carmichael BVM&S, BSc VetSci(Hons), Diploma VCS(Syd), Diploma RC Path, Diplomate ECVCP, MRCVS, RCVS recognised specialist in clinical pathology, of Carmichael Torrance.

Let’s face it, there is nothing more frustrating than performing procedures which yield no results. Not only has a potentially sick animal had to go through a fruitless set of tests , the owners will no doubt have been charged accordingly only to find we are no further forward with a diagnosis.

In my experience this has, on occasion, been the case when performing broncho-alveolar lavages (BALs). We all know this is sometimes the way it is in veterinary medicine, not every case follows the rule book and no matter how hard we try our efforts can come to nothing. However it would be nice to know that my technique for performing BALs is as good as it can be, harvesting as much information as possible from this procedure.

This is exactly what Adam Bell and Nick Carmichael covered at last week’s veterinary webinar organised by ‘The Webinar Vet’. The technique of performing a BAL was made crystal clear by Adam, using video to demonstrate the procedure. Adam suggested getting a specific catheter to perform a BAL as he was concerned that a cut down urinary catheter could cause trauma and lacks flexibility. All the details of Adam’s suggested catheter are within this veterinary webinar.

When performing a BAL, Adam advises pre-filling a catheter and syringe with 7-8mls(for a dog) and 5-6mls (for a cat) of sterile saline. Pre-measure the catheter to rib 9/10 and advance the catheter down an ET tube until some resistance is felt. Install the saline and apply a full 10mls of suction, slowly withdrawing until the suction is lost and fluid appears in the syringe. Detach the syringe, remove the air, reapply the syringe and repeat the procedure.

Once the sample has been obtained Nick Carmichael advises placing the fluid in an EDTA tube, an EDTA tube with 2 drops of 10% formalin, also a plain tube, and obtain a swab for culture and make smears from the tip of the catheter and any ‘floaters’ found in the retrieved fluid. Nick then goes on to describe a number of findings that could help to diagnose a coughing patient including the ability to perform PCRs, looking for infectious agents such as Bordetella bronchiseptica and Angiostrongylus vasorum.

After investing a small amount of time watching this veterinary webinar, it was clear that just a few minor tweaks to my BAL technique could prevent many of those awkward moments having to inform owners that the tests performed provided no useful results. This is an hour very well spent and I highly recommend taking a look.

The Stethoscope (MRCVS)

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