Prior to the procedure, consideration should be given to whether BAL fluid collected in traps or syringes should be kept separate (sometimes done when looking for evidence of hemorrhage or when specimens are being collected from different locations) or mixed (generally done when more than one trap or syringe is used from same location. The total amount of fluid that should be collected is dependent on the types of analyses being performed
Fluid for cell count should be transferred from trap/syringe to a purple top tube (typically 3-5 cc). Order for cell count should be placed and specimen labeled
Fluid for all microbiologic analyses can be submitted together (typically 5-15 cc, table above). These analyses generally require. Orders for the desired individual tests need to be placed. For immune compromised patients there are order sets which may be helpful
Fluid for cytological analysis should be submitted separately (minimum 10 cc, but the more fluid the better). If special stains for organisms or lipid analysis are desired this must be indicated on the requisition as some of these tests are unavailable after the specimen is processed. Makes sure that you use the Cytology, NonGyn Respiratory Tract order (LAB6938) for BAL samples. Don’t use “Bronchoscopy” as the specimen source but rather BAL and laterality when appropriate (right, left, RUL, LUL, etc).
Fluid for alveolar hemorrhage should be collected by means of serial manual lavage. 30 cc of fluid should be instilled and manually aspirated using a 30 cc syringe. Five aliquots are generally performed. After assessment is made via visual inspection the fluid can be mixed and sent for ordered analyses.
