Bronchoalveolar lavage (BAL) is a common, but cumbersome, procedure for collecting fluid samples from the lungs, often done in the ICU.
In new research, Dr. Suveer Singh of the Royal Brompton and Chelsea & Westminster hospitals in the UK, found a unique closed-loop sampling system reduced the risk of sample loss or contamination during BAL.
The independent research, published in Respiration, included 20 bronchoalveolar lavage (BAL) and bronchial washing (BW) procedures. Singh reported the Ambu aScope BronchoSampler simplified sampling in 95 percent of procedures.
He also wrote that in 80 percent of the study’s 20 procedures, the BronchoSampler made it “much easier to collect and protect a sample from start to finish” compared with traditional (BAL) sampling techniques. Clinicians rated the device “easier” in another 15 percent and noted “no difference” in 5 percent of the cases.
Singh disclosed a financial relationship with Ambu in his report. The study is limited in that it is a single-operator case series.
First popularized by Dr. H.Y. Reynolds and Dr. H.H. Newball in Maryland in 1974, BAL has largely become a diagnostic tool for evaluating lower respiratory tract issues. It sometimes also has therapeutic value.
Despite the procedure’s common utility for collecting samples, BAL remains a challenging process, from setup to post-procedure waste disposal.
The procedure involves putting a saline solution through a bronchoscope to wash the airways and capture a fluid sample. Typically, two healthcare providers are involved in obtaining the sample which requires switching between suctioning and sampling, without contaminating the open container holding the sample or spilling it.
The laboratory of Dr. Ronald G. Crystal in the Pulmonary Branch of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) in Bethesda, Maryland, was an original site for lung studies using BAL. Many of the medical staff and trainees who worked in that lab returned to their own centers or relocated to other pulmonary groups to become modern leaders in lung medicine.
Although there have been many innovations in bronchoscope and imaging technology, little has changed in the realm of BAL and BW since the procedures were first introduced in the 1970s.
One of the challenges that physicians have long reported with BAL is that it’s easy to lose these samples that are so vital for diagnosis and treatment, either because of awkward workflows or due to contaminated tools and accessories.
Another BAL workflow challenge includes the potential for a long wait time for a reprocessed flexible bronchoscope. During the procedure itself, switching between suction and sampling can also leave open containers exposed to surrounding elements and contaminants. That can compromise the integrity of the samples collected.
Approximately 500,000 bronchoscopy procedures are performed in the U.S. each year, according to the U.S. Food and Drug Administration.
COVID-19 presented additional BAL challenges in the ICU because aerosolizing procedures can put healthcare workers at increased risk of infection. The disconnection of suction tubing, as well as splashing from specimen containers, are particular areas of concern.
Recommendations from a variety of U.S. and international professional associations issued earlier in the pandemic included using leak-proof specimen collection for suspected COVID-19 patients when bronchoscopy sampling is deemed necessary.
For more information:
Single-use bronchoscopes eliminate the need for reprocessing and help prevent patient cross-contamination. In tandem with a single-use bronchoscope, Ambu’s closed-loop sampling system helps reduce cross contamination in BAL. Click here for more information.