BAL, chest drains and tracheostomy

Question 1

Uses for BAL

Answer 1

To collect lower respiratory tract samples for cytology and microbiology

Question 2

Advantages of BAL

Answer 2

• Relatively rapid procedure
• Minimal risk other than anaesthetic
• Endoscopy allows visualisation of tract
• Quality of cytology is generally high
• Fluid rapidly absorbed

Question 3

Disadvantages of BAL

Answer 3

• Required GA
• Can be expensive
• Careful with hyper responsive airways

Question 4

Method of BAL

Answer 4

1. Pre-oxygenate patient
   
   2. Animal in lateral recumbency
   3. Requires general anaesthetic so ET tube placed (cuffed)
      ○ Short acting light GA
   4. Measure urinary catheter to carina
   5. Careful progress sterile urinary catheter down ET tube
   6. Using syringe inject 0.5ml/kg sterile Hartmann’s into urinary catheter
   7. Immediate suction after instillation of fluid
   8. Remove catheter after getting sample and immediately oxygenate patient on 100% oxygen

Question 5

Indications for chest drains

Answer 5

○ Animals that will require multiple thoracocentesis over a short period of time
○ Large volumes of effusion
○ Pneumothorax
○ Chest wall injuries
Flail chest / Flail segment
○ Bite wounds
○ Pyothorax cases
○ Following chest surgery

Question 6

Advantages of chest drains

Answer 6

• Avoids repeated thoracocentesis
• Secure access to pleural space
• Generally well-tolerated
• Continuous drainage achievable with appropriate equipment

Question 7

Contraindications of chest drains

Answer 7

• Severely dyspnoeic patients should be stabilised prior to drain placement
• Increased risk of infection
• Very invasive

Question 8

Indications of tracheostomy

Answer 8

• Laryngeal injuries/obstruction
• Tracheal trauma
• Neoplastic lesions
• Foreign bodies
• During URT surgery

Question 9

Limitations of tracheostomy

Answer 9

• Maintenance of ventilation
• Intensive management
• Risk of infection
• Risk of blockages