Page 2374 - Cote clinical veterinary advisor dogs and cats 4th

1172.e6 Transtracheal Wash

(catheter position stays unchanged), and Alternatives and Their Pearls
apply the needle guard. Relative Merits • TTW is best used to obtain samples for bac-
VetBooks.ir • Aspirate with empty syringe immediately blind) (p. 1073) and productive cough. It is less useful for
Bronchoalveolar lavage, nonbronchoscopic (i.e.,
• Remove stylet, and flush initial volume of
terial culture from animals with pneumonia
saline.
other types of airway disease diagnoses.
• Allows sample from deeper in airways/lungs
after flushing; avoid aspirating against nega-
• Requires brief general anesthesia
tive pressure (e.g., catheter tip lodged against • Larger volume of sample produced • The major advantage of TTW compared with
other sampling options is that anesthesia is
respiratory mucosa; if so, release negative • Equally simple if not simpler than trans- not required for TTW.
pressure and reposition). If no specimen tracheal wash (TTW), requiring no special • Pre-oxygenate patient if possible.
is obtained, the second volume is flushed equipment • Each method has limitations in how well its
and aspirated again. Some saline that passes Bronchoscopy/tracheobronchoscopy (p. 1074): results reflect the underlying disease process
down the trachea is coughed/expectorated • Visualization of airways to bronchi (diagnostic accuracy).
back toward the catheter. Mucus and tur- • Provides reduced contamination and supe-
bidity are seen in the sample. Often, only rior estimate of cell numbers from lavage SUGGESTED READING
1-2 mL can be retrieved out of every 10 mL specimen Norris CR, et al: Comparison of results of thoracic
infused. • Catheter lavage and brush cytologic analysis radiography, cytologic evaluation of bronchoalveolar
• Withdraw catheter. can both be performed lavage fluid, and histologic evaluation of lung
• Gently wrap neck over insertion site with • Can obtain end bronchial lavage (EBL)/ specimens in dogs with respiratory tract disease:
cast padding, roll gauze, and stretch wrap bronchoalveolar lavage fluid specimen 16 cases (1996-2000). J Am Vet Med Assoc
to reduce risk of SQ emphysema. Keep the • Requires additional equipment, expertise, 218(9):1456-1461, 2001.
neck wrap in place for 12 hours, ensuring and longer procedural time ADDITIONAL SUGGESTED
that it is not too tight. • Tracheobronchoscopy is more accurate than
tracheal wash if both options are available. READING
Postprocedure Transoral tracheal wash (endotracheal wash): Hawkins EC, et al: Cytological analysis of bronchoal-
• Provide supplemental oxygen (p. 1146). • Simpler technique veolar lavage fluid in the diagnosis of spontaneous
• Divide specimen into aliquots for cytologic • Can be faster respiratory tract disease in dogs: a retrospective
analysis, cultures, and slides for cytology; can • Requires more sedation or anesthesia study. J Vet Intern Med 9(6):386-392, 1995.
request Gram stain. • Can result in compromised, contaminated AUTHOR: Mark E. Hitt, DVM, MS, DACVIM
• If respiratory distress occurs, tilt the animal’s specimens for reduced diagnostic accuracy EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
body (head down, allowing fluid to flow • Consists of endotracheal intubation and inser- Thompson, DVM, DABVP
cranially), perform coupage, and consider tion of red rubber catheter to approximately
intubation and oxygen supplementation/ the carina, followed by saline installation and
positive-pressure ventilation. aspiration
• Radiographs to assess for pneumomediasti-
num or subcutaneous emphysema, if needed

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