Page 3288 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Bronchoalveolar Lavage (BAL)

VetBooks.ir Patient name:_________________________________
Pet owner’s name:_____________________________ Med rec #____________
Best contact during/after procedure (e.g., cell phone number):____________________

INTRODUCTION USE OF ANESTHESIA
We want to make sure that you understand the planned medical Both bronchoscopically guided and “blind” BAL procedures
procedure to be performed on your pet. You should know why the require general anesthesia. This means that your pet will be made
procedure has been suggested, what the potential benefits are for unconscious so that we can pass the tube into the lungs. Although
your pet, and the most common/important risks of the procedure. anesthesia is performed routinely with good outcomes, it does bring
Alternatives to this procedure, when applicable, will discussed with risks, including the risk of death. These risks may be increased for
you. It is also important that you recognize that medicine is not an an animal with respiratory disease. In general, the length of time
exact science, and that the outcome cannot be guaranteed. We required for anesthesia for bronchoscopically guided BAL is longer
encourage you to ask us as many questions as required for you than the time required for blind BAL.
to make a well-informed decision.
FORESEEABLE RISKS TO PROCEDURE
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE The most important risk of BAL is hypoxemia, or an inability to
We hope to find evidence that will help us determine what is causing provide oxygen to the blood. A mild degree of hypoxemia is
your pet’s respiratory disorder. This procedure is not a treatment expected, and usually resolves quickly after the procedure has
for disease, but we hope it will help find a diagnosis for a treatable been completed. The risks of hypoxemia are often worse in animals
disease. with respiratory disease, mostly because these animals may already
have trouble with breathing. To minimize the risk, supplemental
EXPLANATION OF THE PROCEDURE oxygen will be provided to your pet both before and after the
There are two ways to obtain BAL, and we tell you which method BAL is completed. Additionally, bronchodilator drugs may be used
we plan to use. to help prevent “bronchoconstriction”, or tightening of the lower
1) Bronchoscopically guided BAL airways that sometimes accompanies BAL. Sometimes, the pet
2) “Blind” BAL may need continued oxygen supplementation even after waking up
“Bronchoalveolar” refers to the deep airways of the respiratory from anesthesia and may require spending a night in the hospital for
system, and “lavage” means washing, or using sterile saline to observation.
withdraw fluid samples from those airways. Bronchoalveolar lavage Unlikely risks include exacerbated cough, airway/lung infection,
(BAL) is designed to sample secretions in the depths of a patient’s cardiac arrhythmia, fever, hemorrhage that can cause coughing of
airways and to provide these as specimens to a laboratory for blood, or cardiac arrest.
analysis. For either procedure, your pet will be anesthetized to
allow us to pass a clean tube through the mouth and down into Other anticipated risks specific to your pet:___________________
the airways. In the case of bronchoscopically guided BAL, a long,
thin camera (the bronchoscope) will be inserted to visually examine _________________________________________________________
the inside of the airways; this camera will be directed to several
different locations in the airways inside the lungs. This method allows Finally, there is a risk that we will not identify a specific cause
us to see mucus, redness, foreign material, tumors, or misshapen of your pet’s illness despite performing the BAL.
airways, and allows us to obtain BAL samples from specific lung
lobes. The bronchoscope will reach many but not all of the airways ALTERNATIVES TO THE PROCEDURE
in the lungs. In the case of “blind” BAL, a tube without any camera Other tests may help with the diagnosis of respiratory disease,
component to it will be inserted into the airways, which means a including imaging tests, blood tests, and others. However, BAL is
general sample will be retrieved and no internal inspection of the one of only a few methods that allow a determination of the cell
airways will occur. In either case, we will “flush” the airway with and/or bacterial type in the airways. Other options may include
sterile saline (salt water), and then remove as much of the fluid as transtracheal lavage, or lung biopsy. Without additional information,
possible. This fluid will be examined for cell count and cell type and we are unable to determine a specific diagnosis, and therefore
may be submitted for special testing such as bacterial culture. The cannot be sure that we know how best to treat your pet.
number and kinds of cells we find, as well as results of special tests,
will allow us to rule out some potential causes and often lead us to AUTHORIZATION
make a diagnosis as to what is likely causing respiratory disease. By signing this form below, you agree that:
The procedure is not a treatment for disease. • You understand how/why the procedure is likely to help your pet
Additional procedures planned for your pet at the same time • You understand what will be done to your pet during the
as the BAL: procedure
• You understand the known risks that accompany the procedure,
____________________________________________________________ and also understand that unforeseen complications may occur

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.