3.55 Blind Bronchoalveolar Lavage or Non‐Bronchoscopic BAL
Category: UWHC Departmental Policy
Policy Number: 3.55
Effective Date: April 1, 2015
Manual: Respiratory Care Services; Special Procedures
To provide a non‐bronchoscopic method of obtaining a sample of bronchoalveolar fluid in the
mechanically ventilated patient who is suspected of having ventilator associated event (VAE).
There are no absolute contra‐indications for non‐bronchoscopic alveolar lavage (Mini‐BAL), however, if
the patient has any of the following conditions, the Respiratory Therapist must discuss and document
with the ordering provider before performing the procedure.
A. Coagulopathy or bleeding disorder: INR less than 1.5 and platelets less than 50,000.
B. Arterial saturation less than 90%.
C. MI within the previous 6 weeks.
D. Serious cardiac arrhythmias.
E. ICPs greater than 20.
F. Peep level of greater than 15 cm H
G. Severe Asthma
A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the
appropriate indications for this procedure are present.
B. Immediately terminate the procedure with any evidence of desaturation and/or bradycardia,
and notify the provider.
C. All non‐ventilated patients with a tracheostomy tube (size 6 or greater) must be in an IMC or
ICU to receive this procedure.
A. Ballard BalCath Kit: Central Supply reference numbers
1. 4007221 (larger catheter – 16 Fr)
2. 4013091 (smaller catheter – 13 Fr)
B. Sterile drape
C. 250 ml bottle of 0.9% sodium chloride
D. Three 30 ml luer lock syringes
E. Sputum container
F. Basin for sodium chloride
G. Sterile Gloves
V. General Procedure
A. Confirm the provider’s order for non‐bronchoscopic BAL or mini BAL.
B. Review patient’s chart.
C. If sedation is needed, assure that there are orders to adequately sedate the patient.
D. Print the lab requisition form and patient labels. (See related link).
E. Identify the patient prior to specimen collection using tat least two forms of patient specific
F. Complete the pre‐procedure verification found on the RT Mini‐Bal doc flow sheet.
G. This procedure requires two health care professionals.
H. Obtain appropriate equipment.
I. Introduce yourself to the patient and family. Explain reasons for the procedure.
J. Complete the following steps prior to procedure: (see related link for complete list).
1. Pre‐oxygenate the patient with 100% oxygen for at least 10 minutes before the
2. Shut off patient’s tube feeds 30 minutes prior to starting the procedure.
3. Suction patient.
4. Empty all ventilator water traps or circuit condensation prior to procedure.
5. Fill three 30 ml syringes with 20 mls of 0.9% sodium chloride.
K. Perform the procedure (see related link).
L. Gloves need not be maintained as sterile, but aseptic technique should be used.
M. Perform the following steps after the procedure is completed:
1. Place patient label on the container.
2. Use the “buddy system” to double‐check that the patient’s label matches the patient
and that the label is securely affixed to the specimen container.
3. Place specimen container in a bag, seal it, and send to the lab with the requisition.
N. Assess patient’s oxygenation status and return to the previous oxygen setting.
A. Mini BAL flow diagram
B. Nosocomial Pneumonia Guideline
C. “Antibiotic Utilization and Outcomes for Patients with Clinically Suspected Ventilator‐
Associated Pneumonia and Negative Quantitative BAL Culture Results,” M.H. and K.E. Kollef,
Chest 2005; 128; 2706‐2713.
VII. Signed by
Medical Director of Respiratory Care
Director of Respiratory Care