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MINI-BRONCHOALVEOLAR LAVAGE
4
MINI-BAL are also reffered to as a "Blind BAL"
Why?
1. Ventilator Associated Pnuemonia (VAP); which should be suspected on > 48 hours of Mechanical ventilation.
2. New or progressive radiographic infiltrate.
3. Onset of fever
4. Luekopenia or luekocytosis
5. Worsening gas exchange.
6. Open the Combicath kit in a sterile fashion.
7. Place sterile gloves on.
8. remove catheter from sheating maintain sterility of catheter
9. Fill two syringes with 20 ml 0.9 NACL saline
15. Aspirate the specimen immediately following the lavage using the syring last used.
16. Repeat the process as neccessary until 4-10ml of fluid is returned.
17. If thick secretions are present and prohibiting proper aspiration, the inner catheter maybe removed and the outer catheter shall be used.
18. Remove the combicath from the airway with the syringe still attached.
19. Using sterile technique specimen from the syringe into the sterile cup.
20. Firmly secure the lid, and place a label on the container.
21. place the specimen in a biohazard bag for transport.
22. suction the pt if indicated, asses oxygenation and return the pt to previous FIO2 value if indicated.
23. Wash and clean hands
24. if bleeding is noted, please relay the information to the ICU resident of phys. on call.
25. Ensure an order has been placed in either Essentri of CHCS for "BAL COLONY COUNT"
JUST A REMINDER TO REFER TO THE SOP FOR ANY PT CARE DISCREPANCIES WITH I.E. NURSES OR PHYSICIANS :)
MINI-BRONCHOALVEOLAR LAVAGE
ABSOLUTE CONTRADINDICATIONS
Conclusion
1. Pt requiring FIO2 greater than 90%
2. PEEP greater than or equal to 14 cm H20
3. Plateau greater than or equal to 35 cm H20
4. Pt is on Bi-level or inverse ratio ventilation with a mean airway pressure than is equal to or greater than 25 cm H20
27. Ensure that specimen is properly labeled and transported to tthe laboratory immediately
28. Properly chart under RC evaluation note.
COMBICATH INSERVICE VIDEO
RRT Jeffrey Davis
GUIDELINES
1. Confirm order
2. Gather equipment
3. Ensure a nurse is present for non-sterile assistance
4. Increase FIO2 to 100% unless otherwise instructed.
5. Suction the pt and insert the bronch airway adapter.
GUIDELINES CONT
INDICATIONS FOR USE
GUIDELINE CONT.
10. Advance combicath until resistance is met, and then with draw 3 CM.
12. Remove the white plastic spacer
13. Gently advance the inner cannula until resistance is met
14. Flush saline into the catheter 4oml for adults equal to greater than 18 years of age; 20 ml for children.