NBL
Non-directed bronchial lavages (NBL) Patients should be pre-oxygenated and sedation ensured.
Indications
Significant respiratory illness (requiring ventilation) as admission diagnosis Secondary respiratory (iatrogenic) illness in intubated and ventilated patient
Abnormal clinical course of known respiratory pathogen e.g. RSV
Diffuse radiological change
Unidentified sepsis
Immunocompromised patients
Research (recognised projects with ethical approval being conducted in PICU, UHW)
Equipment
Use appropriate NBL catheter (sizes 6,8,10 stocked; calculate as for ordinary suction catheters
Use normal saline only: 1ml/kg (minimum 5ml; maximum 20ml)
Sterile gloves (sterile technique)
Mask
Goggles
2 or 3 sterile patient-labelled universal containers (virology, bacteriology, other e.g. TB, PCP, fungi)
20ml syringe
Extra suction catheters of appropriate size
Bagging circuit connected to oxygen supply (for emergencies)
Method
Prewarn lab staff
An assistant will be required
Assess sedation / analgesia score; consider additional sedation +/- paralysis
Attach a catheter mount
Preoxygenate with FiO2 of 1.0 (100%) for at least 3 minutes
Connect prefilled syringe to catheter
Assistant detaches ventilator circuit at ETT connector
Advance catheter through ETT until resistance felt
Instil syringe contents as quickly as possible
Immediately withdraw catheter by 1cm and aspirate with moderate pressure applied to the syringe
Withdraw catheter
The assistant reconnects ventilator circuit to ETT
Divide aspirate into universal containers
Send immediately to appropriate labs and inform them
Reassess clinical condition of patient and treat as appropriate
Operators
Trained staff only
- Physiotherapists (senior paediatric)
- Doctors (consultants and SpRs)
- Nurses (senior, if requested)
Oscillated patients
ONLY PERFORM NBL IF IMPERATIVE
Experienced staff only to perform procedure
Re-recruitment will be needed following procedure