Container Types:
Bronchial specimen trap
Sterile Cup
Tube with CytoRich fixative
SurePath Vial
Preferred Draw Volume
Adequate bronchial brushing and washing specimens should contain large numbers of well-preserved bronchial lining cells, with as little contaminating oral and upper airway material as possible.
The adequacy of a BAL and sputum specimens is determined primarily by the presence of alveolar macrophages, which indicate that the specimen obtained is a deep cough specimen producing material from the lower airways.
Unacceptable Conditions
Missing patient identification
Source not written on outside of container
Laterality not provided
Leaking containers
Collection Comments
*** Collect a separate specimen for Microbiology studies whenever possible.
Cerner order: Type “ BAL “ , “Washing”, or “Brushing” under specimen type. Options will be available to choose in the drop -down menu. In the comments section add in specimen source.
Submitting personnel must verify source by writing on Cerner label and providing signature.
Document laterality on the outside of the container as well as in the requisition comments.
Bronchial Washing:
Using standard bronchoscopy technique, lavage the area of the bronchus to be sampled. Collect the wash in a sterile container or bronchial specimen trap. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag.
Bronchial Alveolar Lavage (BAL):
Using standard bronchoscopy BAL technique, lavage the lung area in question with sterile, normal saline (or other physiologic solution). Collect the lavage specimen in a sterile specimen container or Bronchial specimen trap. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag.
Bronchial Brushing:
Using standard bronchoscopy technique, identify the lesion in question and obtain a brushing sample of the lesion. Upon withdrawing the brush, agitate the brush vigorously in a 5–10 mL cytology fixative. DO NOT APPLY THE BRUSH DIRECTLY TO SLIDES. Cut or detach the brush and place in the wide mouth opening of the SurePath vial. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag. Call cytopathology for any vials needed.
Sputum:
When clinically feasible, obtain 5 mL of sputum (about one teaspoon) or more if possible, from a deep cough specimen. The optimum time for specimen collection is within 15–30 minutes of waking and before eating breakfast. Brushing of teeth or rinsing of the mouth thoroughly with water will reduce contamination by saliva. Instruct the patient to inhale and exhale deeply, forcing air from the lungs using the diaphragm. Repeat until the patient coughs and is able to produce a sputum specimen.
Collect the specimen in sterile container. Specimen should be a deep cough specimen and not saliva. Saliva is of no diagnostic value. Greater diagnostic yield may be obtained if specimens are submitted on three to five successive mornings.
Label the container with patient identification. Write the specimen type on the outside of the container before packaging into biohazard bag.
Bronchoalveolar lavage (BAL), washings, brushings, and sputum specimens explore large as well as discrete areas of the respiratory tract. Alterations in cellular morphology reflect pathological changes in the lung parenchyma including malignancy and inflammatory conditions.
Container Types:
Bronchial specimen trap
Sterile Cup
Tube with CytoRich fixative
SurePath Vial
Preferred Draw Volume
Adequate bronchial brushing and washing specimens should contain large numbers of well-preserved bronchial lining cells, with as little contaminating oral and upper airway material as possible.
The adequacy of a BAL and sputum specimens is determined primarily by the presence of alveolar macrophages, which indicate that the specimen obtained is a deep cough specimen producing material from the lower airways.
Unacceptable Conditions
Missing patient identification
Source not written on outside of container
Laterality not provided
Leaking containers
Collection Comments
*** Collect a separate specimen for Microbiology studies whenever possible.
Cerner order: Type “ BAL “ , “Washing”, or “Brushing” under specimen type. Options will be available to choose in the drop -down menu. In the comments section add in specimen source.
Submitting personnel must verify source by writing on Cerner label and providing signature.
Document laterality on the outside of the container as well as in the requisition comments.
Bronchial Washing:
Using standard bronchoscopy technique, lavage the area of the bronchus to be sampled. Collect the wash in a sterile container or bronchial specimen trap. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag.
Bronchial Alveolar Lavage (BAL):
Using standard bronchoscopy BAL technique, lavage the lung area in question with sterile, normal saline (or other physiologic solution). Collect the lavage specimen in a sterile specimen container or Bronchial specimen trap. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag.
Bronchial Brushing:
Using standard bronchoscopy technique, identify the lesion in question and obtain a brushing sample of the lesion. Upon withdrawing the brush, agitate the brush vigorously in a 5–10 mL cytology fixative. DO NOT APPLY THE BRUSH DIRECTLY TO SLIDES. Cut or detach the brush and place in the wide mouth opening of the SurePath vial. Label the container with patient identification. Write the specimen type and laterality on the outside of the container before packaging into biohazard bag. Call cytopathology for any vials needed.
Sputum:
When clinically feasible, obtain 5 mL of sputum (about one teaspoon) or more if possible, from a deep cough specimen. The optimum time for specimen collection is within 15–30 minutes of waking and before eating breakfast. Brushing of teeth or rinsing of the mouth thoroughly with water will reduce contamination by saliva. Instruct the patient to inhale and exhale deeply, forcing air from the lungs using the diaphragm. Repeat until the patient coughs and is able to produce a sputum specimen.
Collect the specimen in sterile container. Specimen should be a deep cough specimen and not saliva. Saliva is of no diagnostic value. Greater diagnostic yield may be obtained if specimens are submitted on three to five successive mornings.
Label the container with patient identification. Write the specimen type on the outside of the container before packaging into biohazard bag.
Bronchoalveolar lavage (BAL), washings, brushings, and sputum specimens explore large as well as discrete areas of the respiratory tract. Alterations in cellular morphology reflect pathological changes in the lung parenchyma including malignancy and inflammatory conditions.
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