TABLE 2.
CLINICAL CONSIDERATIONS WHEN PERFORMING RESEARCH-RELATED BRONCHOALVEOLAR LAVAGE PROCEDURES
| Factors relevant to approvals by institutional or ethical review boards: |
| • Increase in procedure time, BAL volumes, and resulting changes in adverse event/risk profiles, compared with clinically indicated BALs, need to be acknowledged in study protocols and consent forms |
| Before the BAL procedure: |
| • Obtain signed study consent before sedative medication |
| • Confirm lack of recent upper respiratory tract or oral cavity infection |
| • Assess chest radiographs—localize lung pathology or confirm lack thereof |
| • Establish intravenous access (for blood sampling and emergency interventions) |
| • Calculate maximally permissible volumes of sprays and gels based on the total permitted lidocaine dose of 4.5 mg/kg body weight* |
| During the BAL procedure: |
| • Have an anesthesiologist or CPR-trained person available |
| • Administer conscious sedation at operator discretion (e.g., midazolam and/or fentanyl) |
| • Monitor use of lidocaine in sprays and gels during the procedure—stop procedure once a total of 4.5 mg/kg body weight has been used |
| • Continously monitor heart rate, blood pressure, and O2 saturation |
| • Provide supplemental O2 via nasal prongs |
| • Stop BAL procedure at a sustained O2 saturation < 88% |
| After the BAL procedure: |
| • Observe study subject for a minimum of 1 h |
| • Monitor heart rate, blood pressure, O2 saturation |
| • Do not permit eating or drinking until swallow reflexes have recovered |
| • Discuss driving safety |
| • Provide health care personnel contact information and encourage return to the clinic, at any time, should symptoms such as dyspnea, fever, cough, hemoptysis, or thoracic pain be noted |
| • Appropriately decontaminate bronchoscopes to prevent nosocomial infection |
Definition of abbreviations: BAL = bronchoalveolar lavage; CPR = cardiopulmonary resuscitation.
*
Modified from: British Thoracic Society Bronchoscopy Guidelines Committee, Subcommittee of the Standards of Care Committee of British Thoracic Society. The British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001;56(Suppl I):i1–i21.