TABLE 3.

TECHNICAL FACTORS IMPACTING ON BRONCHOALVEOLAR CELL YIELD

BAL fluid:

• Use sterile 0.9% sodium chloride (NaCl) at room temperature

• Total instillation volumes vary between 100 and 300 ml

Choice of BAL location:

• One or two lung segments (up to 150 ml each) can be lavaged—in patients with TB, e.g., radiographically affected and unaffected lung areas and in healthy persons, two adjacent segments

Approach to harvesting the BAL fluid:

• Using 60-ml syringes and three-way valves for manual instillation and suction of the BAL fluid provides an exquisitely sensitive approach to increasing the yield by reducing airway collapse (70–85% yield of instilled saline fluid from healthy persons, less from persons with TB)

• Alternatively, use lowest possible wall suction strength to minimize airway collapse and cellular damage, and preserve optimal immunological function of the BACs

• Maximal yields of BAL fluid are obtained from the right middle lobe and from the lower lobes. In the upper lobes aspirated volumes are unpredictable and substantially reduced

Definition of abbreviations: BACs = bronchoalveolar cells; BAL = bronchoalveolar lavage; TB = tuberculosis.