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The Comparison of Characteristics of Recoverd Fluid between two Aspiration Techniques of Bronchoalveolar Lavage Procedures (Hand Suction Versus Controlled Wall Suction)

Pulmonary Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

PURPOSE: According to ATS statement of bronchoalveolar lavage in adults with pulmonary diseases (1990) about fluid instillation. It mentioned 2 different aspiration techniques (hand suction versus wall suction) that were used in the procedure. BAL fluid characteristics and volume will be affected by airway collapse and bronchial contamination from uncontrolled suction. Our aim was to investigate the differences between fluid from 2 methods.

METHODS: Prospective randomized study in the adult patients underwent diagnostic bronchoscopy during October 2002-April 2003. When BAL procedures were performed, serial 4 separated 50-ml aliquots of saline were instilled and fluid was aspirated by hand suction into syringe (2 aliquots), followed by controlled wall suction (2 aliquots). The second aliquot from each method was selected. Recovered fluid volume measurement and cell analysis were done. Statistical analyses were 2-sample t-test and Wilcoxon signed rank test.

RESULTS: Thirty patients were enrolled, and 60 fluid specimens were obtained. Diffused / localized lung disease ratio was 1/2. Between hand suction and wall suction methods, there was no significant difference in recovered fluid volume(23.93+/-8.66 ml vs. 21.36+/-9.68 ml, p > 0.283), the total cells count( median 3.55x 10⁶ vs. 3.51x10⁶cells, p > 0.959), percentage of alveolar macrophage (61.16+/-27.82 vs. 70.96+/-30.49, p > 0.198) and number of bronchial epithelium per 100 nucleated cells.

CONCLUSION: There was no difference in volume and characteristics of the BAL fluid obtained from hand suction and wall suction.

CLINICAL IMPLICATION: Both hand suction and wall suction with controlled pressure can be performed in BAL procedure without effect on the BAL fluid interpretation.

DISCLOSURE: T. Kawamatawong, None.