Transtracheal Wash

	Transtracheal Wash Tim Hackett, DVM, MS Diplomate ACVECC Department of Clinical Sciences Colorado State University Click here to download video! Approximate download time at 56K: 46 minutes
This downloadable video is for personal use only. Not to be resold or distributed without the express written permission of Waltham USA. Abridged from the complete procedure available on Waltham Forum® Video Vol. 10, No. 4.

KEY FACTS

The transtracheal wash is a safe, useful, and simple procedure to help evaluate the patient with respiratory tract disease.
In medium to large dogs a catheter is used to collect specimens with the patient given local anesthesia only.
In cats and small dogs the procedure warrants general anesthesia and an endotracheal tube is used for sample collection.

OUTLINE

I. General

A. Purpose: For evaluation of and characterization of disease process in a patient with lower respiratory tract disease.

B. Do not perform procedure in animals with collapsing trachea or those in severe respiratory distress.

C. Methods.

1. Use local anesthesia procedure in medium to large dogs.

2. Use general anesthesia and obtain wash through endotracheal tube in cats and small dogs.

II. Procedure

A. Preparation.

1. Clip and scrub.

2. Elevate head.

3. Palpate area between two transtracheal rings, halfway down the neck.

4. Use lidocaine for local anesthetic.

B. Catheter placement.

1. With the bevel down, advance the needle slowly, directing it straight at the tracheal midline.

2. Walk needle off edge of tracheal ring through ligament between rings.

3. Entering trachea causes popping sound and coughing or swallowing.

4. Hold needle in place, raise it to a 45 degree angle and advance the catheter.

5. Withdraw the needle slightly and remove the stylet.

C. Taking sample.

1. Inject 3 to 10 ml of sterile saline, then aspirate.

2. Repeat once, looking for flecks of mucoid or purulent material or frothy bubbles.

3. May instill a total of 30 to 50 ml of sterile saline into a medium to large dog.

III. Evaluation of Sample

A. Perform cytologic examination and culture and sensitivity on the sample.

1. Normal cells include pulmonary macrophages and respiratory ciliated epithelial cells and an occasional healthy neutrophil.

a. Absence of normal cells indicates inadequate procedure.

2. Abnormal findings include many neutrophils and intracellular bacteria.

a. Perform culture even if bacteria are not seen.

B. Potential complications are not life threatening.

1. Subcutaneous emphysema.

2. Asymptomatic pneumomediastinum.

OUTLINE
I.	General
	A.	Purpose: For evaluation of and characterization of disease process in a patient with lower respiratory tract disease.
	B.	Do not perform procedure in animals with collapsing trachea or those in severe respiratory distress.
	C.	Methods.
		1.	Use local anesthesia procedure in medium to large dogs.
		2.	Use general anesthesia and obtain wash through endotracheal tube in cats and small dogs.

II.	Procedure
	A.	Preparation.
		1.	Clip and scrub.
		2.	Elevate head.
		3.	Palpate area between two transtracheal rings, halfway down the neck.
		4.	Use lidocaine for local anesthetic.
	B.	Catheter placement.
		1.	With the bevel down, advance the needle slowly, directing it straight at the tracheal midline.
		2.	Walk needle off edge of tracheal ring through ligament between rings.
		3.	Entering trachea causes popping sound and coughing or swallowing.
		4.	Hold needle in place, raise it to a 45 degree angle and advance the catheter.
		5.	Withdraw the needle slightly and remove the stylet.
	C.	Taking sample.
		1.	Inject 3 to 10 ml of sterile saline, then aspirate.
		2.	Repeat once, looking for flecks of mucoid or purulent material or frothy bubbles.
		3.	May instill a total of 30 to 50 ml of sterile saline into a medium to large dog.

III.	Evaluation of Sample
	A.	Perform cytologic examination and culture and sensitivity on the sample.
		1.	Normal cells include pulmonary macrophages and respiratory ciliated epithelial cells and an occasional healthy neutrophil.
			a.	Absence of normal cells indicates inadequate procedure.
		2.	Abnormal findings include many neutrophils and intracellular bacteria.
			a.	Perform culture even if bacteria are not seen.
	B.	Potential complications are not life threatening.
		1.	Subcutaneous emphysema.
		2.	Asymptomatic pneumomediastinum.