Blind Bronchial Aveolar lavage for VAP diagnosis

[Celia M, ASN, RN]

Our RT dept is suggesting that we routinely do a blind BAL for all our vented patients at 48 hrs to r/o VAP, does any one have a policy or experience with this?

Thanks Celia

[TennRN2004]

Our RT dept is suggesting that we routinely do a blind BAL for all our vented patients at 48 hrs to r/o VAP, does any one have a policy or experience with this?

Thanks Celia

No, we don't do this nor have I heard of it being a standard of care or recommendation for it associated with VAP. We look at the clinical data-what do the secretions look like, does patient have a lot of secretions or only a little, keep the HOB up 30 degrees, daily CXR- is it showing increase/decrease in infiltrates, religious oral care to prevent VAP, and daily wean trials when applicable to give the patient every opportunity to wean as quickly as possible off the vent. What we will do is a sputum culture if we're thinking they have a pneumonia. In my oppinion, routine bronchial lavage is a little invasive when there are other things to look at to diagnose pneumonia. Obviously, if the patient is not doing well in spite of vent settings and antibiotics or there is clearly a whited out lung on CXR, then we will do a bronch lavage to clean the lung out.