The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

SAFETY OF NON-BRONCHOSCOPIC BAL PERFORMED BY RESPIRATORY THERAPISTS: EXPERIENCE FROM A LARGE ONCOLOGICAL ICU

Clarence Finch BS, BA, RRT, S. Egbert Pravinkumar MD, FRCP, FCCP, Joseph L. Nates, MD, MBA, FCCM, George Geevarghese, RRT, Kim Meek, RRT, Reed Perkins, RRT, Cindy Han, MBA, RRT, Kristen J. Price MD, FCCP.

University of Texas- MD Anderson Cancer Center, Houston, Texas

Background: The risk of VAP is considered high in ventilated critically ill cancer patients compared to non-cancer patients. Both bronchoscopic bronchoalveolar lavage (B-BAL) and non-bronchoscopic BAL (NB-BAL) procedures are commonly used for microbiological analysis in ventilated patients. The NB-BAL is carried out by respiratory therapist (RT) with significant cost advantage, when compared to B-BAL. However, there is a general concern that NB-BAL technique could undermine patient safety, since this is done without direct visualization of lower airways in high risk patients, such as hematological malignancy and also because it is performed by non-physicians. We investigated the safety of NB-BAL performed by RT in our medical and surgical oncological ICU.

Methods: All NB-BAL procedures between September 2004 and January 2006 were reviewed in the respiratory care database for reported complications. The data was collected as part of ongoing respiratory care quality assurance program. The NB-BAL procedures were done by RT according to an established departmental protocol; using Kimberley Clark protected 16 Fr BAL catheter. The protocol included mandatory reporting of the occurrence of any pre-defined complication.

Results: During the study period, a total of 109 patients underwent RT performed NB-BAL in our oncological ICU. In 90% of patients who underwent NB-BAL, no procedure related adverse events were noted.  There were no major complications such as bronchospasm, pneumothorax, hemoptysis and bleeding post procedure. Minor complications - blood tinged BAL 5%, tachycardia 2%, and oxygen desaturation 2%, systolic pressure variation 1% were noted. No patient died or clinically deteriorated as a result of NB-BAL procedure.

Conclusion:  Non-bronchoscopic BAL technique can be readily and safely performed by RT in selected group of critically ill cancer patients. No major adverse events were noted with this procedure in cancer patients despite the high incidence of neutropenia, thrombocytopenia and coagulation abnormality in this population. Presence of a carefully designed NB-BAL policy improved operator confidence and patient safety.

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