Bacteria - Culture & Sensitivities – Respiratory (Lower)

BAL
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect the remaining fluid in a clean, sterile container via suction.

Bronchial washing/brush specimens
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). For washings, inject aliquots of approximately 20 to 30 mL of 0.85% sterile saline (nonbacteriostatic) for adults or 5 mL for children. Suction washings into a sterile container.
○ For brushings, instill brush to collect cellular material from bronchial epithelial wall. Place protected brush sample in sterile container with 1 mL of saline.

Lung aspirates (e.g. pleural fluid)
○ Samples should be collected aseptically through decontaminated skin using a syringe and needle and placed in a sterile container.
○ Decontaminate skin. Insert needle into pleural space, aspirate fluid into syringe OR collect pleural fluid directly from drain if chest tube has been inserted to drain pleural space. Transfer specimen into sterile (at least 1 mL), leakproof container.

Tissue (Respiratory tract)
○ Collect 5-10 mm3 tissue aseptically using surgical technique/punch biopsy. Place in a clean, sterile container with a small amount of sterile saline.

Sputum/tracheal aspirate
○ Collect sputum by expectoration, induction or by tracheal aspiration in sterile container.
○ For endotracheal aspirates, collect aspirated material using a NEW sterile catheter or in-line catheter and aspirate material from the trachea using a syringe or suction device