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Antemortem Respiratory Diagnostics:
Transtracheal Wash (TTW) and Bronchoalveolar Lavage (BAL)
Terry J. Engelken, DVM MSJim Thompson, DVM MSVicki Cooper, DVM PhD
College of Veterinary MedicineIowa State University
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Antemortem Respiratory DiagnosticsTTW and BAL are useful tools
- individual animals- problem pens (high morbidity)- herd outbreaks- common research tool
Advantages of procedure
- relatively non-invasive- done prior to treatment- sample at the point of infection- more specific than nasal swab- versatile sample / easily handled- very useful for diagnostics
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Antemortem Respiratory Diagnostics
TTW / BAL not technically difficult
- commercial kits are available- practitioner “adaptations”- adequate restraint needed- “clean” environment
TTW / BAL give similar results
- sterile collection equipment- BAL tubes are reusable - contamination from URT?
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Antemortem Respiratory Diagnostics
TTW Procedure
Equipment
- large TTW kit (HarVet, Inc)- 30 cc. syringes containing nonbacteriostatic saline- 2% Lidocaine and syringe + needle- scalpel blade- clippers and surgical prep
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Antemortem Respiratory Diagnostics
TTW Procedure (cont.)
Adequate head restraint – chute + halter (cross tie if needed)
- small area over middle 1/3 of trachea is clipped- surgical prep
Lidocaine “bleb” on point of insertion
- midline of trachea between the muscle bundles- scalpel blade incision through the skin
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Antemortem Respiratory Diagnostics TTW Procedure (cont.)
Insertion of trocar and cannula between cartilaginous rings
- firm hold on the trachea- may feel two “pops” from trocar and cannula
Sterile polyethylene tubing is introduced and pushed
- stop when you feel resistance
Attach syringe and 30 ml. of saline is introduced
- aspiration as tubing is moved up and down
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Antemortem Respiratory Diagnostics
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Antemortem Respiratory Diagnostics
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Antemortem Respiratory Diagnostics
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Antemortem Respiratory Diagnostics
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Antemortem Respiratory Diagnostics
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Antemortem Respiratory Diagnostics
Need a minimum of 1.5 - 3 mls. for diagnostic sample
Sample may be clear or cloudy - may contain flecks of fibrin
- may need to inject more saline and repeat procedure
Keep cool until shipment and ship on ice with other samples
- red top tube of blood and nasal swabs
Please include diagnostic lab submission form and calf data form
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Antemortem Respiratory Diagnostics
TTW and BAL samples can used for multiple tests
Submitted in plastic container or red top tube
- Virus isolation, PCR, IHC or FA- Culture and sensitivity
Samples in purple top (EDTA) can be used for cytology
- also for IHC and FA- EDTA impedes PCR and VI
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