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These instructions are for all physicians, clerical, nursing, laboratory or other staff that are involved in the preservation, transportation, and/or collection of bronchoalveolar lavage specimens.
Notification
- The BAL lab should be contacted about a BAL request as soon as the procedure is scheduled. At least 24 hours notice is preferable for outpatients, and one hour notice for inpatients.
- The BAL supervisor, Pat Smith, should be notified by calling the lab office at 317-988-3811. If Pat Smith is not available, please leave the information with the secretary. The following information should be provided:
- Name of patient
- Hospital and medical record number
- Name and pager number of requesting physician
- Date of BAL
- Approximate time that the BAL will be delivered
- Tentative diagnosis
- BAL Request Forms
- A BAL Request Form must always be completed in full and sent with the BAL specimen. Please print legibly. The time the sample was collected must be reported. For “other” diagnosis and drug effects, please specify type. Indicate all three volumes 1) volume instilled 2) volume returned 3) volume given to BAL lab (necessary since aliquots are sometimes removed and sent to other labs before sample receipt). If more than one BAL specimen is sent for the same patient, please indicate the site of the BAL on both the specimen container and the request form.
- Place the patient ID label or stamp where indicated on the request form. If appropriately sized labels are not available, stamp medical record number (MRN) information on the back of the request card. Always circle the patient ID#. If a label or stamp is not available, a legibly printed name and MRN will be acceptable. If the ID stamp is "cut off" or not legible repeat the stamp on the back of the card.
- If the BAL request forms are not available or are running low in your area, please contact our office as soon as possible. If a BAL request form is needed immediately but is not available, please request that a copy be faxed to the requesting office. This should then be completed and sent with the specimen.
- We must receive written notification (a BAL Request Form). If for some reason a BAL Request Form is not sent with the BAL specimen, one must be sent to our office within 15 days. Results will not be sent until written consent has been sent.
- Whenever "other" is selected under suspected diagnosis, the other suspected diagnosis should be listed.
- A pager or contact number should always be listed in case there are any questions or missing information.
Specimen Labeling
The specimen label should always contain:
- Patient name
- Hospital name and Medical Record Number
- Date of patient admission
- All samples should be labeled as a potential biohazard and transported appropriately
Specimen Preservation / Transportation
- The specimen should be placed in a plastic storage bag and accompanied with a completed BAL form.
- The specimen should be stored in the refrigerator or on ice. DO NOT FREEZE. The sample should be transported on ice and always be delivered as soon as possible.
- If the specimen is sent by courier, it is recommended that the client call ahead of time.
The specimen should be sent directly to the lab at:
Richard L. Roudebush VA Medical Center
1481 West 10th Street, Room C – 6138
Indianapolis, IN 46202
Phone: 317-988-3811
Fax: 317-988-3976
Directions to our location
- Coming in off of 10th street, park in the first visitors lot on the right.
- Enter the building at the doors facing this parking lot.
- Take the C wing elevators (the first set of elevators you see) to the 6th floor.
- Make a left out of the elevator.
- Make a right at the next hallway.
- Enter the double doors for the IU Pulmonary offices.
- The reception desk is on the right.
The BAL lab office telephone number (317-988-3811) should be given to the courier service in case the courier is having difficulty delivering the specimen.
Specimen Processing and Results
The BAL lab will be responsible for:
- Processing the specimen by performing centrifugation, removing red cell contamination, preparing and staining cytopreps, and determining the cell differential.
- Subtyping lymphocytes and determining the helper/suppressor ratio if the lymphocyte count is 15% or more by the cell differential count.
We also offer CD1a surface marker staining, hemosiderin staining, and oil red O staining (if requested and if the cytoprep is compatible with the diagnosis).
Suboptimal conditions and potential causes for sample rejection
- BAL processed more than 24 hrs after specimen collection
- BAL contains less than 1 x 106 cells
- BAL < 20% of volume instilled
- BAL contaminated with more than 10% epithelial cells
All bronchoalveolar lavage samples will be processed unless they are not properly identified with the patient name and ID number or arrive at the lab in subsatisfactory conditions (i.e., container not intact, sample frozen, sample > 20 hrs old).
Questions / Comments
Any questions, requests, complaints can be directed to the supervisor, Pat Smith, by calling 317-988-3811. |
