The term “lung washing” usually refers to Bronchoalveolar Lavage (BAL), a common diagnostic procedure. BAL collects a sample of fluid and cells from the lower respiratory tract, specifically the small air sacs known as alveoli, to help diagnose various lung conditions. Because the procedure involves placing a thin instrument into the airways, patients often worry about discomfort. Medication is used to minimize sensation and ensure comfort throughout the short process.
What Is Bronchoalveolar Lavage?
Bronchoalveolar Lavage is performed during a bronchoscopy using a flexible tube called a bronchoscope. The bronchoscope is guided through the mouth or nose, down the throat, and into the air passages of the lungs. This minimally invasive procedure serves as a primary method for examining lung tissue without major surgery.
Once the bronchoscope is “wedged” into a targeted lung segment, sterile saline solution is gently instilled. This fluid washes over the small airways and alveoli, collecting cells, infectious organisms, and other components. The physician uses gentle suction to retrieve the fluid, which is then sent to a laboratory for analysis.
A standard BAL uses 100 to 240 milliliters of saline, administered in smaller increments. This collected fluid provides information useful for diagnosing pulmonary infections, interstitial lung diseases, and malignancies. It is important to distinguish BAL from Whole Lung Lavage (WLL), which is a much more extensive therapeutic procedure used primarily for pulmonary alveolar proteinosis. WLL involves filling and draining one entire lung at a time using 17 to 50 liters of fluid under general anesthesia.
How Discomfort Is Managed During the Procedure
The primary goal during BAL is ensuring the patient is relaxed and experiences minimal discomfort, achieved through sedation and local anesthesia. Most patients receive intravenous (IV) conscious sedation, which helps them relax deeply and often results in little memory of the procedure. The medical team carefully monitors this sedation, tracking vital signs like heart rate, blood pressure, and oxygen saturation levels throughout the process.
Before the bronchoscope is inserted, a local anesthetic, such as lidocaine, is typically sprayed into the throat and airways to numb sensitive tissues. This topical agent suppresses the natural gag reflex and prevents the urge to cough as the bronchoscope passes into the lower airways. While the procedure is not painful in the conventional sense due to the medication, patients may still perceive certain sensations.
One common sensation is a feeling of pressure or fullness in the chest when the saline solution is instilled into the lung segment. Patients may also briefly feel the cool temperature of the saline, although some facilities pre-warm the fluid to body temperature to minimize this effect. Despite the numbing medication, the instillation of fluid can sometimes trigger a temporary urge to cough, which the medical team actively manages with additional medication if necessary. The procedure is performed using a flexible bronchoscope and conscious sedation, meaning general anesthesia is not required.
Preparing for and Recovering From Lung Washing
Preparation for BAL starts several hours before the procedure to reduce the risk of complications related to sedation and aspiration. Patients are instructed to fast from solid foods and sometimes clear liquids prior to the procedure. It is also standard practice to review all medications with the physician, as some, particularly blood thinners, may need to be temporarily stopped.
Following the procedure, patients are moved to a recovery area for close monitoring as the effects of conscious sedation wear off. This observation period usually lasts one to two hours, ensuring the patient’s vital signs remain stable. Due to the lasting effects of the sedation, patients are prohibited from driving, operating machinery, or making important decisions for the remainder of the day.
While significant pain is uncommon, temporary discomfort is a frequent part of recovery. The most common side effect is a mild sore throat or temporary hoarseness, caused by the bronchoscope passing through the vocal cords and upper airway. Some individuals may experience fatigue or a mild, transient fever within the first 24 hours. Additionally, a temporary increase in coughing or mild, short-lived shortness of breath can occur as the body reacts to the manipulation and fluid instillation.