Tracheal wash (TW), sometimes referred to as a transtracheal wash (TTW) or endotracheal wash (ETW), is a procedure used to evaluate the lungs for evidence of infection, inflammation, or cancer. A similar procedure is called a bronchoalveolar lavage (BAL). A tracheal wash is done in cases of both acute and chronic lung disease to look for an underlying cause such as an infectious pneumonia (bacterial or fungal); allergic airway disease (“allergic bronchitis”); or cancer. The patient is given an intravenous injection of a short-acting anesthetic, and a sterile endotracheal tube (“breathing tube”) is placed is placed into the trachea. A smaller tube is placed through the first one and then a small volume of sterile saline is instilled into the lungs. The fluid comes into contact with the surface of the airway, and then suctioned back out. This is done 2-3 times to ensure a reliable sample is obtained. The fluid is then submitted for culture (to look for an infectious cause) as well as for evaluation for a pathologist to look at the cells present. This procedure only takes 5-10 minutes, and the patient is able to go home when the short-acting anesthetic wears off. A BAL is a procedure requiring general anesthesia so that a bronchoscope (similar to an endoscope) can be placed into the lungs to visually inspect the airway. During a BAL, the scope is used to instill the fluid and remove it in a similar fashion as the tracheal wash. There is only infrequently a need for visualization of the airways, and in most cases a TW is performed rather than a BAL.
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