Halyard MINI-BAL Manual Del Usuario página 4

(Inner catheter should now be in a wedge position.)
b. Lock outer sheath in position by sliding blue slidelock
(Fig. 2g) on Elbow to locked position.
c. Perform BAL according to protocol.
6. After obtaining the final sample, pull the inner catheter back until
the black strip is visible behind the control hub seal.
7A. Detachment Protocol (For use directly with artificial airway)
a. Remove Mini-BAL and elbow from the circuit and reconnect the
ventilator.
7B. Detachment Protocol (For Use with HALYARD* MAP CSS)
a. Open the blue slidelock of Mini-BAL adapter and retract
Mini-BAL completely.
b. Depress plunger button and rotate HALYARD* MAP Closed Suction
Manifold to the "Off" or "Suction" position.
c. Remove the Seal Cassette and Mini-BAL Adapter by rotating
counter clockwise.
d. Replace with new Seal Cassette (Fig. 1c) found in Mini-BAL
package after each use or instrument insertion.
Adult Non-Intubated Patients
1. Prepare the upper airway according to standard anesthetic protocol
for transnasal bronchoscopy.
2. Attach suction adapter (Fig. 1a) and 20/50 ml syringe with saline
to 3-way stopcock. (Fig. 2e)
3. Attach sputum trap and suction apparatus to Mini-BAL.
4. Guide Mini-BAL through the nostril until the tip of the catheter can
be seen in the midline of the pharynx. The directional tip should be
on the midsagittal plane.
5. Place the head in a neutral position or with the chin tipped slightly
toward the chest.
6. Instruct the patient to take a slow deep breath, advance the
catheter during this inspiration.
7. Position the curve of directional tip catheter for right or left lung
(oxygen port (Fig. 2d) on same side). To guide the directional tip,
rotate the oxygen port right or left toward the desired lung.
8. Continue to advance the Mini-BAL until the catheter tip is
approximately 15 cm beyond the vocal cords.
9. Flush the tip by instilling 2 ml saline. Check for up and down
movement of fluid within the catheter with respiration to confirm
airway placement.
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Warning
Oxygen flow through the Mini-BAL device should not be
initiated until catheter placement within the trachea or
bronchi has been confirmed by evidence of expiratory vapor
inside the catheter, to and fro movement of flush solution, or
x-ray confirmation.
Caution
Low flow oxygen, up to 5 LPM, prior to, and during the procedure
may be desirable. Oxygen should be administered by nasal cannula
prior to the procedure and then delivered through the Mini-BAL
oxygen port during the procedure. Pulse oximetry should be used to
monitor oxygen saturation. Appropriate monitoring and emergency
resuscitation equipment should be readily available.
10. Low flow oxygen, up to 5 LPM, may be administered by oxygen line
to the oxygen port (Fig. 2d). Oxygen should not be initiated until
catheter placement within the trachea has been confirmed.
11. To reach the wedge position, hold the outer sheath in place and
advance the inner catheter until resistance is met. (Fig. 5)
(Achievement of a proper wedge position will ensure adequate
lavage solution returns. If lavage return is inadequate, slight
withdrawal of the inner catheter may be necessary. If the patient
coughs fluid from the airway, the wedge is inadequate and the
catheter needs to be advanced).
12. Perform BAL according to protocol.
13. After obtaining the final sample, pull the inner catheter back until
the black strip is visible behind the control hub seal. Remove the
Mini-BAL from the patient airway.