In this VETgirl online veterinary continuing education blog, we demonstrate how to perform an endotracheal lavage (ENL) in a dog. This is commonly limited to small dogs and cats, as larger sized dogs would have a transtracheal wash (TTW) performed instead (as it doesn’t require general anesthesia).

So why do we perform an endotracheal lavage? This is done to obtain fluid analysis and culture of the lower airway. As the lower airway is sterile, an ENL should be performed using sterile technique. First, make sure you have all your supplies set up prior to anesthesia. This should include:

    • Multiple sterile endotracheal tubes (ETT) with the cuff tested for leaks
    • Sterile lubrication
    • Sterile gloves
    • A sterile 10 ml and 60 ml syringe
    • Sterile saline drawn up in 10 ml aliquots
    • A sterile, appropriately sized red rubber catheter or polypropylene catheter to deliver saline and aspirate fluid back from
    • An EDTA tube (for fluid analysis) and red top tube or culturette (for culture)
    • An anesthetist or anesthesiologist to perform the procedure

As most of the patients that we are performing an ENL in are hypoxemic, make sure to pre-oxygenate the patient prior to sedation. Give a quick-acting sedation (through a previously placed IV catheter) – in this case, we used fentanyl, midazolam, and propofol to effect. Place a sterile endotracheal tube into the airway, trying not to touch or contaminate the tip to the oropharyngeal area (NOTE: Sterile gloves typically aren’t necessary as long as you don’t touch the tip or the lumen of the endotracheal tube). Once the endotracheal tube is in place, place a sterile polypropylene catheter into the center lumen of the tube and administer 5-10 mls of sterile saline. Immediately use manual suction (in this case, a 60 ml syringe) to aspirate back quickly. Simultaneously, someone should gently coupage the dog during suction to help with fluid accumulation. A small amount of fluid is typically obtained, and this should be submitted for fluid analysis and culture. If fluid isn’t obtained, one can repeat the administration of 5-10 mls of sterile 0.9% saline down the endotracheal tube, followed immediately by additional suction. Once a diagnostic sample has been obtained, the patient should be hooked up immediately to 100% oxygen therapy until fully recovered from anesthesia. Lastly, make sure to evaluate in-house cytology also, as this will help guide appropriate therapy. For example, in this case (which was a 6-year-old, male neutered Chihuahua with a chronic history of cough), the diagnosis of pulmonary eosinophilic bronchopneumopathy was diagnosed, and steroid treatment was initiated promptly. Check out our other VETgirl videos to learn more!

  1. Hello,

    Great, informative video. One question though: How far down are you placing the red rubber tube or polypropylene catheter? What are the landmarks on the body if one were to pre-measure the tube for proper placement?

    Many thanks!

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