A transtracheal wash in dogs is a way to obtain fluid sample from your dog's lower respiratory tract. Perhaps your vet found a bronchial pattern on X-rays or suspects tracheobronchial disease and he or she feels this warrants further investigation. You may be therefore wondering what happens exactly during a transtracheal wash, whether there are risks for complications and the costs for a transtracheal wash in dogs. As the name implies, a transtracheal wash in dogs is a procedure meant to collect secretions with the help of a "wash" of saline. Learning more about what happens, the possible complications and costs of a transtracheal wash in dogs may help dog owners get better acquainted with this procedure.
An Insight into the Procedure
There are two different ways a tracheal wash procedure may be carried out: transoral tracheal wash (TOTW) and transtracheal wash (TTW). One choice over the other is based on the vet's preference and the characteristics of the dog in need of the procedure. Both procedures share the fact that saline is infused to help the vet retrieve airway secretions.
The transoral tracheal wash (TOTW) is performed on briefly anesthetized dogs who are intubated. As the name implies, "transoral" means through the mouth. An endotracheal tube is inserted through the mouth and a smaller endoscopic tube is thread through the tracheal tube and into the airways.
The scope allows the vet to visualize the trachea up to all the way down to the level of a bronchus. A small volume of saline wash will then be placed into the airway and then the fluid is aspirated back and collected. This fluid will be analyzed.
This procedure is mostly performed on small dogs or brachycephalic dog breeds which are known to have a trachea of decreased diameter and thick necks making it difficult to palpate the trachea and obtain a sample via transtracheal wash.
The main disadvantage of this procedure is the use of anesthesia (typically propofol is used), although the procedure is quick enough to just permit intubation and gain a sample. There are of course other risks associated with this procedure such as infection and damage to the trachea or main bronchi. As the dog recuperates, a slight cough may be present afterward, but this is a just a temporary side effect.
The transtracheal wash (TTW) is instead performed on an awake or lightly sedated dogs (dexdomitor and its reversal agent antisedan). The dog's cough reflex should remain intact despite sedation. As the name implies, "transtracheal" refers to being inserted directly into the trachea. In this procedure, the skin is surgically prepared and a large needle and catheter is inserted directly into the skin and then is directed down the trachea. Saline is injected into the trachea and then some fluid is aspirated back into the syringe. This fluid is then analyzed.
This procedure is commonly performed on medium to large dogs. While no need for anesthesia ia big plus for this procedure, the main disadvantage is the risk for complications such as lacerations and bleeding of the trachea and subcutaneous emphysema (air entering the skin of the chest wall from the neck area). In this latter case, dog owners may notice a crackling sound or a soft bulge in the dog's neck region that will subside within hours or days.
Both procedures carry some risks associated with the use of the saline wash and these include lowered concentration of oxygen and bronchospasm, a spasm of the bronchial smooth muscle leading to narrowed airways. Complications are more likely to occur in compromised dogs such as those with significant pulmonary dysfunction in which the pros and cons of this procedure should be therefore evaluated carefully.
Of course, there are risks associated with the use of both sedation or anesthesia, but with proper care and monitoring, it is unusual to have complications with either type of procedure.
Did you know? A bronchoalveolar lavage (BAL) is a another procedure that allows the vet to collect samples from deeper within the lung. It's helpful for cases of chronic airway disease. This procedure may be done should a tracheal wash fail to provide rewarding results.
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Evaluating the Sample
Once the sample is collected, it is evaluated by the vet and then the sample is sent for further evaluation to a pathologist. The goal is to have the sample analyzed for cells, bacteria and fungal organisms.
By looking at the cell types collected from the sample, some conditions can be recognized and potentially diagnosed. Certain types of cells for example may be seen with inflammation, asthma, parasites, cancer, etc.
A culture of the sample can provide important information pertaining what bacteria or fungus are exactly found and therefore can suggest what's the best type of antibiotic or antifungal medication to treat the condition. This can help in cases where, for example, dogs are coughing and after several treatments with antibiotics, there is no improvement.
It's important to consider that sometimes bacteria coming from the GI tract may contaminate the samples collected. For example, E coli is not commonly found in the dog's respiratory tract, but it is usually found in the dog's GI tract.
It may end up on a sample though should the dog end up inhaling vomit. Typically, bacteria commonly found in the lung include mycoplasma or strep, explains veterinarian Dr. Gary.
While a transtracheal wash can provide important insights and even diagnostic findings, the absence of any abnormalities doesn't necessarily rule out cancer and infections. Further specialized diagnostic tests may therefore be needed.
Cost of Transtracheal Wash in Dogs
Vet care costs tend to vary from city to city and even from one state to another. Sometimes, the best way to get accurate costs is by simply calling around vet offices. The receptionist may be willing to give out rough estimates.
The cost of both procedures may also vary considerably. The transoral tracheal wash is preferred because it permits the vet to visually inspect the dog's airway, but it is more expensive because it requires the dog to be anesthetized. Generally, between the anesthesia and procedure dog owner may be expected to pay anywhere between $500 and $1,200.
The transtracheal wash may be cheaper due to the lack of anesthesia and therefore may vary between $300 and $800. Of, course these are just rough estimates. Only by calling around or talking to the vet it is possible to gain more exact figures.
Wikimedia Commons, Slick-o-bot, Ayaks, a military police working dog, is put under general anesthesia before getting preventative surgery on his stomach at the Veterinary Treatment Facility