RESPIRATORY/MEDICINE Options for a sample submission are as follows:


● Culturette swab (aerobic or anaerobic/aerobic) ● Bacterial culture collection and transport systeme


● Blood culture vials ● Red top tube


For cases in which you submit the sample for cytol- ogy, you should first make and then air dry some slides (similar to making blood smears). In addi- tion, you should submit part of the sample in a lavender top tube.


7. Results Summary of steps for the transtracheal wash:


● Sedate as required. ● Clip and aseptically prepare the site. ● Infiltrate the site with 2 to 4 mL of 2% lido- caine using the 25-guage needle and 3-mL syringe.


● Don sterile gloves. ● Draw up 20 to 30 mL of sterile saline into each of the two 60-mL syringes.


● Open the scalpel blade onto the sterile field. ● Move the sterile field with all equipment to within reach of the horse.


● Make a skin incision with the #15 scalpel blade.


● Locate the TTW site and stabilize the trachea with your nondominant hand.


● Insert the introduction needle or catheter into the trachea between two tracheal rings.  Hold introduction needle parallel to the ground with bevel down.


● Once inside the trachea, direct the introduc- tion needle towards the lungs.


● Remove introduction needle/catheter stylet if present.


● Insert flushing catheter through the introduc- tion catheter and direct it into the tracheal puddle.


● Slowly inject sterile saline. ● Slowly aspirate tracheal secretions. ● Remove the flushing catheter. ● Remove the introduction needle/catheter. ● Place 4  4 gauze and self-adhesive elastic bandaged over incision site for 30 minutes to 1 hour.


8. Discussion


Transtracheal Wash Cautions Risks before the procedure if horses are in respira- tory distress:


● If the animal is in severe respiratory distress or is hypoxic (usually because of a pneumonia), the sedation and saline injection into the tra- chea may be fatal.


● If the horse has a profuse amount of secretions in the lumen of the trachea, the diameter left for the air to flow through the trachea is tre- mendously reduced. Adding saline into such a tracheal lumen will decrease the circumfer- ential area of the lumen further. This will increase resistance to airflow and worsen the respiratory distress.


Risks you have to keep in mind when performing the TTW procedure:


● Perforating the carotid artery or the jugular vein:  Can happen when the horse is not handled or sedated properly.


 Can happen when the veterinarian does not hold the trachea and skin properly when passing the TTW introduction nee- dle/catheter.


● Damaging a tracheal ring:  It is important to pass the catheter between the two tracheal rings to avoid possible dam- age or laceration to the cartilages.2


● Damaging the dorsal tracheal wall:  When inserting the introduction needle/ catheter, too much force may result in the sharp end perforating or lacerating the dor- sal trachea, which can result in emphy- sema, chronic abscessation, or infection.


 Care must be taken at this step to apply enough force to pop into the tracheal lumen between the cartilage rings, but control is required to stop the forward momentum once the lumen is entered.


● Cutting/breaking the flushing catheter and losing the catheter down the trachea:  This can occur if the introduction needle/ catheter has a sharp end (this is less likely with new kits or when using an intrave- nous catheter). If your introduction nee- dle/catheter has a very sharp end, with- draw the introduction needle/catheter first until the sharp end is completely out of the skin. Then withdraw the flushing cathe- ter. This will reduce the chance of shear- ing the flushing catheter on the end of the introduction needle/catheter but does in- crease the chance of introducing infection into the tissue.


 When injecting saline into the flushing catheter, the end of the syringe attachment may break off or become dislodged from the main catheter when bent or put under lat- eral forces (especially when using a dog urinary catheter). It is very important to hold the flushing catheter when injecting or withdrawing fluid using the syringe.


 If a flushing catheter is lost in the trachea, most horses will cough up the catheter within 30 minutes.12 If the catheter is not


AAEP PROCEEDINGS  Vol. 61  2015 519


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