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What is Tracheal Wash?

A tracheal wash is performed by passing a sterile fluid into the upper airways of the lung, and then recovering that fluid along with tissue samples “washed” out with the fluid for analysis to determine underlying pathological conditions that may be causing illness in your cat. 

There are two types of tracheal washes: transoral and transtracheal. The procedure used for transoral tracheal washes involves passing a tube through the mouth, into the trachea and then inserting fluid which is then pumped back up along with tissue cells for analysis. This is more commonly used in cats than the alternative trans-tracheal wash, which involves a catheter being placed through the skin into the trachea and fluid inserted and recovered via this pathway. 

This procedure is used to assess the cause of a respiratory disorder. Samples of lung tissue cells can identify bacteria, fungus, foreign organisms such as protozoans, and even cancerous cells present in the lungs, and is an extremely useful diagnostic test your veterinarian may use when your cat is experiencing respiratory disorder. 

Tracheal Wash Procedure in Cats

During a tracheal wash your veterinarian will anesthetize you cat and will insert a sterile tube, usually through the mouth, and into the upper airways of the lungs. A second tube is then inserted into the first and sterile fluid, usually a small amount of 4-6 ml, is then instilled into the smaller tube. Usually the patient will then cough and fluid and material will be withdrawn from the tube using a syringe and collected for analysis. The tracheal tube may then be connected to oxygen, and maintained until your cat recovers, at which time the tracheal tube can be removed. Samples of fluid and cells from the lung are submitted for testing by microscopic review and cultures. These tests will reveal the presence of fungus, bacteria, cancerous cells and foreign organisms present in the lungs. 

Transoral Tracheal Wash

This procedure is the most commonly used in cats. Prior to a transoral wash your cat will be put under sedation and light intravenous anesthetic for a short period of time. A relatively large tube is inserted through the mouth into the trachea (windpipe). A smaller tube is inserted into the large tube and into your cat's upper airways. A small amount (4-6 ml) of sterile fluid is trickled into the small tube and down into the airways of the lungs. This fluid is then sucked back out of the lungs using a syringe and collected for analysis of the fluid and any cells that may have washed out with the fluid. Some fluid will remain in the lungs, this fluid will absorb back into the tissues and is not usually problematic for your cat.

Transtracheal Wash

More commonly used in larger animals, a transtracheal wash involves passing a catheter through the skin into the windpipe to perform the tracheal wash. Your pet may be lightly sedated and a local anesthetic used to numb skin. The area for insertion will be clipped and cleaned antiseptically. A needle will be passed through the skin into the animal's airway between the cartilage rings and the trachea and then a catheter inserted. Sterile fluid is then inserted and aspirated through this passage. 

Efficacy of Tracheal Wash in Cats

Tracheal washes are very valuable diagnostic tools in cats experiencing chronic breathing problems. They produce excellent cellular samples from the lungs for analysis. In acute cases, other diagnostic tools including radiographs, blood tests, and urine tests may be adequate to identify pathology. 

Tracheal Wash Recovery in Cats

It is common after a tracheal wash for your cat to have a cough due to irritation from the endotracheal tube, and until any remaining fluid is absorbed by the lung tissues. This cough usually resolves itself shortly and is not of concern. 

If a transtracheal wash was performed there may be some leakage where the needle was inserted through the skin and air may accumulate under the skin (subcutaneous emphysema). When you pet your cat there will be a crackling sound due to the trapped air. This usually resolves itself, if it persists or causes respiratory distress, follow up as soon as possible with your veterinarian. 

If your cat coughs up blood or has a severe cough after tracheal wash this is not normal and veterinary care should be sought immediately.

Cost of Tracheal Wash in Cats

The cost of a tracheal wash procedure in cats is approximately $200-$300 including sedation and anesthesia.

Cat Tracheal Wash Considerations

Because cats requiring tracheal wash are already experiencing respiratory problems, there is a risk of their condition becoming complicated by this procedure. 

Excessive fluid can be aspirated, which can cause respiratory distress or cause your cat to stop breathing. This risk is small and when the procedure is performed by a qualified veterinarian who controls the airway and with oxygen present to mitigate respiratory issues, it is unlikely to occur.

The procedure does require sedation and anesthesia; there is always a risk of respiratory issues or allergic reaction with anesthetic. Again, the presence of oxygen and respiratory assistance such as positive pressure ventilation can mitigate this concern.

Tracheal Wash Prevention in Cats

Most commonly used to diagnosis chronic breathing problems in cats such as asthma, tracheal washes can be avoided by mitigating the chances of your cat experiencing a chronic asthma-type condition. Exposure to allergens, contaminants, and secondhand smoke can increase your cat’s lihood of developing asthma. Keeping your home free of smoke and dust that aggravates asthma can be beneficial to your family and your cat. Some parasites and protozoan organisms can also cause respiratory distress. Monitoring your cat for signs of infection with parasites, fungus or bacteria, and providing treatment before breathing problems occur, can eliminate the need of investigation of lung tissues acquired through tracheal wash.

Tracheal Wash Questions and Advice from Veterinary Professionals

Paisley
Siamese
12 Years
Serious condition
1 found helpful
Serious condition

Has Symptoms

Coughing sneezing nose eye
Coughing sneezing nose eye dischg
Coughing

Is a tracheal wash the next step in diagnosing the issue with my cat?
My cat was diagnosed with lungworms last September based on coughing and blood work. She was given medication for the lungworms and a topical anti parasitic for the following two months. At the end of the two months she developed an anal gland abscess. It was left open to heal and clavomox was given. Clavomox not so good, so switched to Convenia. Abscess would not heal, so it was stitched up and Baytril given. Wound finally healed then she developed what appeared to be an upper respiratory or head cold... lots of sneezing, snoring, runny left eye and left nostril with thick mucus expelled on sneezing. Given Convenia injection. Cold appears to resolve. 3 weeks later the same head cold symptoms return. Chest X-ray taken which is clear. Given 3 more injections of Convenia , each 2 weeks apart for a total of 6 weeks on Convenia. Cat has appeared to be healthy for 4 to 5 weeks. 3 weeks after the last injection, the same head cold symptoms have again returned. They now want to do the trans tracheal wash. Is that the next best course of action since her lungs were clear on the X-ray? Or will that help diagnose her head congestion issues?

Dr. Michele King, DVM
Dr. Michele King, DVM
1610 Recommendations
Without seeing her or knowing more about Paisley's specific condition, it is hard for me to comment on what might be going on with her, but if her issues seem to be in her nasal passages and with congestion, it would make sense to me to have xrays or laparoscopy of her nasal passages done before a transtracheal wash. That may be something that you want to talk about with your veterinarian, as they are able to see her and know more about what is going on. I hope that she is okay.

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Pumpkin
long-haired
Five Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Wheezing, high respiration rate

how many cats have problems with this procedure?? Our cat is scheduled. she has had three different antibiotics, steroids, three different inhalers, five x-rays of her lungs and nothing is looking better. I'm worried - how many cats have complications or die - any percentage?? She apparently has asthma, with complications from pneumonia or something.

Dr. Michele King, DVM
Dr. Michele King, DVM
1610 Recommendations
A tracheal wash is a valuable, and relatively benign procedure that can give your veterinarian much more information on the cause of Pumpkin's respiratory disease. The biggest risk is with the anesthesia, which would be true of any procedure. I hope that all goes well for her.

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Tomer
Domestic shorthair
10 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Heavy/fast breathing over 30 bpm

Medication Used

inhaler
Prednisolone

My cat has been breathing heavily for a while now. I took him to my general veterinarian and they did x-rays and put him on a steroid and an inhaler. after 2 weeks we saw no improvement and noticed the arteries to his heart seemed enlarged, so I was sent to and internal specialist. The specialist did blood work to check for virus and also heart worms, they also ran another x-ray. They came back negative. The next step is a lung flush to get cell samples from the lungs. I am very worried about this procedure, is it a risky procedure or is there a less invasive alternative?

Dr. Michele King, DVM
Dr. Michele King, DVM
1610 Recommendations
Thank you for your email. Unfortunately, the less invasive procedures have already been done for Tomer, with his x-rays and lab work. Collecting a cellular sample from the lungs is a fairly non-invasive procedure, and the biggest risk tends to be the anesthesia, which your veterinarian seems to have prepared for with the testing that has been done. I hope that you are able to get some answers for him.

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charlie
tabby
15 Years
Fair condition
0 found helpful
Fair condition

Has Symptoms

Coughing,

My cat had been coughing for a little while and I took him to the vet. They gave me antibiotics to give him for 10 days and the coughing has stopped. They want to do the procedure where they "wash" out his lungs. Since his cough has stopped I am reluctant to do the procedure. He is 15 years old and I don't to put him through any unnecessary discomfort. Any thoughts?

Dr. Michele King, DVM
Dr. Michele King, DVM
1610 Recommendations
I would think if the antibiotics helped, and there aren't any other indications to think that there might be a problem (like x-rays), I'm not sure that a tracheal wash would be necessary at this point. Those are typically done when a cough does not resolve and we need to get a better picture of what is happening in the lungs.

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Coco
domestic short hair
8 Years
Serious condition
0 found helpful
Serious condition

Has Symptoms

Coughing, irritated throat.

Medication Used

Steroids Clavaseptin
steroids

My 8 year old cat has had a cough since February. I thought it was hairballs but released it presented more as feline asthma. She has been on steroids and antibiotics for 2 weeks and the level of cough improved - not so deep but still coughed at times. . Then change in antibiotic. Now on clavaseptin. Been on it plus steroids four days and not doing well on this two coughing fits Saturday and Sunday night. First for three hours, second on and off during night. Previous antibiotic I can't locate name but was in paste form. Next step? I am on a tight budget and she either has an awake chest x-ray or should I go straight to the bronchiasatis or something of that name (the wash). It is very expensive a thousand dollars here in NZ? Her throat when pressed is irritated and her cough is less deep but persistent.What an inhaler first - how effective as a treatment? She has not been given one. Thanks.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
3320 Recommendations
Without examining Coco I cannot start to determine an underlying cause or make a diagnosis; chronic cough may be caused by infections, allergies, foreign objects, stray hairs among other causes. Further diagnostics are required, but I cannot determine the next best step without examining Coco first although an x-ray would show how clear the lungs are and would identify any masses or other issues that may be present before progressing onto more invasive diagnostics. Regards Dr Callum Turner DVM

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