Download Transesophageal Echocardiography (TEE) Procedural Process

Transesophageal Echocardiography (TEE) Procedural Process
Pre-Procedure
Room preparation:
 TEE probe is connected to ultrasound machine, and the calibration completed
 Check controls on TEE probe prior to intubation
 Place bite guard on probe
 Prepare supplies needed to perform the procedure (i.e. lubricant, gloves, lidocaine, sedation
medications, IV set up, oxygen and suction tubing)
 Enter patient demographics/information
 Ensure crash cart is located in the TEE room
 Ensure availability of performing cardiologist
Patient preparation:
 Reminder phone calls/notices sent out prior to procedure date—patient instructed to be NPO
for 6 hours prior to time of appointment
 Patient requires an escort with them in order to take them home
 Introductions and explanation of procedure given with time allowed for questions
 Patient identification confirmed
 Perform a pre procedure assessment (e.g. NPO 6 hours, allergies, trouble swallowing, dentures)
 Obtain a medical history including any allergies, history of ulcers, hiatal hernia or swallowing
difficulties.
 Have patient change into a gown—explain drooling during the procedure is normal and
suctioning will be performed as needed
 Ensure a clear ECG signal for appropriate looping of digital images
 Apply ECG electrodes for monitoring of vital signs throughout the procedure
 Insert an IV line for administration of IV sedation and for access in case of emergency
 Document patients room air saturation level and apply oxygen by nasal prongs if level below
96%
 Have cardiologist performing the exam inform the patient of the procedure and associated risks
prior to obtaining a written consent
 Position patient on left lateral side with chin tucked to chest
Procedure
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Cardiologist preps throat with Lidocaine gargle and spray to suppress gag reflex
IV sedation, preliminary dose given to relax patient - patient to remain awake in order to
swallow during intubation process
Cardiologist/anaesthetist will intubate the patient while the sonographer operates the
ultrasound machine controls
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Maintain patient comfort during procedure - additional sedation is given as required and
ordered by the cardiologist
Patients may respond well to reassurances during the test
After all images have been acquired the cardiologist/anaesthetist will extubate the patient
Recovery
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Patient will be recovered according to the sedation type, dosage and effect
Separate recovery room with heamodynamic monitors and staff is preferred
Patient remains monitored and IV line patency is maintained until fully recovered
Airway, respirations, level of consciousness, heart rhythm and blood pressure will be monitored
post procedure, until patient can protect their airway and is hemodynamically stable (+/20mmg of pre-procedure MAP/BP)
Utilize recovery assessment tools (such as Aldrete score) to assess level of readiness for
discharge
Written discharge instructions are given to patient and accompanying adult prior to discharge
Potential Complications:
 Esophageal perforation: may require immediate surgery to repair
 Life threatening arrhythmias: treated by cardiologist; ensure emergency cart is immediately
available
 Respiratory distress: ensure emergency cart immediately available, including artificial airways
and recovery support staff such as anaesthetist; anaesthesia assistant; registered nurse (RN)
trained in recovery post anesthesia
 Tracheal intubation: remove TEE probe, assess airway
Documentation
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Completed by the cardiologist and appropriate recovery support staff
Final report by cardiologist
Documentation of vitals and patient tolerance to procedure usually completed by sonographer
or RN
Full documentation of medications given: name, dose, time and effect
Documentation of comments made by patient pre and post procedure