Transesophageal Echocardiogram (TEE) probe usage and damage can be the single highest cost associated with ultrasound today. The complexity of the device coupled with the density of components throughout necessitates a very small thus fragile assembly. There are times when TEE transducers do wear out but in the majority of cases, malfunctions and damage are caused by mishandling or not caring for the device properly.
Let’s start with TEE care/usage 101: USE A BITEGUARD! I understand there are many different types of personnel who operate a TEE probe and some of them can be stubborn about being told what/how to do something but using a biteguard is the single, easiest, most cost-effective way to prevent damage. I have been told “the patient is out and cannot bite” but reflexes beg to differ and even dragging a lens, bending rubber or insertion tube over sharp teeth can and will cause damage.
TEE probes are typically soaked in a caustic chemical solution for high-level disinfection but ensure the probe is only immersed from the tip to about 1-2 centimeters before the strain relief on the handle. From this point to the connector, only an approved disinfectant spray or wipe should be used.
When using a chemical soak, ensure several items: the chemical is approved by the manufacturer of the transducer, appropriate soak times (set by the manufacturer of the disinfectant) are adhered to and the probe is thoroughly rinsed after soaking.
Prior to disinfecting, the probe should be inspected from the tip to the handle for any nicks, cuts or pinholes; these are relatively easy and inexpensive repairs for us. If any defects are found, remove the probe from service immediately for safety and damage mitigation. If a compromised probe is soaked, fluid intrusion will occur and the damage/cost increases exponentially.
Storing TEE probes should also be addressed; probes should be hung vertically in protective tubes with tip guards installed. If a probe is temporarily stored on a flat surface, never coil the insertion tube tighter than 12 to 14-inches in diameter.
The Intersocietal Accreditation Commission (IAC) has set new standards for TEE testing as well. As of December 31, 2015, all probes must be tested for electrical safety between each use. Again, thoroughly inspect the probe prior to testing for integrity breaches to avoid possible fluid intrusion.
The recommendations presented here are a good start in preventing or limiting TEE damage but the subject goes much deeper than this space permits. If you wish to discuss this further, please contact me at email@example.com.
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