Watch the above video for 16 most important views to get on TEE.
Here is a comprehensive Transesophageal Echocardiography (TEE) protocol with tips and tricks:
Pre-Procedure Preparation
1. *Patient preparation*: Ensure the patient is fasting for at least 4-6 hours before the procedure.
2. *Informed consent*: Obtain informed consent from the patient, explaining the procedure, risks, and benefits.
3. *Vital sign assessment*: Assess the patient's vital signs, including blood pressure, heart rate, and oxygen saturation.
4. *Medication review*: Review the patient's medications and consider withholding anticoagulants or adjusting sedation as needed.
Equipment Preparation
1. *TEE probe*: Ensure the TEE probe is properly cleaned, disinfected, and ready for use.
2. *Ultrasound system*: Set up the ultrasound system, selecting the TEE probe and adjusting settings as needed.
3. *Monitoring equipment*: Ensure monitoring equipment, such as ECG, blood pressure, and oxygen saturation monitors, are available and functioning properly.
Procedure Protocol
*Step 1: Esophageal Intubation*
1. *Topical anesthesia*: Apply topical anesthesia to the patient's oropharynx and esophagus.
2. *TEE probe insertion*: Insert the TEE probe through the patient's mouth and into the esophagus, guided by the ultrasound image.
3. *Probe positioning*: Position the probe to obtain optimal images of the heart.
*Step 2: Image Acquisition*
1. *Transverse views*: Obtain transverse views of the heart, including the aortic valve, left atrium, and left ventricle.
2. *Longitudinal views*: Obtain longitudinal views of the heart, including the mitral valve, tricuspid valve, and right ventricle.
3. *Additional views*: Obtain additional views as needed, such as the ascending aorta, descending aorta, and pulmonary veins.
*Step 3: Doppler Evaluation*
1. *Color Doppler*: Use color Doppler to evaluate blood flow through the heart valves and chambers.
2. *Pulsed-wave Doppler*: Use pulsed-wave Doppler to evaluate blood flow velocities and pressures.
3. *Continuous-wave Doppler*: Use continuous-wave Doppler to evaluate high-velocity blood flow, such as through the aortic valve.
*Step 4: Additional Evaluations*
1. *Contrast echocardiography*: Use contrast echocardiography to evaluate left ventricular function and detect myocardial perfusion defects.
2. *3D echocardiography*: Use 3D echocardiography to evaluate cardiac anatomy and function.
Tips and Tricks
1. *Use a gentle and slow probe insertion technique* to minimize patient discomfort and reduce the risk of esophageal injury.
2. *Adjust the probe position and angle* to optimize image quality and minimize artifacts.
3. *Use the "TEE probe manipulation" technique* to adjust the probe position and angle, allowing for optimal imaging of specific cardiac structures.
4. *Monitor the patient's vital signs and comfort level* throughout the procedure, adjusting sedation and probe position as needed.
5. *Use the "TEE-Doppler alignment" technique* to optimize Doppler signal quality and minimize artifacts.
Post-Procedure Care
1. *Monitor the patient's vital signs* for at least 30 minutes after the procedure.
2. *Assess the patient's comfort level* and provide pain management as needed.
3. *Provide post-procedure instructions* to the patient, including diet, activity, and follow-up care.
By following this comprehensive TEE protocol and incorporating these tips and tricks, you can ensure a safe and effective procedure for your patients.
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