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Introduction ⬇

TEE is a type of cardiac ultrasound that permits optimal ultrasonic visualization of the heart when traditional transthoracic (noninvasive) echocardiography fails or proves inconclusive. A miniaturized high-frequency ultrasound transducer is mounted on an endoscope and coupled with an ultrasound instrument to display and record ultrasound images from the heart. Endoscope controls allow remote manipulation of the transducer tip. Various images of heart anatomy can be displayed by rotating the tip of the instrument and by varying the depth of insertion into the esophagus.

Indications for TEE include the following:

  1. To assess function of prosthetic valves, diagnose endocarditis, evaluate valvular regurgitation and congenital abnormalities, and examine the aorta for dissecting aneurysms.

  2. To monitor left ventricular wall motion intraoperatively.

  3. To measure ejection fraction in selected patients.

  4. When a transthoracic echocardiogram has not been satisfactory (e.g., obesity, chest wall trauma, chronic obstructive pulmonary disease).

  5. When results of traditional transthoracic echocardiography do not agree or correlate with other clinical findings.

Procedure ⬆ ⬇

  1. Apply a topical anesthetic to the pharynx. Insert a bite block into the mouth and secure it. This reduces the risk of damage to the patient’s teeth and oral structures and inadvertent damage to the endoscope.

  2. Ask the patient to assume a left lateral decubitus position while the lubricated endoscopic instrument is inserted to a depth of 30–50 cm. Ask the patient to swallow to facilitate advancement of the device.

  3. Manipulate the ultrasound transducer to provide a number of image planes.

  4. See Chapter 1 guidelines for intratest care.

Clinical Alert

A variety of medications may be used during this procedure. Generally, these drugs are intended to sedate, anesthetize, reduce secretions, and serve as contrast agents for the ultrasound

Clinical Implications ⬆ ⬇

TEE findings may identify:

  1. Heart valve disease: Stenosis, insufficiency, prolapse, and regurgitation

  2. Pericardial effusion, pericarditis, tamponade

  3. CHD

  4. Aortic dissection

  5. Left ventricular dysfunction

  6. Endocarditis

  7. Intracardiac tumors or thrombi

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, and the benefits and risks of the test.

  2. Ensure that the patient has been fasting for at least 4–8 hours before the procedure to reduce the risk of aspiration. Administer pretest medication, such as analgesic agents or sedatives, as ordered.

  3. Ensure that a signed consent is in the patient’s medical record.

  4. Obtain baseline vital signs.

  5. Establish an intravenous access line to administer medications or contrast agents.

  6. Remove dentures and any loose objects from the patient’s mouth.

  7. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Patient Posttest Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Monitor vital signs and level of consciousness (if the patient is sedated). Ensure patent airway.

  3. Explain need for possible further testing and treatment: medical (drugs) or surgical (e.g., cardiac catheterization).

  4. Position the patient on the side, if sedated, to prevent risk of aspiration.

  5. Ascertain return of swallowing, coughing, and gag reflexes before allowing the patient to take oral food or fluids. Generally, the patient should remain NPO for at least 1 hour after the test.

  6. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

Swallowing reflexes may be diminished for several hours because of the effects of the topical anesthetic

Reference Values ⬆

Normal