Transesophageal echocardiography (TEE) is an invasive test 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.
To assess function of prosthetic valves, diagnose endocarditis, evaluate valvular regurgitation and congenital abnormalities, and examine the aorta for dissecting aneurysms
To monitor left ventricular wall motion intraoperatively
To measure EF in selected patients
Situations in which a transthoracic echocardiogram has not been satisfactory (e.g., obesity, chest wall trauma, chronic obstructive pulmonary disease)
When results of traditional transthoracic echocardiography do not agree or correlate with other clinical findings
Explain test purpose, procedure, benefits, and risks.
Apply a topical anesthetic to the pharynx. Insert a bite block into the mouth to reduce the risk for damage to the teeth and other oral structures as well as the endoscope itself (see Chapter 12).
Have the patient assume a left lateral decubitus position before the lubricated endoscopic instrument is inserted to a depth of 30-50 cm. The patient may be asked to swallow so that the scope advances more easily.
Manipulation of the ultrasound transducer allows a number of image planes to be visualized.
Follow guidelines in Chapter 1 for safe, effective, informed intratest care.
Abnormal TEE findings may reveal the following conditions:
Heart valve diseases
Pericardial effusion
Congenital heart disease
Endocarditis
Intracardiac tumors or thrombi
Left ventricular dysfunction
Pretest Patient Care
Explain test purpose, procedure, benefits, and risks.
Ensure that the patient fasts from food and fluids at least 8 hours before the procedure to reduce the risk for aspiration. Premedications such as analgesic agents or sedatives may be ordered. Prescribed oral medications may be taken with small sips of water.
Follow guidelines in Chapter 1 for safe, effective, informed pretest care.
Posttest Patient Care
Review test results; report and record findings. Modify the nursing care plan as needed.
Monitor vital signs and level of consciousness (if sedated). Ensure patent airway at all times.
Position the patient on the side if sedated to prevent risk for aspiration.
Swallowing reflexes may be diminished for several hours because of topical anesthetic effects. Ingesting food or fluids may result in aspiration if these reflexes are not intact. Evaluate return of swallow, cough, and gag reflexes before introducing food or fluids orally.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.