Equipment, Infection Control, and Safety
Steven Ginsberg and Jonathan Kraidin
I am talking TEE, not TTE. It’s not ultrasound to find some flounder or neck vein!
The Good: Safety First
Latex: the skin of the probe should be latex free.
Set up an Echo Service
The Echo probes are expensive and fragile $$$$$
Before you make the investment or get new equipment (10–15 years) make sure these are in place:
Who maintains the machine onsite?
What is the actual cleaning process?
Where do you keep the probes prior to insertion into the patient?
Where do you place the dirty probe?
Who fixes a problem with the machine?
Who regularly will reboot this electronic monster?
The Ugly (Bad Will Come Later): Cleaning—You Need a System
What should we do with the probe to have it ready for the next case?
Have you considered cleaning it?
But there is lots of schmutz (not schmaltz) on this thing.
Place a plastic cover over the tip of the probe until it is in use.
The Physical Probe: How’s it Look?
Insert: How’s it Go?
Patient has an esophageal diverticulum
Patient is bleeding from those varices and I can’t see a thing
Make sure that baby is “unlocked”—you want it to easily change direction with the patient if needed.
Make sure the tip is in neutral position.
If the teeth aren’t loose then raise the lower jaw.
Watch out for the junior resident knocking those teeth out.
Maybe use a laryngoscope if you are having a tough time of it—it goes in the hole on bottom.
Don’t force it. If you must have Echo then use a pedie probe!
Ergonomics
Don’t grip the transducer with excessive force. Try telling the surgeon that you can’t do a TEE because his last case took so long that you now have carpal tunnel! Don’t stand in one place while doing your echo. Move around. Loosen up that back of yours and relax your shoulders. This shouldn’t hurt.
The Bad
What did I do to the poor patient?
Did I rupture a variceal with that locked probe?
Went through a tumor in the esophagus with the probe?
I perforated the esophagus—try to peg this one on the endoscopist?
I was too busy checking the Echo and did not notice the patient was hypotensive or had a fatal arrhythmia—you pinched yourself and woke up to treat in time.
Questions (Echo Safety)—True/False
1. Never place an Echo probe in the locked position?
2. After each use put the Echo probe in a tight circle so that its shape retains memory for the next time?
3. Modern machines never have to be shut down?
4. The anesthesiologist should bring the probe, in cidex, to central processing after each case?
5. Soaking the entire probe in cidex for 10–15 minutes is sufficient maintenance?
6. It is possible that probe insertion can help to ensure a right main stem intubation?
7. Post-op complaints of dysphagia will often go away on their own?
8. During long cases there is a concern for radiation exposure?
9. Direct laryngoscopy can help with a difficult probe insertion?
10. Small scratch marks may develop at the end of the probe when a bite block is not routinely used?
