TRANSESOPHAGEAL ECHOCARDIOGRAPHY – Purpose, Interfering Factors, Client Preparation, Procedure, After Care, Advantages and Complication (NURSING PROCEDURE)
- A transesophageal echocardiography is an invasive procedure that uses ultrasound technique to detect enlargement of cardiac chambers and variations in chamber size during the cardiac cycle. It also assesses vascular function, septal defects and pericardial effusion. Although these accomplished with a transesophageal echocardiogram
- A transesophageal echocardiography permits a better view on the position atrium and aorta. Transesophageal echocardiography is also indicated when a transthoracic approach is inadequate, such as when the client is obese or has chest wall structure abnormalities
PURPOSE
Indications of transesophageal echocardiography include diagnosis of:
- A thoracic aortic pathological condition, including suspected aneurysm
- Mitral valve disease
- Suspected endocarditis
- Congenital heart diseases for example atrial septal defect
- Left atrial intracranial thrombi
- Cardiac tumors
- It is also used to assess cardiac function during minimally invasive cardiac surgery (MICS) and to assess prosthetic valves
INTERFERING FACTORS
Transesophageal echocardiography should not be performed if the client has a history of irradiation of the mediastinum, esophaged, dysphagia or structural abnormalities
CLIENT PREPARATION
- Ensure that a signed informed consent form has been obtained
- Ask the client about any disorder of the esophagus, stomach, throat or vocal cord
- Inquire if the client has dentures, bridges or plates
- Report to the physician any history of arthritis of the neck, respiratory problems of anticoagulants therapy
- Maintain the client on a nothing by mouth starts for 6-8 hours
- Describe the procedure to the client, especially the need for a mouth guard, positioning and the need to swallow when asked
- If the client has prosthetic heart valves, prophylactic antibiotics may be prescribed
- Report any indications in the mouth or throat
- Administer antianxiety medication as prescribed
PROCEDURE
- The procedure may also be used intraoperatively where conventional echocardiography is ineffective
- The client needs to be in bed or on table with ECG leads attached. ECG and BP are monitored
- The throat is anesthetized and sedation is given
- Instruct the client to gargle with various lidocaine and then to swallow
- Warn the client that it will make the tongue and throat feel swollen
- A mouth guard is placed to prevent the client from biting down on the endoscope
- The client is positioned on the left side in the chin-chest position. The head may be supported with a small pillow
- The probe is lubricated with lidocaine jelly and slowly inserted as the client swallows
- Monitor the client for a vasovagal response from the medication given to dry up secretions
- Check the client for gagging and observe the oximeter for oxygen saturation is reading
AFTER CARE
- Assess the client for return of the gag reflex before resuming oral intake
- Instruct the client to avoid hot liquids or foods for 2 hours
- If an outpatient, the client should be accompanied home by another person
- Give lozenges for relief of throat discomfort
ADVANTAGES
- Transesophageal echocardiography (TEE) gives a higher quality picture of the heart than does a regular echocardiogram
- It is especially useful in clients who have thickened lung tissue or thick chest walls or are obese
- TEE allows clear visibility of the heart and its structures it is most useful in diagnosis of cardiac masses, prosthetic valve function and aneurysm
COMPLICATION
- TEE has several complications that are related to the placement of the probe in the esophagus, including esophageal perforation, transient hypoxia, dysrthythmias and vasovagal response
