Organization of TEE Service



Organization of TEE Service


Solomon Aronson1

Glenn S. Murphy2

Joseph P. Mathew2

Stanton K. Shernan2


1OUTLINE AUTHOR

2ORIGINAL CHAPTER AUTHORS





▪ KEY POINTS



  • Physicians performing intraoperative transesophageal echocardiography (TEE) should establish a collaborative relationship with a colleague who has advanced training in TEE.


  • After each TEE examination, the probe should be carefully inspected for any cracks or perforations.


  • The risks of an electrical injury to a patient will be reduced if a leakage current test is performed after each use of the probe.


  • During the preoperative history and physical, patients should be examined for any signs or symptoms of esophageal or gastric disease. The risks and benefits of TEE must be carefully evaluated in patients with relative contraindications to TEE.


  • Routine antibiotic prophylaxis to prevent endocarditis is not required prior to TEE except in high-risk patients.


  • Transesophageal echocardiography probes must be disinfected for at least 20 minutes in a glutaraldehyde-based solution to eliminate bacterial and viral contaminants.


  • Continuous Quality Improvement (CQI) programs are a necessary component of every TEE service.


I. INTRODUCTION

Since its introduction in the 1980s, intraoperative TEE has become a routine component of cardiac anesthesia practice and is commonly employed during noncardiac procedures for aiding diagnostics. The majority of intraoperative TEE examinations are preformed and interpreted by anesthesiologists in the United States and Canada (Figs. 7-1 and 7-2).


II. REQUIREMENTS



  • Investment in people and personnel


  • Close collaboration with other services


  • Investment for maintenance and equipment upgrades



  • Space for equipment storage, archiving studies, and reading


  • Understanding of billing compliance


  • A quality assurance program






▪ FIGURE 7.1


III. TRAINING AND CREDENTIALING



  • 1996: Task force on practice guidelines for TEE established skills recommended to perform an exam and are listed in Table 7-1


  • 2003: Task force on training guidelines established recommendations for basic and advanced levels


  • Basic level 150 exams be performed with appropriate supervision including 50 that are personally performed


  • Advanced level 300 exams be performed with appropriate supervision including 150 that are personally performed


  • It is recommended that basic and advanced level of training maintain 20 and 50 hours of CME, respectively.






▪ FIGURE 7.2










TABLE 7.1 RECOMMENDED TRAINING OBJECTIVES FOR BASIC AND ADVANCED PERIOPERATIVE ECHOCARDIOGRAPHY










































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May 26, 2016 | Posted by in CARDIOLOGY | Comments Off on Organization of TEE Service

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Basic Training

Cognitive Skills

1.

Knowledge of the physical principles of echocardiographic image formation and blood velocity measurement

2.

Knowledge of the operation of ultrasonographs including all controls that affect the quality of data displayed

3.

Knowledge of the equipment handling, infection control, and electrical safety associated with the techniques of perioperative echocardiography

4.

Knowledge of the indications, contraindications, and potential complications for perioperative echocardiography

5.

Knowledge of the appropriate alternative diagnostic techniques

6.

Knowledge of the normal tomographic anatomy as revealed by perioperative echocardiographic techniques

7.

Knowledge of commonly encountered blood flow velocity profiles as measured by Doppler echocardiography

8.

Knowledge of the echocardiographic manifestations of native valvular lesions and dysfunction

9.