Freshmen Week 5 - AL

TEE?

Transesophageal echocardiogram

TTE?

Transthoracic Echocardiogram

An echocardiogram via the esophagus, obtained with a specialized probe, the doctor/anesthesiologist will insert the probe down the patients esophagus.

TEE

Who inserts and manipulates the probe during a TEE?

The doctor

Who obtains the windows and views during a TEE?

The doctor

What does the ultrasound tech do during the TEE?

We work the machine, acquire the images the doctor wants us to acquire, put color over the different valves, doppler.

Does TEE do everything that TTE can do?

Yes

Name all the responsibilities of the cardiac sonographer for a TEE?

Collect supplies and equipment, patient education, inspect TEE probe for cracks, tears, and any signs of damage, ensure the TEE probe is working properly, operate the ultrasound machine during the exam and acquire images, disinfect, inspect, and store the TEE probe.

What is the number one thing to ensure that any procedure that we do goes smoothly?

Patient education

Our images are only going to be as great as the doctors _____ and ____ during a TEE.

Windows and views

What are the nurses responsibilities for a TEE?

Patient education, Start IV and may administer medications, Monitor vitals including BP, HR, O2 sat, patient receives a nasal cannula with low flow O2, Operate the suction devices to remove excess secretions, monitor the patient until awake, make sure gag reflex returns, make sure vital signs are stable.

What is the cardiologist/anesthesiologist responsibilities for a TEE?

Patient education, examine TEE probe for proper function and signs of damage, with team assistance turn patient to left lateral decubitus, spray throat with a topical oropharyngeal anesthesia, tell patient to tuck chin to chest, and pass the probe while instructing the patient to swallow, manipulate the probe and acquire the windows and views while sonographer acquires the images, interpret the exam.

What is the team involved for a TEE?

Cardiac sonographer, nurse, and cardiologist/anesthesiologist

Explain a TEE to a patient?

Hi, my name is, I am going to be your sonographer today, my job is to take the pictures while the doctor performs this procedure on you. Has anyone explained the procedure to you? Do you have any questions?

An advantage of TEE is that is offers _____________ because its higher frequency range _________.

Superior resolution, 3-10MHz

What is the decrease in intensity, power, and amplitude of a sound wave as it travels?

Attenuation

Not much to penetrate through so a better image is produced is aka?

Attenuation

TEE probe is within the esophagus and stomach so there is less ________.

Attenuation

What provides access in patients who cannot be imaged via the chest wall?

TEE

Reasons a patient would have to have a TEE?

Patients that are post chest trauma, or surgery, patients undergoing surgery- valve repair/replacement, coronary artery bypasses, or aortic dissection repair, a limited TTE study seen with lung disease, or obesity.

Biggest overall advantage of TEE compared to TTE is?

We are able to get good images, when we are not able to on TTE.

What is the main disadvantage of TEE?

It's an invasive procedure with increased risk of complications.

List 5 disadvantages of TEE?

Aspiration, Dental injury, esophageal trauma, gastric trauma, sore throat

________ requires continuous nursing care, additional staff, a room, and a stretcher for recovery.

Conscious sedation

_______ is more expensive than a _____.

TEE, TTE

Pediatric TEE exam requires a ________. Heavy sedation and/or anesthesia, and a ___________.

Smaller TEE probe, well trained staff.

What supplies are necessary for a TEE?

TEE probe, ultrasound machine, sterilized gel, consent form, and PPE

What does NPO mean?

Nothing by mouth

How long should a patient be NPO before a patient has a TEE?

4-6 hours

What medications can be used for conscious sedation?

Versed and Demerol

What are the reversal agents for conscious sedation?

Romazicon and Narcan

Spray/ gargle is known as?

Topical oropharyngeal anesthesia

Topical oropharyngeal anesthesia are what medications?

Benzocaine, Lidocaine, and Cetacaine (aka Hurricane Spray)

A vomit bag would be known as what?

Emesis basin

What are some contraindications for a TEE?

Uncooperative or unwilling patient, patients that have esophageal bleeding, recent surgeries, and/ or a history of swallowing difficulty, unstable respiratory status, gastrointestinal disorder and/ or bleeding, and unstable cervical spine.

Indications for a TEE?

Source of embolus, tumor, mass, myxoma, or thrombus

The TEE probes excellent _______, multiple ________, and __________ position make it very ______ and ______.

Resolution, scanning planes, posterior, sensitive, and accurate

TEE is ideal for patients in Afib prior to cardioversion to rule out ______.

LA/LAA clot

Infection in the heart, usually attaches on the valves, typically a form of bacteria eating away at the valve, sometimes they can be very small that is why TEE is very good for looking at these.

Infective endocarditis/vegetation

A TEE is great for imagining what defects?

ASD's and VSD's

A bubble study provides a definitive diagnosis and helps determine ________ direction.

Shunts

What is used in a bubble study?

3 way stopcock, 2ml of air, 8ml of saline

What is it called when a blood clot reaches the lungs?

Pulmonary embolism

A blood clot that causes a stroke?

Embolic stroke

The act of the thrombus using the shunt to go over to the left side of the heart is called what?

Paradoxical embolus

During a bubble study little to no bubbles should go in which side of the heart?

Left

During our first bubble study of the patient the patient is ________.

Relaxed

During our second bubble study of the patient we have them?

Cough, Valsalva, or we push down on their stomach

Why would we have the patient cough, Valsalva, or we would push down on their stomach?

Sometimes this causes the shunt to be bidirectional or get bubbles over to the other side.

Bubble studies are primarily used for?

ASD's and VSD's

A negative contrast area may be visualized within the micro bubbles because the shunt will actually thrust the micro bubbles back to the right heart this is known as?

Left to right shunt

Other reasons we may do a TEE?

Valvular heart disease, MI, Cardiomyopathy, heart failure, post cardiac surgery

We typically use what during a TEE?

Omniplane probe

Adult multiplane probe is recommend for those who weigh _______

>25kg

Mini-multiplane probe is recommended for those who weigh _____

>3-3.5kg

Micro-multiplane probe is recommended for those who weigh _____

>2.5kg

______ echo is very popular with TEE because it improves superior resolution, and it improves the evaluation of cardiac volume, EF, Valvular heart disease, valve size, and tumor.

3D

Upper Esophageal (UE) window-

20-25cm deep

Midesophageal (ME) window-

30-40cm deep

Transgatric (TG) window-

40-50cm deep

Deep transgastric (DTG)-

Window is beyond TG

In the adult, there are ____ standard views acquired with the multiplane probe.

20

ASE recommends a series of ______ views for a comprehensive TEE in children and adults with congenital heart disease.

28

Name the TEE windows and depth-

UE- 20-25cm deep, ME- 30-40cm deep, TG- 40-50cm deep, DTG- window beyond TG

Incorporates a stress test with an echocardiogram?

Stress echocardiogram

What are the most common reasons to do a stress echo?

To see if the patient has ischemic heart disease (IHD) or Coronary artery disease (CAD)

Coronary artery disease occurs when the heart gets blocked by ______.

Plaque

For a stress echo we will have a ____ lead EKG hooked up to the patient and it will take ____ pictures and have ____ stickers.

12, 12, 10

What are the types of stress echo tests?

Physiological and pharmacological stress echocardiogram

Physiological stress test is when the patient ___________ on a __________ or ________________.

Exercises, treadmill, supine bicycle

When a patient is given medication that makes the heart act as if it were exercising because patient is unable to perform a physiological stress test.

Pharmacological stress echocardiogram

Pharmacological stress test puts the body into a ____________.

Exercising state

The most common drug used for a pharmacological stress test?

Dobutamine(DSE)

Causes arteries to dilate?

Vasodilator

What are the different types of vasodilators?

Dipyridamole, adenosine, regadenoson

Test reserved for people who strictly are unable to exercise.

Pharmacological stress echo

Who determines the stressor for a stress echo?

The doctor

What is the preferred stress echo?

Exercise

_______ is preferred if possible because its natural.

ESE

SE induces the _____ effect of stress

Hemodynamic

What to look for on a SE?

Ischemia, myocardial supply and demand issue, WMA, Valvular abnormality

Lack of O2/ good blood to tissue?

Ischemia

What gives the heart its good blood?

Coronary arteries

WMA that may reflect that the walls are not squeezing as well as they should be?

Hypokinesis, akinesis, hibernation

Cardiac sonographers job during a stress echo?

Acquire pictures before, potentially during, and after stress test

Who is in the room for stress echo?

stress tech, cardiac sonographer, nurse, and doctor

UEA?

Ultrasound enhancement agent

Advantages of a stress echo?

Noninvasive, No exposure to radiation, inexpensive, quick and reliable, immediate feedback, more sensitive that regular stress test

Stress echo provides a live, visual connection between the patients symptoms and cardiac function, including-

Global function, WMA, RVSP, Transvalvular velocity, PG

Indications for a stress echo(SE)-

Abnormal EKG, CP, SOB, heart failure

Trouble breathing while exercising?

Dyspnea on exertion(DOE)

The stress echo should not be performed under any circumstance?

Absolute contraindication

If the physician determines that the benefit outweighs the risk, the stress echo is performed with extreme caution.

Relative contraindication

If a patient has a EF of 10% what would this be an example of?

Absolute contraindication

If a patient has an EF of 47% what would this be an example of?

Relative contraindication

Name some contraindications for a stress echo?

Decreased EF, MI within last 48 hours, patient refuses, pregnant, seizures

One of the main goals during a stress echo is to achieve the _____.

Target heart rate(THR)

The THR is fully dependent on the patients _______.

Age

Desired THR is _____% of the maximum predicted heart rate.

85-90%

Must achieve the THR for how long before we can take photos?

1 minute