By Kevin Murphy
Transesophageal Echo (TEE) probes are a vital part of cardiac departments. TEEs allow cardiologist to have a less obstructed view of the heart by placing a transducer on the tip of a flexible scope to be inserted in the esophagus and perform a 2D/3D ultrasonic study. TEEs are much more complex than general imaging probes, as they have a control housing, insertion tube, articulation controls and motors to control the movement of the device and transducer. TEEs also require a higher level of disinfection and electrical leakage and safety testing before each use and can decrease the lifespan of these assets.
IAC (Intersocietal Accreditation Commission) requires that each TEE pass electrical leakage and safety testing as well as high-level disinfection (HLD) before each use. The responsibility for these procedures has always raised the question of who is responsible for these procedures. Responsibility has primarily been on the end user at the department level. There has been a shift in recent years with facilities have turning those duties over to sterile processing as they have personnel, equipment and procedures in place to handle the disinfection and testing. The move to sterile processing has added handoffs, transportation and procedural difficulties.
Typically, the cardiac department would perform the HLD and leakage testing within the department to minimize movement of these fragile assets. In some instances, that process now involves transporting the TEE through the facility where it is handed off to sterile processing. Unfortunately, we have seen the transport take place in pillowcases, storage bins and by hand. Improper transportation can lead to unintended damage to the TEE. We recommend having a procedure in place to document the current disinfection stage in conjunction with a TEE specific storage and transportation container. The process protects both the asset and the employees who handle it. It’s also recommended that the end user perform low-level disinfection (LLD) within the originating department. Performing LLD allows the department to inspect the TEE for any damage and perform corrective actions, preventing further damage.
Understanding TEEs will help establish the proper cleaning and disinfection protocol and reduce damage. Let’s identify the components of a TEE.
- Tip – end of the scope with transducer
- Bending Neck Rubber – flexible rubber that allows for articulation
- Insertion Tube – black coated tube with depth markers
- Strain Relief – flexible rubber alleviates strain at the housing
- Control Housing – contains controls for motor manipulation and articulation
- Cable – multiple wires inside sheath
- Connector – physical connection to ultrasound machine
When performing leakage testing or HLD soak, the solution should not reach the end of the insertion tube at the strain relief end. Insertion beyond the strain relief can cause catastrophic damage to the internal components. TEEs should never be completely submerged in any liquid.
Leakage and safety testing should be completed after LLD and before HLD. Leakage testing ensures the electrical integrity of the device and verifies that the device is safe to use on patients. Testing can be completed with the use of a stand-alone ultrasound leakage tester with pass/fail indications, numerical value of <100µA (IEC 60601) or alternate value provided by manufacturer. In the event of a leakage failure, test again to confirm. If there is a confirmed failure, remove from solution and perform corrective action. Passing TEEs can proceed to the HLD process recommended by the manufacturer.
HLD consists of a timed soak in an approved disinfection solution, followed by a rinse and proper storage. Consult the manufacturer for an approved list of solutions and recommended soak times. Exceeding the recommended soak times may lead to damage of the TEE. The control housing, strain reliefs, cable and connector should be cleaned with an approved cleaning solution. Once HLD is complete, perform a rinse to remove any residue and dry with a clean dry cloth. When possible, store the probe in a TEE specific storage container or vertical hanging storage cabinet.
Initiating a standard process and educating all departments involved will reduce cost of ownership, minimize downtime, increase efficiency and allow your department to provide outstanding care to your patients.
Kevin Murphy is a senior ultrasound support specialist for Avante Health Solutions. For more information about comprehensive ultrasound solutions from Avante, visit avantehs.com.