CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2022; 06(01): 093-096
DOI: 10.1055/s-0042-1750210
Letter To Editor Response

Innovative Troubleshooting of Difficult TEE Probe Insertion: Letter To Editor Response

Noopur Bansal
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
,
1   Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
› Author Affiliations

Transesophageal echocardiography (TEE) is an integral component of modern-day cardiac surgical conduct.[1] While TEE probe insertion is a relatively simple procedure usually successful in the first attempt, it is not sans risks particularly when difficulties are encountered while performing the same. The American Society of Echocardiography and Society of Cardiovascular Anesthesiologists outlines a complication rate of 0.03 to 1.2% with intraoperative or i-TEE.[2] The consequences of trauma owing to multiple attempts at probe insertion can pose considerable concerns of oropharyngeal injury and/or bleeding.[3] [4] This becomes further compounded in view of preoperative anticoagulants, systemic heparinization, and a predisposed patient profile (e.g., cyanotics).[5]

Centralizing the focus on the anatomical peculiarities, there are some potential sites of resistance to a smooth TEE probe insertion namely pyriform fossa and arytenoids.[3] [6] Herein, simple positioning maneuvers can be instrumental in overcoming the same. Appropriate to the context, the SORT maneuver: (S)niffing position with an anteflexed probe (O)rientation, contralateral head (R)otation and probe (T)wisting, described by Najafi and Golzari, classifies as a noteworthy proposition for nasogastric tube (NGT) and TEE probe insertion.[7] We present a case series highlighting the application of a modified version of the originally described maneuver to aid difficult TEE probe insertion in cardiac catheterization laboratory (CCL), followed by the use of the former in operation theater (OT) setting.

Note

Support was provided solely from institutional and/or departmental sources.




Publication History

Article published online:
01 June 2022

© 2022. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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