TEE CARE

05/10/2016

TEE Probe Maintenance Tips: Identify TEE Probe Defects
Posted by Natasha Russell on Wednesday, February 19, 2014 Under: TEE PROBE /ECHO
Written By Jason Smith ,Axess

Transesophageal echocardiogram (TEE) probes tend to be “budget busters” when it comes to TEE probe repair or replacement. TEE probes require constant inspection to ensure they aren’t in need of repair and are performing at their peak.

Many TEE probe defects are so small they go unnoticed by everyone handling the probe. In some cases, the smallest TEE probe defects, like tiny holes or cracks, turn into the biggest TEE probe repairs. If a bite guard isn’t used during a TEE probe procedure, a patient’s bite reflex can leave cuts or holes in the bending rubber, covering the articulating portion of the insertion tube. This can allow fluid to infiltrate into the probe. Fluid in the TEE probe can then lead to corrosion throughout the entire probe and ultimately require a complete probe rebuild. These holes also greatly increase patient risk, related to electrical current leakage and potential cross-contamination.

Not catching probe defects early, like the ones listed above, leads to high priced probe repairs and/or replacements. In some cases TEE probes can cost as much as $8,000 for probe repair and up to $28,000 for a TEE probe replacement. And to think that bite holes can be avoided by using a two dollar bite guard. It makes you wonder why they aren’t used on every TEE probe procedure.


By understanding what TEE probe defects to look for, you can start to identify common problems, like corrosion in the steering control, crushed insertion tubes, bite marks in the insertion tube or bending rubber, and damage to the tip or lens. Identifying these issues early reduces your repair costs significantly and extends the life of your TEE probe. For example, if you catch a hole in the bending rubber early, you can fix it for around $1,000, but if you leave the probe defect unattended, it will eventually lead to fluid in the TEE probe and a TEE probe replacement costing as much as $28,000.

Just remember, little TEE probe defects don’t get better with time - they only get bigger and more costly!

Check out some of the common TEE probe defects we find at Axess Ultrasound and start your path to a proactive probe asset management approach.

28/09/2016

28/09/2016

GE recommends proper handling of TEE probes....have a look!!!!!

28/09/2016

Cleaning is a critical step to ensure proper reprocessing of TEE probes

How important is pre-cleaning, or point of care cleaning?

Pre-cleaning is the first and most critical step to ensuring a successful high-level disinfection of a TEE ultrasound transducer; the industry commonly interchanges the terms "pre-cleaning" and "cleaning". Properly cleaning the probe optimizes the disinfection process and "must always be performed prior to high-level disinfection."1 Skipping this simple step or if it is performed inadequately, can easily compromise the entire disinfection procedure.

What is cleaning?

The Centers for Disease Control and Prevention (CDC) defines cleaning as:

"Cleaning is the removal of foreign material (e.g., soil, and organic material) from objects and is normally accomplished using water with detergents or enzymatic products. Thorough cleaning is required before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes."2
How do I properly clean a probe?
Pre-cleaning must be done for the successful reprocessing cycle of a "dirty" TEE probe. When the probe is removed from the patient it should be wiped with an enzymatic product, like the TEEZyme™ TEE Probe Enzymatic Sponge, to remove organic and inorganic soil so as to prevent these materials from drying on the probe.
Cleaning should be done prior to high-level disinfection of the TEE probe. The probe should be rinsed to remove the pre-cleaning solution with a large volume of tempered water. The general recommendation is for a one minute contact time per eight liters of water.
The rinse water then must be drained or removed from the basin or sink.
The basin or sink is again filled with the tempered water along with enzymatic solution for an enzymatic bath.
The TEE probe is submerged into this bath. The handle and connection cable should never be placed in the soak basin or sink to avoid damage to the probe.
Soak the probe shaft for the manufacturer's directed time found in the instructions for use.
After the enzymatic bath is complete, the basin or sink should be emptied and fresh tempered water should be used to rinse the TEE probe. This rinse should also use a large volume of tempered water.
A drying step, like the QwikDry™ TEE Probe Drying Cloth, is recommended before placing the probe into the high-level disinfectant solution. This can eliminate excess moisture that could interfere with subsequent microbicidal processes. Debris and gel can act as a barrier, while water can dilute the disinfectant which can mitigate the disinfection process. With reusable disinfectants this can become problematic. The healthcare professional must be vigilant in conducting a Minimum Required Concentration (MRC) test prior to each and every high-level disinfection process.
What do inspectors look for?
When it comes to cleaning probes, inspectors will look for the following:

Are you following manufacturer's instructions for cleaning or evidence-based guidelines?
Are you visually inspecting the probe prior to high-level disinfection for residual soil and re-cleaning as needed before high-level disinfection?
Is cleaning still required when using an automated reprocessor?
Yes. Cleaning is still required when using an automated reprocessor. As with manual disinfection methods, you need to start the disinfection process with a clean probe. One might ask why cleaning is necessary if you're going to perform a high-level disinfection or sterilization process.

Consider this:

"Cleaning residual organic or inorganic matter left on the probe increases the margin of safety and shortens the exposure time required to kill the entire microbial load."3
Any remaining transducer gel can also act as a barrier to the high level disinfectant and diminish the efficacy of reusable disinfectant.

19/09/2016

CS Medical LLC announces the release of its new 2015 products catalog dedicated to TEE probe testing, cleaning, disinfection and storage. The new catalog provides solutions to healthcare professionals that are tasked with occupational safety or in minimizing healthcare-associated infections. For years, CS Medical has provided the TD 100® Automated TEE Probe Disinfector to healthcare facilities throughout the United States. Today, more than 1,000 devices are in operation and providing a validated and repeatable high-level disinfection for TEE probes.

CS Medical’s 2015 catalog addresses new focal areas for TEE probe care like electrical leakage testing, bedside cleaning and probe storage. Our core product, the TD 100®, is an example of our commitment to innovation and to the health and safety of medical patients and staff.

CS Medical LLC has pioneered the automated disinfection process for transesophageal ultrasound probes with the development and release of the TD 100® Automated TEE Probe Disinfector. The TD 100® is the first FDA-cleared, automated disinfection process with printed verification for TEE ultrasound probes. During the disinfection process, the TEE probe receives high-level disinfection in five minutes followed by five complete rinse cycles before disinfection confirmation is acknowledged and a report is printed. The TD 100® Automated TEE Probe Disinfector eliminates manual reprocessing of delicate and expensive TEE ultrasound probes while providing a repeatable and FDA cleared disinfection process.

12/09/2016

TEE PROBE LEAK TEST BECOMES MANDATORY DECEMBER 31, 2015…ARE YOU READY?
Back in July 2013, one of the revisions to the IAC Standards and Guidelines included “the structural and electrical integrity of the transducer must be checked between each use, using an ultrasound transducer leakage tester.” This revision becomes effective December 31st, 2015. That’s great, but why do we have to do this? What is a leakage tester? How does it work? Where can I get one?
STANDARD
Let’s start by reviewing the IAC Standards. Performing electrical checks of TEE probes ensures electrical safety and prevents harm to both sonographers and patients. The IAC Standard (2.2.3B) will require TEE probe electrical checks between each use starting December 31st, 2015. According to the standard, “Passed” or “Failed” must be recorded in the routine TEE probe cleaning/maintenance log along with action taken if “Failed”.
HOW DO I PERFORM A LEAKAGE TEST?
Thankfully, this procedure is simple and can easily be made an automatic process in your lab.
Overview
Step One:
The first step is to purchase the vendor specific leakage tester for your TEE probe. (See link at the end of this article)
Step Two:
Once you have the equipment you can easily implement the use of it into any step of your current cleaning protocols. Remember, testing just requires that the probe to be sitting in a liquid to complete the electrical leakage test. You can test the probe while it’s soaking in the enzymatic cleaner OR while it’s soaking in water.
Step Three:
Plug the connector port into the Leakage Tester and place the electrode from the Leakage tester into the water

Formal Procedure

So now you understand the 3 steps involved to implementing Leakage Testing the next step would include writing a formal policy and procedure and training staff. Here is an example of how your policy can address checking the structural and electrical integrity of the transducer.
Electrical and Structural Testing Procedure
1. Pre-clean the TEE probe according to your manufacturer’s guidelines.
2. Inspect the TEE probe for signs of damage:
o Lens: Separating from housing, multiple holes, or swollen
o Connector: Bent pins, dents in housing, dirty
o Bending rubber (Flexible shaft): Contaminated or stained, holes and most common, bite marks
o Cable: Pulled out, strain relief, tears, scratches, faded labeling
3. Fill the TEE basin (or cylinder, whatever container you soak your probe in) to the level indicated with a saline or enzyme solution that will conduct electricity.
4. Place just the Flexible shaft of the TEE probe into the enzymatic solution/saline bath, fully immersing the shaft BUT NOT THE control housing (handle), cable or connector housing
5. Place the tester’s dual electrode at least one inch into the enzymatic solution/saline bath.
6. Perform conductivity test: Turn test button on. Move switch to Conductivity and click test button again.
o Green light means passed.
o Red light means failed. If conductivity fails, make sure that electrodes are at a depth of 1 inch and everything is firmly connected. Try again. If conduction test fails, do not attempt leakage test. Notify Biomed and or troubleshoot per manufacturer instructions.
7. Only if Conduction test passes: Perform leakage test. Move switch to leakage and click test button.
o Green light means passed.
o Red light means failed.
8. If Leakage test fails check all equipment and try again to ensure it wasn’t a procedural error. If Leakage test continues to fail remove the probe from patient care and immediately notify Biomed and or the field engineer.
CASE STUDY
We interviewed the biomedical manager at a hospital in South Florida. He implemented electrical testing three years ago in their facility.
When and why was electrical testing implemented?
The facility was constantly fixing or replacing TEE probes and he realized that damage to the probe was occurring before symptoms of the damage could be seen. This included tiny bite holes undetectable by the eye that after multiple soakings this left the TEE probe unusable. After replacing their probes three times, their warranty was no longer valid and they had to pay $14,000 to replace the probe. A month and a half later it happened again so they implemented electrical testing.
How was testing implemented?
The biomed manager’s goal in addition to ensuring compliance was to make the testing a mindless task, that would be completed automatically. The leak tester they had was complex and not very easy to use and the hospital uses TEE transducers from multiple vendors. He mounted the tester in the sterilization room and modified the sterilization tube to sit on the electrical connector. He also purchased a universal adaptor for the tester that allows many different vendor probes to be tested on it. Now, the tester just has to connect the transducer to the universal converter, dip the tip of the probe into the modified sterilization tube full of water and run the test. The tester is immediately notified if it is “Pass” or “Fail.”
SUMMARY
Mandatory testing is coming so start preparing now by making sure you have proper equipment, procedures and training for your facility. IAC presented an excellent webinar on this very subject and we have provided a link to their PowerPoint. If you have any questions reach out to your biomed department, ultrasound equipment vendor or sterilization department

12/09/2016

TEE electrical leak test

12/09/2016

TEE care products

12/09/2016

disinfection of TEE probe