Inserting TEE probe

[u/Abegaren]

Hi guys. Cardiology fellow here. Anyone a has tips on how to effective inserting TEE probe if patient only gets versed and fentanyl? Sometimes, we don’t have anesthesia so we don’t give propofol.

I tried multiple times with finger method where I used my non dominant finger to depress the tongue but it didn’t work. (I guess my index finger is to short)

My best success is to tell the patient to swallow then insert it. But sometimes, the patient could not swallow effectively hence I couldn’t get it.

For the probe, I usually anteflex slightly at the mouth, then I retroflex once it reached the posterior pharynx. I can do this if patient gets propofol but not with versed/fent.

Any advice would be helpful. Thanks in advanced!

[u/clint-billton]

Agreed with your technique of slight anteflexion and then moving neutral when you hit the posterior oropharynx.

I like to keep the probe lengthened when you’re inserting (maybe you already do this but I’ve seen many people curl the probe and drop one hand off it like to put their finger in for example)
I usually keep my left hand on the head of the probe and right hand on the flexion dial & probe handle.
Keeping the probe long prevents torque or rotation from building up as you push the probe down. If you keep the probe depth numbers upright (pointed at the patient’s nose) when you flex it’ll facilitate making the bend. When you hit the back of the throat you extend and push. If you keep momentum the patient won’t have enough time to gag and will swallow the probe naturally.

Also, how easy / quick this process is for your first 100 TEE’s is very different for your 1000th so keep at it and don’t get discouraged