Mon Apr 27 2009

Care and Testing of the TEE Probe

Comment: The Philips X7-2t transesophogeal probe is a marvel of engineering, with about 2500 elements in a matrix array that can produce real-time 3D (also known as 4D) images of a beating heart on the iE33 ultrasound system. The X7-2t TEE probes cost $70,000 new in the United States. It is always important with TEE probes to follow the manufacturer's recommendations for use of bite guards, visual inspections and electrical leakage testing. This helps ensure patient safety, with the biggest risks being cross-contamination and electrical shock. It also will reduce costs, by finding a bite mark or tear in the bending neck sheath or insertion tube, or a tear in the scanhead membrane before fluid infiltration causes more damage to the probe. Because of the design characteristics of the X7-2t, it is absolutely critical that the probe not be "soaked" internally with the disinfecting solution or any other fluid. ----> If the X7-2t has fluid infiltration and is connected to the iE33, it is very likely that the electronics in the distal end of the insertion tube will be irreparably damaged. The attached technical bulletin is provided to show and explain why proper care and testing of this TEE probe is so important. 1. We recommend doing a visual inspection after every TEE examination. This can be done as part of the wipe down of the probe with a cleaning solution such as Cavi-wipes. While cleaning the probe before disinfection, as recommended by all the manufacturers, the probe can be inspected for any damage or wear that has caused a hole or tear. If any damage is noted, the probe should not be immersed in the disinfecting fluid, and should be removed from service and sent for repair immediately. If no damage is seen, the probe should get an electrical leakage just prior to or at the beginning of the disinfection cycle. The User Reference Manual for the iE33 (Rev A) has a lot of information about TEE probes in Chapter 17, including these statements: "Scrutinize the entire transducer and test all of the controls before each use." "Carefully inspect the entire surface of the distal tip and flexible shaft for protrusions, holes, dents, abrasions, cuts, burrs, or cracks that could be extremely hazardous to both you and your patient." "CAUTION - All patients should wear a bite guard during a TEE exam. A bite guard protects against dangerous transducer mechanical and electrical malfunction caused by involuntary biting. Even anesthetized patients require bite guards to prevent damage to both their teeth and to the transducer." By the way, you can pull up the User Reference Manual on the iE33 by pressing the Help key on the QWERTY keyboard. 2. Replacing the Bending Rubber will only cost you $250.00 at most places. At least here. Sometimes there is no fluid intrusion. Using 2 layers helps. If there is and you want the fluid to just dry up and or stay inside the probe there is no extra cost. The probe may not work very much longer though if it is still working at all. Some people have called the strain relief on the insertion tube the "boot". That's why I asked. 3. Different model probes have different challenges. In my opinion once there has been fluid intrusion to the inner workings of the distal end and control housing the honest way to repair it is to completely disassemble the probe for cleaning, repair, and proper re-assembly. That is if the array has not already been damaged permanently. For example Acuson V5M arrays go bad quickly if they get wet with sterilizing fluids. I would make sure that if a repair vendor is partially opening up drying out your probe and then making it look good on the outside that they tell you that and not call that a refurbed probe. This tactic may get it back in service but the probe is more likely to have problems sooner than later. I personally would not want a probe done this way to be used on me or anyone I know. If you really want to do it right you remove the array and if necessary repair the flexible circuits that attach it to the cable. You then remove the insertion tube and steering cable assembly. Steering cables corrode quickly also. Insertion tube coatings can delaminate from the inside out. If the cable has wicked up enough fluid the wires will eventually begin to corrode shielding first. Replacing the cable is best when it is like this. The only way to find out for sure is take it apart and look at it. All this is very labor and cost intensive. If the tip case has to be removed for any reason the least it will cost is $3500. Full blown refurb on a late model probe is $6500. See the attached word document for what that entails and to see how far we go to refurb some Philips models. Make sure your vendor is doing all these things for your big dollars. Minor type repairs could be a bent connector pin replacement, or articulation adjustment. $250 here. Repair, recoating and renumbering of an insertion tube should be about $1k and include a new bending rubber. Element tests, phantom image stills, electrical safety results, and microscopic digital photographs can help substantiate repair quotes. That's all free here. Not all probes are repairable. Unless you are willing to replace absolutely any part up to and including the entire probe. "Dead" probes can provide needed parts to repair other probes in not so bad of shape. Other needed parts have to be purchased or manufactured. One more thing. If you have a Philips or Acuson pediatric omniplane TEE with a black cable and its splitting apart all over that can be repaired. DON'T EXCHANGE IT FOR THAT REASON ONLY!

   RE: Ultrasound Transducer Report Post
Fri Jul 01 2011Reply from EH
EH
Unisyn Medical Technologies has a white paper titled, "On the Proper Care of a Transesophageal (TE) Probe." Please feel free to contact me if you would like a copy.

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