Page 309 - Cardiac Nursing

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C HAPTER 1 3 / Echocardiography 285
Diastole Systole
■ Figure 13-14 Top: Apical four-chamber view.
Middle: Apical two-chamber view. Bottom: Apical long
axis view. RV, right ventricle; LV, left ventricle; RA,
right atrium; LA, left atrium; Ao, aorta. (Echo cour-
tesy of University of Washington Medical Center,
Seattle, Washington.)

or coagulopathy are some contraindications that may require con- and analgesic administration, and in oral airway management is
sultations with a gastroenterologist first. Anticoagulation with necessary. Conscious sedation requires that heart rate, blood pres-
warfarin or heparin is not an absolute contraindication but the in- sure, respiration, and arterial oxygen saturation are monitored
ternationalized normalized ratio and partial thromboplastin time throughout the procedure. This monitoring is routinely per-
should be checked beforehand to ensure that supratherapeutic lev- formed by the nurse. However, clinical circumstances may exist
els are not present. The patient should be fasting for 6 hours and where an anesthesiologist should be present during the procedure.
the patient should remain fasting postprocedure until there is an An intravenous catheter is needed to administer analgesics and
appropriate level of consciousness and the local anesthetic of the sedatives. Medicines to reverse analgesics (naloxone for opioids)
posterior pharynx has dissipated. and sedatives (flumazenil for benzodiazepines) should be readily
For the procedure, the patient is positioned in the left lateral available. Suctioning should always be available to manage excess
decubitus position to minimize the risk of aspiration. A topical oral secretions.
anesthetic agent is used on the posterior pharynx to suppress the Risks of TEE include, but are not limited to, aspiration, bron-
gag reflex, allowing easier passage of the probe into the esophagus. chospasm, respiratory depression, or hypotension from sedation,
Typically, TEEs are performed under conscious sedation. There- bleeding, and trauma to the teeth, esophagus or stomach such as
fore, supervision by nurses with experience and training in sedative perforation. 2