Appropriate care of TTE probes is essential to prolonging the life of the equipment and maintaining patient safety. For each type of probe, the manufacturer’s specific recommendations regarding cleaning, disinfection, storage, and maintenance must be followed. However, the following comments are generally applicable.

Most TTE probes are designed for high-level disinfection (or occasionally sterilization) in 2% or greater glutaraldehyde solutions, such as Metricide and Omnicide (devices that are used against intact skin require low-level disinfection, and devices that are directly exposed to blood or compromised tissue require a sterile sheath or formal sterilization). In some cases, non-glutaraldehyde-based solutions (e.g., Cidex OPA) may be used for high-level disinfection (but not sterilization) on the manufacturer’s specific recommendations.

Glutaraldehyde is used for the cold high-level disinfection or sterilization of heat-sensitive equipment. It is toxic by direct contact and by inhalation. Symptoms of toxicity include throat and lung irritation, wheezing, headaches, nausea, burning eyes, and rashes. Additional information is available from the Centers for Disease Control Web site or from product manufacturers.

Glutaraldehyde should be used only in a dedicated cleaning facility with appropriate ventilation and chemical storage and disposal capabilities. The glutaraldehyde bath should be kept in a sealed container under a fume hood at room temperature. Staff should be appropriately trained in the safe handling of glutaraldehyde (along with the principles of infection control and universal precautions), which should include the use of protective goggles, splash shields, and gloves (nitrile or butyl rubber, not latex) during direct contact.

The probe should be cleaned and disinfected (or sterilized) as follows:

• 1.
  

  Wipe the acoustic coupling gel from the probe.

  
  
• 2.
  

  Remove any organic matter from the shaft of the probe using soapy water or an approved enzymatic cleaner, such as MetriZyme.

  
  
• 3.
  

  Wipe down the handle of the probe and connector with a 70% alcohol solution. Avoid wetting or immersing these areas because, for most probes, the steering mechanism and connector are not sealed and can be damaged by water or cleaning fluids.

  
  
• 4.
  

  Rinse the shaft of the probe in water.

  
  
• 5.
  

  Disinfect the shaft of the probe by immersing in glutaraldehyde (or a similar high-level disinfectant) for 45 minutes or per instructions. For sterilization, immerse for 10 hours or according to the manufacturer’s instructions.

  
  
• 6.
  

  Remove the shaft of the probe from the glutaraldehyde solution and thoroughly rinse it in water per manufacturer’s instructions.

  
  
• 7.
  

  Allow the probe to air-dry in a hanging storage facility.

  
  
• 8.
  

  Do not routinely soak the probes for extended periods (e.g., overnight) as this will, with time, weaken the outer sheath.

The following general precautions should also be observed to minimize injury to patients and prolong the life of the probe:

• •
  

  Before use, inspect the probe for damage (particularly defects in the outer sheath) or inadequacy of cleaning (e.g., secretions or blood on the handle).

  
  
• •
  

  Ensure that the probe is dry to prevent potential patient exposure to glutaraldehyde.

  
  
• •
  

  When inserting, advancing, or withdrawing the probe, ensure that the flexion lock is released and the probe is in a neutral position. The probe should also be stored with the tip in a neutral position.

  
  
• •
  

  Do not bend or coil the shaft of the probe in a circle of less than 30 cm in diameter.

  
  
• •
  

  Keep the probe straight and avoid movement during the synchronization process with the ultrasound machine.

  
  
• •
  

  A bite guard should always be used to prevent damage to the probe. In edentulous patients, it is prudent to use a bite guard to prevent pressure contact on the gums by the shaft of the probe.

  
  
• •
  

  The probe should undergo regular current leakage testing (at least every 6 months). Failure in this test may be the first sign of a defect in the protective covering of the probe.

  
  
• •
  

  Contact with certain antibacterial skin cleaning solutions that can damage the probe (e.g., phenol, benzoyl peroxide, or benzothonium chloride) should be avoided. The acoustic coupling medium should be glycol, glycerol, or water based; gels containing acetone, methanol, or mineral oil can damage the probe.

In addition to the care of the probe, the echocardiography machine requires regular cleaning, disinfection, servicing, and software updates according to the manufacturer’s recommendations.