TOE Standards

All the standards for transthoracic echocardiography in addition to the following:

View the TOE checklist.

Staffing and training.

  1. All centres must have a designated Head of TOE. This will usually be the Clinical Head of Echocardiography
  2. Outpatient TOE studies require an operator with appropriate training, a cardiac-trained nurse with experience in managing airways and, ideally, a sonographer
  3. Continuing education must be provided for the operators
  4. Each operator should perform or directly supervise at least 50 studies per annum
  5. Ideally operators should have BSE/ACTA/EAE TOE accreditation
  6. A list of indications for TOE should be agreed

Process

  1. Minimum standards for studies should be established and the head of TOE must be responsible for ensuring that all operators adhere to them
  2. A preoperative checklist should be used
  3. Whenever sedation is used, it should be in accordance with the recommendations given in 'Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures in Adults' published by the Academy of the Royal Colleges in 2001 and regulations stated in the NPSA Risk of Overdose with Midazolam Injection in Adults 2008
  4. The TOE probe must be checked electrically at a frequency dependent on usage. A log of these checks must be kept
  5. The TOE probe should be cleaned regularly

Organisation and equipment

There should be appropriate provision of:

  • Room (ideally > 25 m2 in area)
  • Couch with facility for head-down tilt
  • Facilities for cleaning and sterilising the probe.
  • Storage cupboard for the probe
  • Resuscitation apparatus and drugs
  • Lockable drug cupboard
  • Suction
  • Oxygen
  • Pulse oxymeter
  • Sphygmomanometer
  • Facilities for recovery of the patient
  • Protocols for patient care (example Appendix C of the departmental accreditation document link).

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