ADVANTAGES AND LIMITATIONS
Many advantages exist to this novel technique. First, this can avoid
mechanical ventilation in patients who can potentially be managed with
conscious sedation that can save resources for the hospital. Moreover,
these patients could potentially have issues with general anasethsia
(side effects of medications and hemodynamic instability in the presence
of large PEs and RV strain) and mechanical ventilation and perhaps would
be better to avoid. Second, it does not require the presence of another
cardiologist to perform TEE.
ICE from the arm could be challenging to interpret because it will be
inverted. One way to go around that is to use the “invert” button on
the echo machine. Operators familiar with ICE should have no problem
with performing and correctly interpreting ICE from the arm. Closure of
the 10 Fr basilic vein access could theoretically be an issue; however,
we have closed both patients with pressure dressing and a co-band
without any complications.