tee

to a tee

Perfectly; completely; exactly. More commonly seen as "to a T." The origin of the phrase is uncertain. You look beautiful. That color really suits you to a tee. You have to make sure the fabric lines up to a tee, or the stitching will start coming out before too long. Bold, reckless, and daring—that fits him to a tee all right.See also: tee

tee off

1. To begin a game of golf by hitting the ball on the first hole. We tee off at 9 AM, so you should arrive at the golf course around 8:30. It was already nearing 90 degrees when we teed off, so we weren't sure if we would make it through all 18 holes.2. By extension, to begin or mark the beginning of something; to kick something off. In this usage, a noun or pronoun can be used between "tee" and "off." They teed off the party with a game of musical chairs. Let's tee things off with some brainstorming exercises.3. To make someone particularly annoyed, angry, or frustrated. In this usage, a noun or pronoun can be used between "tee" and "off." It really tees me off the way people drive in the bus lane, when they clearly aren't supposed to! Nothing teed my mom off more than having guests come into the house with dirty shoes.See also: off, tee

tee up

1. To place a golf ball on a tee and line oneself up to take a shot. Please by quiet while other players are teeing up. He teed up and hit the ball, only to see it disappear into the sand trap.2. To put a ball of some kind into the proper position ahead of a shot. In this usage, a noun or pronoun can be used between "tee" and "up." The kicker teed the ball up and delivered an amazing shot through the keeper's hands to the top-right corner of the net.3. To put someone or something into a position of readiness for some imminent action. In this usage, a noun or pronoun can be used between "tee" and "up." Senators from both political parties helped tee up the legislation, with a vote expected as early as Tuesday. The reduction of interest rates by the federal reserve has teed the economy up for explosive growth in the coming year. The mayor's statement teed up his opponent for a barrage of scathing accusations.See also: tee, up

suit (one) to a tee

To be ideal or perfectly appropriate for one; to be completely in line with one's tastes, preferences, interests, style, etc. A: "Gosh, it's been sweltering lately!" B: "I'm cold all the time, so this hot weather suits me to a tee." I was nervous when he said he was buying a purple tuxedo, but it somehow suits him to a tee. That kind of work suited her to a tee, but when the company closed she had to settle for something a bit more mundane.See also: suit, tee

teed (off)

Exceptionally annoyed, angry, or frustrated. There's no use getting teed off about something that's out of your control! I was so teed by the end of the presentation that I had to just leave the conference room before I shouted at someone.See also: tee

tee-tee

1. noun, slang A childish word for urine. You have to be careful when you use the potty that no tee-tee gets on the floor or your clothes.2. verb, slang A childish word meaning to urinate. Do you need to poo-poo or tee-tee, sweetie? Mommy, Daddy? I tee-teed in my bed while I was sleeping.

have (something) down to a T

To do something well or efficiently, typically due to one's experience at it. I'm a working mom of three, so I've got lunch-making down to a T—I put out all the pieces of bread, add jelly to each one, and then do the same with peanut butter.See also: down, have

tee off

1. Lit. to start the first hole in a game of golf. It's time to tee off. Let's get on the course. What time do we tee off? 2. Fig. to begin [doing anything]; to be the first one to start something. The master of ceremonies teed off with a few jokes and then introduced the first act. Everyone is seated and ready to begin. Why don't you tee off?See also: off, tee

tee someone off

Sl. to make someone angry. (See also teed off.) That really teed me off! Well, you sure managed to tee off everybody!See also: off, tee

teed off

Inf. angry. I'm not teed off! I'm enraged. I was so teed off I could have spit!See also: off, tee

teed (up)

Sl. intoxicated. She was totally teed up by midnight. Tom was too teed to drive.See also: tee

tee off

1. Start or begin, as in We teed off the fundraising drive with a banquet. This usage is a metaphor taken from golf, where tee off means "start play by driving a golf ball from the tee." [Second half of 1900s] 2. Make angry or irritated, as in That rude comment teed him off, or I was teed off because it rained all weekend. [Slang; mid-1900s] Also see tick off. See also: off, tee

to a tee

to a T

COMMON People use to a tee or to a T to mean that something is perfectly or exactly right. The description of the thieves fitted them to a tee. Note: People also say down to a tee or down to a T. The job suits him down to a tee. Lucy wanted perfection, and everything had to be exactly right, rehearsed down to a T. Note: People say that someone has something down to a tee or down to a T to mean that they have practised it and are now able to do it perfectly. He had the organization of the event down to a tee, writing each person an individual letter about it all. Note: T stands for `tittle', a small mark in printing such as the dot over an i. The expression refers to writing being very clear and exactly right. See also: tee

to a ˈT/ˈtee

(British English, informal) exactly; perfectly: This new job suits me to a T (= it is perfect for me). ♢ This portrait is excellent — it’s Rosemary to a T. This may be a short form of the old phrase to a tittle which meant ‘to the smallest detail’. A tittle was a small mark or point on a letter.See also: tee

tee off

v.1. To drive a golf ball from the tee: The golfer teed off with a 300-yard drive.2. To hit something or someone solidly with a sweeping blow or stroke: The batter teed off on the pitch and the ball flew over the outfield wall. The boxer was staggering, and his opponent teed off with a hard right-hand punch.3. To start or begin something: They teed off the fundraising campaign with a dinner. We teed the evening off with cocktails at the hotel.4. To start; begin: The conference will tee off Saturday morning.5. Slang To make someone angry or disgusted: These phone solicitations really tee me off. The rude remarks teed off the speaker.6. tee off on Slang To attack someone verbally: Critics teed off on the mayor for failing to balance the budget.See also: off, tee

tee up

v. To place some ball on a tee: The golfer bent over and teed the ball up. The kicker teed up the football and stepped backward. The golfer pulled out a golf club and teed up.See also: tee, up

tee someone off

tv. to make someone angry. (see also teed off.) Well, you sure managed to tee off everybody! See also: off, someone, tee

teed off

mod. angry. I was so teed off I could have spit! See also: off, tee

teed (up)

mod. alcohol or drug intoxicated. She was totally teed up by midnight. See also: tee, up

teed

verbSee teed upSee also: tee

tee-tee

(ˈtiti)1. in. to urinate. (Juvenile. Usually objectionable.) Jimmy, please go tee-tee before we leave. 2. n. urine. (Juvenile. Usually objectionable.) There’s tee-tee on the floor.

to a tee

Perfectly; exactly: a plan that suits me to a tee.See also: tee

TEE

Transesophageal echocardiography, see there.

Echocardiography, Transesophageal

Synonym/acronym: Echo, TEE.

Common use

To assess and visualize cardiovascular structures toward diagnosing disorders such as tumors, congenital defects, valve disorders, chamber disorders, and bleeding.

Area of application

Chest/thorax.

Contrast

Can be done with or without noniodinated contrast medium (lipid microspheres).

Description

Transesophageal echocardiography (TEE) is performed to assist in the diagnosis of cardiovascular disorders when noninvasive echocardiography is contraindicated or does not reveal enough information to confirm a diagnosis. Noninvasive echocardiography may be an inadequate procedure for patients who are obese, have chest wall structure abnormalities, or have chronic obstructive pulmonary disease (COPD). TEE provides a better view of the posterior aspect of the heart, including the atrium and aorta. It is done with a transducer attached to a gastroscope that is inserted into the esophagus. The transducer and the ultrasound (US) instrument allow the beam to be directed to the back of the heart. The echoes are amplified and recorded on a screen for visualization and recorded on graph paper or videotape. The depth of the endoscope and movement of the transducer is controlled to obtain various images of the heart structures. TEE is usually performed during surgery; it is also used on patients who are in the intensive care unit, in whom the transmission of waves to and from the chest has been compromised and more definitive information is needed. The images obtained by TEE have better resolution than those obtained by routine transthoracic echocardiography because TEE uses higher frequency sound waves and offers closer proximity of the transducer to the cardiac structures. Cardiac contrast medium such as DEFINITY or Optison, is used to improve the visualization of viable myocardial tissue within the heart.

This procedure is contraindicated for

high alertA variety of circumstances that may be considered absolute or relative depending on the facility’s providers:
Barrett esophagus
Bleeding disorders
Esophageal obstruction (e.g., spasm, stricture, tumor)
Esophageal trauma (e.g., laceration, perforation)
Esophageal varices
Known upper esophagus disease
Tracheoesophageal fistula
Recent esophageal surgery (e.g., esophagectomy or esophagogastrectomy)
Unstable cardiac or respiratory status
Zenker diverticulum

Indications

Confirm diagnosis if conventional echocardiography does not correlate with other findings
Detect and evaluate congenital heart disorders
Detect atrial tumors (myxomas)
Detect or determine the severity of valvular abnormalities and regurgitation
Detect subaortic stenosis as evidenced by displacement of the anterior atrial leaflet and reduction in aortic valve flow, depending on the obstruction
Detect thoracic aortic dissection and coronary artery disease (CAD)
Detect ventricular or atrial mural thrombi and evaluate cardiac wall motion after myocardial infarction
Determine the presence of pericardial effusion
Evaluate aneurysms and ventricular thrombus
Evaluate or monitor biological and prosthetic valve function
Evaluate septal defects
Measure the size of the heart’s chambers and determine if hypertrophic cardiomyopathy or congestive heart failure is present
Monitor cardiac function during open heart surgery (most sensitive method for monitoring ischemia)
Reevaluate after inadequate visualization with conventional echocardiography as a result of obesity, trauma to or deformity of the chest wall, or lung hyperinflation associated with COPD

Potential diagnosis

Normal findings

Normal appearance of the size, position, structure, movements of the heart valves and heart muscle walls, and chamber blood filling; no evidence of valvular stenosis or insufficiency, cardiac tumor, foreign bodies, or CAD. The established values for the measurement of heart activities obtained by the study may vary by health-care provider (HCP) and institution.

Abnormal findings related to

Aortic aneurysm
Aortic valve abnormalities
CAD
Cardiomyopathy
Congenital heart defects
Congestive heart failure
Mitral valve abnormalities
Myocardial infarction
Myxoma
Pericardial effusion
Pulmonary hypertension
Pulmonary valve abnormalities
Septal defects
Shunting of blood flow
Thrombus
Ventricular hypertrophy
Ventricular or atrial mural thrombi

Critical findings

Aortic aneurysm
Aortic dissection
It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.
Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

Factors that may impair clear imaging
- Incorrect placement of the transducer over the desired test site.
- Retained barium from a previous radiological procedure.
- Patients who are dehydrated, resulting in failure to demonstrate the boundaries between organs and tissue structures.
- Large diaphragmatic hernia.
- Unknown upper esophageal pathology.
- Conditions such as esophageal dysphagia and irradiation of the mediastinum related to difficulty manipulating the US probe once it has been inserted in the esophagus.
- The presence of COPD or use of mechanical ventilation, which increases the air between the heart and chest wall (hyperinflation) and can attenuate the US waves.
- Obese patients due to the enlarged space between the transducer and the heart.
- The presence of arrhythmias.
- Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
Other considerations
- Failure to follow dietary restrictions before the procedure may cause the procedure to be canceled or repeated.

Nursing Implications and Procedure

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this procedure can assist in assessing cardiac (heart) function.
Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex, anesthetics, contrast medium, or sedatives.
Obtain a history of the patient’s cardiovascular system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). Ensure that barium studies were performed at least 24 hr before this test.
Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women.
Obtain a list of the patient’s current medications, including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus). Note the last time and dose of medication taken.
Review the procedure with the patient. Address concerns about pain related to the procedure. Explain that some pain may be experienced during the test, and there may be moments of discomfort during insertion of the scope. Lidocaine is sprayed in the patient’s throat to reduce discomfort caused by the presence of the endoscope. Inform the patient that the procedure is performed in a US or cardiology department, usually by an HCP, and takes approximately 30 to 60 min.
Explain that an IV line may be inserted to allow infusion of IV fluids such as normal saline, anesthetics, sedatives, or emergency medications.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
Instruct the patient to fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary among facilities.
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

Intratest

Potential complications:
While complications are rare, trauma to the upper GI tract (e.g., esophageal bleeding, perforation, or rupture) may occur. Other potential complications include undiagnosed esophageal pathology, laryngospasm, or bronchospasm.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
Ensure that the patient has complied with dietary and fluid restriction for at least 8 hr prior to the procedure.
Ensure the patient has removed all external metallic objects from the area to be examined prior to the procedure.
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Have emergency equipment readily available.
Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
Obtain and record the patient’s vital signs.
Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
Ask the patient, as appropriate, to remove his or her dentures.
Monitor pulse oximetry to determine oxygen saturation in sedated patients.
Establish an IV fluid line for the injection of saline, sedatives, contrast medium, or emergency medications.
Expose the chest, and attach electrocardiogram leads for simultaneous tracings, if desired.
Spray or swab the patient’s throat with a local anesthetic, and place the oral bridge device in the mouth to prevent biting of the endoscope.
Place the patient in a left side-lying position on a flat table with foam wedges to help maintain position and immobilization. The pharyngeal area is anesthetized, and the endoscope with the ultrasound device attached to its tip is inserted 30 to 50 cm to the posterior area of the heart, as in any esophagogastroduodenoscopy procedure.
Ask the patient to swallow as the scope is inserted. When the transducer is in place, the scope is manipulated by controls on the handle to obtain scanning that provides real-time images of the heart motion and recordings of the images for viewing. Actual scanning is usually limited to 15 min or until the desired number of image planes is obtained at different depths of the scope.
Administer contrast medium, if ordered. A second series of images is obtained.

Post-Test

Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
Monitor vital signs and neurological status every 15 min for 1 hr, then every 2 hr for 4 hr, and as ordered. Take temperature every 4 hr for 24 hr. Monitor intake and output at least every 8 hr. Compare with baseline values. Notify the HCP if temperature is elevated. Protocols may vary among facilities.
Instruct the patient to resume usual diet and activity 4 to 6 hr after the test, as directed by the HCP.
Instruct the patient to treat throat discomfort with lozenges and warm gargles when the gag reflex returns.
Recognize anxiety related to test results, and offer support. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
Nutritional Considerations: Abnormal findings may be associated with cardiovascular disease. Nutritional therapy is recommended for the patient identified to be at risk for developing CAD or for individuals who have specific risk factors and/or existing medical conditions (e.g., elevated LDL cholesterol levels, other lipid disorders, insulin-dependent diabetes, insulin resistance, or metabolic syndrome). Other changeable risk factors warranting patient education include strategies to encourage patients, especially those who are overweight and with high blood pressure, to safely decrease sodium intake, achieve a normal weight, ensure regular participation in moderate aerobic physical activity three to four times per week, eliminate tobacco use, and adhere to a heart-healthy diet. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in conjunction with the National Heart, Lung, and Blood Institute (NHLBI) recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the Dietary Approach to Stop Hypertension (DASH) makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium.
Social and Cultural Considerations: Numerous studies point to the prevalence of excess body weight in American children and adolescents. Experts estimate that obesity is present in 25% of the population ages 6 to 11 yr. The medical, social, and emotional consequences of excess body weight are significant. Special attention should be given to instructing the child and caregiver regarding health risks and weight control education.
Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Heart Association (www.americanheart.org) or the NHLBI (www.nhlbi.nih.gov).
Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

Related tests include antiarrhythmic drugs, apolipoprotein A and B, AST, atrial natriuretic peptide, BNP, blood gases, blood pool imaging, calcium, chest x-ray, cholesterol (total, HDL, LDL), CT cardiac scoring, CT thorax, CRP, CK and isoenzymes, echocardiography, electrocardiogram, exercise stress test, glucose, glycated hemoglobin, Holter monitor, homocysteine, ketones, LDH and isos, lipoprotein electrophoresis, lung perfusion scan, magnesium, MRI chest, MI infarct scan, myocardial perfusion heart scan, myoglobin, PET heart, potassium, pulse oximetry, sodium, triglycerides, and troponin.
Refer to the Cardiovascular System table at the end of the book for related tests by body system.

Patient discussion about TEE

Q. I am scheduled for a TEE and i am very scared. what is exactly going to happen there? I am scheduled for a Transesophageal echocardiogram (TEE) for my heart valve problem and i am very scared. what is exactly going to happen there to me? I understand i need to swallow somthing and I am not sure I'll be able to do it. I have a strong gag reflex. can someone tell me what I can do to reduce the fear? A. During a TEE you will be requested to swallow something that looks like a big chocolate kiss. This is all the swallowing that is involved. It is not fun, and me too have a strong gag reflex. I asked the doctor to let me watch the TEE of the guy that was before me in the line. After I saw how this test is done it was easier for me.
(Don't get me wrong, you will want to puke but you will be able to handle this urge)

Q. My mother had a chest pain and she was sent for a TEE. When do you need a TEE and when a normal echo is fine? My mother had a chest pain few weeks ago. we were sure its a heart attack and went to the ER. There the doctors did some tests and she was sent for a (trans thoracic echocardiogram) TEE. I want to know when do you need a TEE and when you can do just a normal echocardiogram because the TEE was very painful for her and we want to know if ther was a better way.A. The main difference between TEE and normal echo is that in TEE u put the transducer directly in the esophagus. The transducer is the same and the idea is to put it as close as possible to the heart.
As far as I know there are some heart situations the TEE is better for diagnosis that normal echo. Maybe your mom had one of those situations?
I can recommend you to ask the ER doctor. he will probably be able to give a better explanation for his choice

More discussions about TEE

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to a tee

tee off

tee up

suit (one) to a tee

teed (off)

tee-tee

have (something) down to a T

tee off

tee someone off

teed off

teed (up)

tee off

to a tee

to a T

to a ˈT/ˈtee

tee off

tee up

tee someone off

teed off

teed (up)

teed

tee-tee

to a tee

tee

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TEE

TEE

Echocardiography, Transesophageal

Common use

Area of application

Contrast

Description

This procedure is contraindicated for

Indications

Potential diagnosis

Normal findings

Abnormal findings related to

Critical findings

Interfering factors

Factors that may impair clear imaging

Other considerations

Nursing Implications and Procedure

Pretest

Intratest

Post-Test

Related Monographs

Patient discussion about TEE

TEE

tee

Synonyms for tee

noun the starting place for each hole on a golf course

Synonyms

Related Words

noun support holding a football on end and above the ground preparatory to the kickoff

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noun a short peg put into the ground to hold a golf ball off the ground

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verb place on a tee

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verb connect with a tee

tee¹

tee²

tee¹

tee²