How to Measure Temperature

1. How to Measure Temperature Vital Signs in the Ambulatory Setting:An Evidence-Based Approach Cecelia L. Crawford RN, MSN

2. Temperature Techniques & Methods:An Overview • Temperatures can be different depending on • Type of Thermometer • Glass or Chemical Dots • Electronic or Tympanic • Body Site • Oral, Axillary, Rectal, Ear

3. Type of Thermometer - Glass • Once viewed as the “Gold Standard” • Must be left in for several minutes • Up to 7 minutes for an accurate temperature! • Now associated with adverse events • Rectal or oral trauma • Breakable • Mercury exposure

4. Type of Thermometer – Chemical Dots • Single use • Disposable & inexpensive • Axillary, Rectal, Oral • Can be difficult to read • Long measurement time needed • Up to 7 minutes for an accurate temperature!

5. Axillary Temperature • Safe & inexpensive • Often inaccurate because: • Long measurement time needed • Patient must be still • Patient must be positioned or held • Not recommended for young children • Must document as an axillary temp and NOT an oral temp

6. Rectal Temperature • Thought to be as accurate as an oral temp • Needs lubrication • Long measurement time needed • May cause rectal trauma & cannot be used with: • Newborns • Diarrhea • Rectal surgery or bleeding • Patient may be embarrassed • Patient must be positioned or held • Must document as a rectal temp

7. Oral Temperature • Comfortable & easy, no positioning needed • Accurate temps when proper technique used • Must place thermometer tip in left or right mouth pocket under tongue • IS influenced by hot & cold fluids • NOT influenced by breathing

8. Oral Temperature • Long measurement time • Should not be used with: • Confused or uncooperative patients • Infants & small children • Oral surgery or oral trauma • History of seizures or chills

9. Temperature Technology Automated Temperature Machines • Electronic and infrared thermometers • Convenient • May save time & labor

10. Ear (Tympanic) Temperatures • Easy site to use with accurate temps • Rapid measurement – 2 to 5 seconds! • Uses disposable, single use probes • No interference with breathing • Little patient positioning needed • Not effected by food, drink, or smoking • Can be used with all age groups & most patients • Newborns (no heat loss), infants & small children • Useful with confused & uncooperative patients

11. Ear (Tympanic) Temperatures • Can be affected by heat & cold: • Heating & cooling measures • Hot packs, ice packs, heating blankets • Extreme outside and inside temperatures • Air conditioners, overheated rooms • Very hot or very cold days • Bathing or swimming • May need to wait 20 minutes for accurate temp

12. Ear (Tympanic) Temperatures • Can also be affected by: • Impacted ear wax & ear infections • Whether an ear tug is used • Should NOT be used if patient had ear surgery

13. Ear (Tympanic) Temperatures • What Patients Think About Ear Temperatures • Parents of pediatric patients like them! • Fast, easy, clean, and safe • Pediatric patients react better! • Faster measurement • Can stay in parent’s lap or arms • No holding or restraining • No positioning

14. Temperature – It’s All About The Numbers! Terminal Digit Preference • Some people may show a preference for certain numbers in temperature readings* • Zeros, even numbers, odd numbers • Be aware you might “like” some numbers more than others! (*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)

15. Tympanic Temperature Procedure • Wash hands & put on gloves if appropriate • Assist patient into a comfortable position • Head turned to side, away from HCW • Pediatric patients can be in parent’s arms or lap

16. Tympanic Temperature Procedure 3. Remove thermometer from handheld unit • Slide disposable probe cover over probe tip until locked in place • Do not touch lens cover • Do not apply pressure to ejection button http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

17. Tympanic Temperature Procedure • Use correct ear to measure temperature • If holding thermometer in right hand, use right ear • If holding thermometer in left hand, use left ear http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

18. Tympanic Temperature Procedure 5. Insert covered thermometer probe into ear canal and position properly • Children 1 year & older/Adults: Gently pull top of ear back, up, & out • Children less than 1 year: Gently pull top of ear straight back • Point tip towards nose • Less than 2 yrs: point tip between eyebrows & sideburns • Snugly fit probe tip in ear canal and do not move

19. Tympanic Temperature Procedure • Depress scan button on handheld unit • Leave probe in place until a “beep” is heard • Temperature will appear on digital display screen • Carefully remove probe from ear canal • Push ejection button on handheld unit to remove probe cover • Place used probe cover in trash – DO NOT REUSE!

20. Tympanic Temperature Procedure • To repeat a temperature measurement: • Use a new probe cover • Wait 2-3 minutes if using the same ear • May use the opposite ear with new probe cover • When temperature measurement is done: • Return handheld unit to thermometer base • Tell patient the temperature reading • Assist patient to comfortable position • Remove gloves & wash hands

21. Tympanic Temperature Procedure • Inform RN or MD if: • Very low or very high temperature • Normal temp: between 97o to 100o F • Ear wax is seen in ear or on probe cover • Unable to get a temperature reading due to: • Uncooperative patient • Confused patient • Parent or patient refuses • Machine malfunction

22. Tympanic Temperature Procedure 12. Document the Results • Flowsheet, clinic record, or clinic chart 13. Communicate the Results • RN • MD

23. Temperature Measurement in the Clinic • YOU can make the difference: • Welcoming presence • Decrease any anxieties & fears • Reassure patients & family • Accurate vital signs