Rectal temps in peds - page 2

In our ER our docs insist on us taking rectal temps on babies. I don't mind doing this if they aren't squirming all over the place, (makes me nervous) but I'm just curious how anyone else takes temps... Read More

  1. by   Jolie
    Quote from Erin RN
    I do not agree that tympanic temps are as accurate as rectal. Several years ago I took my daughter to the ED or should I say, drove like a wild woman to the ED. She was 18 months old and had, had a fever off and on for 3 days. I was doing the tylenol every 4 and advil every 6 even through the night (yes..I was an ER nurse at the time)..kept her dressed down. Finally one afternoon she had a temp of 102 so I gave her tylenol and put her down for a nap..I checked her and she extremely hot so I did a rectal the thermometer went right up to 104 and kept going so off we went. She was lethargic and had that glazed look. We got to the ER that I worked at the triage nurse took her temp tympanic and said 102.5 so we sat down to wait, I indicated that I knew she was hotter than that..then she seized. we took her back did the rectal and she was 106...I just don't think that the tympanic is accurate and we all know that the little ones can crash and burn in a big hurry. I vote for the rectal which is most accurate. Erin


    Perhaps you misunderstood me. I stated that properly taken, AXILLARY temps are quite accurate in kids. I realize that the accuracy of tympanic temperatures is questioned in children, but my point is that they CAN show trends of steadily increasing or decreasing temps. Verifying a temp occasionally with a rectal in an acutely ill child seems preferable to me over using them as a standard, especially in active, healthy children.
  2. by   MrsWampthang
    Quote from tiredfeetED
    All kids under the age of 2 are supposed to get rectal temps...It is more accurate than tympanics. We have just went to the use of Temporal artery probes which are suppose to be more accurate than rectal. We had a trial and at first did not like them. After awhile it was very accurate and less traumatic to the kids. We just got 2 in today...makes triage alot faster!
    and where do you get them? I'm all for doing something that is less traumatizing to a child! :hatparty:

    Thanks, Pam
  3. by   veetach
    Quote from Erin RN
    I do not agree that tympanic temps are as accurate as rectal. Several years ago I took my daughter to the ED or should I say, drove like a wild woman to the ED. She was 18 months old and had, had a fever off and on for 3 days. I was doing the tylenol every 4 and advil every 6 even through the night (yes..I was an ER nurse at the time)..kept her dressed down. Finally one afternoon she had a temp of 102 so I gave her tylenol and put her down for a nap..I checked her and she extremely hot so I did a rectal the thermometer went right up to 104 and kept going so off we went. She was lethargic and had that glazed look. We got to the ER that I worked at the triage nurse took her temp tympanic and said 102.5 so we sat down to wait, I indicated that I knew she was hotter than that..then she seized. we took her back did the rectal and she was 106...I just don't think that the tympanic is accurate and we all know that the little ones can crash and burn in a big hurry. I vote for the rectal which is most accurate. Erin

    I agree with you, Erin. Tympanics are not nearly as accurate as rectal temps. If you dont believe me just take a tympanic temp on a child who has just come in from the frigid temps of PA in the winter. :chuckle

    Rectal temps are definately more accurate and not affected by external factors.

    I have never seen a rectal tear in a pediatric patient as the result of taking a temp. How many times does this actually happen?
  4. by   teeituptom
    In our ER Our MD s insist either oral or rectal

    How can you say a rectal temp on an infant is traumatic, that is what the bo bo is for, taking rectal temps.
    Much more accurate and is the standard of care in most ERS
    Now that rectal temp might be more traumatic to the parents, that I will believe
    Some parents are stupid as can be anyway, no matter how intelligent they are, or think they are.

    I have even seen parents refuse rectal temps on their infants claiming it is sexual abuse, ok I chart no temp parents refused and let the doctor deal with them.
  5. by   Jolie
    Quote from teeituptom
    In our ER Our MD s insist either oral or rectal

    How can you say a rectal temp on an infant is traumatic, that is what the bo bo is for, taking rectal temps.
    Much more accurate and is the standard of care in most ERS
    Now that rectal temp might be more traumatic to the parents, that I will believe
    Some parents are stupid as can be anyway, no matter how intelligent they are, or think they are.

    I have even seen parents refuse rectal temps on their infants claiming it is sexual abuse, ok I chart no temp parents refused and let the doctor deal with them.
    I agree that it is a rare complication, but rectal/intestinal damage can happen with rectal temps. About 10 years ago, I cared for a newborn with an intestinal perforation caused by an improperly taken rectal temp. The little guy was 4 or 5 days old and was brought to the ER for a bili. He was not severly jaundiced, but ended up with an intestinal perforation. I wonder just how far the thermometer was inserted. He needed a temporary colostomy, became septic, and spent his first month of life in the NICU. Just not worth it, especially since the baby arrived at the ER healthy.
  6. by   teeituptom
    some nurse or tech or whoever should never have shoved it that far in anyway, all my yrs Ive never seen it. And thats alot
    In the old days they like rectal temps at birth to check for an Imperforate anus
  7. by   Erin RN
    Quote from teeituptom
    In our ER Our MD s insist either oral or rectal

    How can you say a rectal temp on an infant is traumatic, that is what the bo bo is for, taking rectal temps.
    Much more accurate and is the standard of care in most ERS
    Now that rectal temp might be more traumatic to the parents, that I will believe
    Some parents are stupid as can be anyway, no matter how intelligent they are, or think they are.

    I have even seen parents refuse rectal temps on their infants claiming it is sexual abuse, ok I chart no temp parents refused and let the doctor deal with them.

    In my experience the axillary temp(esp on really little ones) is the most traumatic..they hate having any part of their body held in place for any amt of time. With the rectal, they usually just looked at me and by the time they thought to cry it was over. Of course, there is a rsik so nurses techs etc should really know how far to put that probe in.
  8. by   mommatrauma
    There have been multiple studies showing tympanics are not accurate...core temp is and always has been the most accurate. We do rectals on all children under 2 regardless of complaint...We do only orals and rectals...my biggest pet peeve is COPD grandma comes in SOB with a PO temp of 96...she can't breathe, her temp is not going to be accurate...do a damn rectal...be accurate...
  9. by   *PICURN*
    Our policy is AXILLARY for all kids, however most of the time we have the skin temp probes that are connected to the monitor and give us a continuous temp for the kid. I have also seen rectal being done, but not often
  10. by   prmenrs
    I believe most NICUs and NB services do axillary--it can be very dangerous to do rectals (there was a whole series of perforated bowels in one study). You might do one to see if the anus is patent, but if there is meconium all over the place, it's patent, and I've still seen nurses get a rectal "because that's what the routine is".

    I never took rectals on my son, and told the pediatrician I wasn't going to either. I think it's rude!!
  11. by   Vicki_RN
    Quote from Traumamama59
    In our ER our docs insist on us taking rectal temps on babies. I don't mind doing this if they aren't squirming all over the place, (makes me nervous) but I'm just curious how anyone else takes temps on peds.

    I have called up to my peds floor to give report and asked about rectal temps and told that they don't do them up there. Anyone have any thoughts on the advantages, disadvantages of rectal temps?

    Thanks, Pam
    Interesting, that we have the same situation in our institution... the Peds unit does not do rectal and the ED does. However, the whole facility is currently looking to purchase the new temporal artery scanners. We just completed a trial and they appeared very accurate. As many have said, there are issues with the tympanics if they are not used correctly. However, the temporal artery scanners need to be used correctly as well, for instance, you can't scan an area of the forehead that has been bundled or facing down in bed. But I do think that there is less room for error with the temporal artery scanner than tympanic, due to it's ease of use and method of operation. Hope this helps!
  12. by   ERNurse678
    We do rectal temps on all pt's under the age of 3. This is the most accurate way. And it does matter whether their temp is 101 or 106. As for our ER we have different protocols for tylenol and motrin depending on the fever.
    Also, if a child has a temp of 106 and I am the triage nurse, they are going to the critical care area versus the intermediate area
  13. by   nurse_wannabe
    I'm glad this post came back up again...

    I am due to have a baby boy in a few months. I do NOT want a rectal temp taken on him in the newborn nursery. The risks of a perforated bowel may not be very high, but if there is any risk at all, I don't want it to be performed on my baby when it is completely unneccessary.

    Does anyone have any ideas on how to handle this request with the nurses? Do I have the right to request axillary or tympanic temp instead?

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