Rectal temps in peds

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Have been a pedi nurse for many years and note that for some reason people just can't let go of the old-fashioned notion that rectal temps are better. There is more risk involved. Our pedi MDs do not want rectal temps, unless ordered by them. Yet the ER still insists on doing them. If a kid has a temp over 101.5 axillary, he has a temp. Why expose yourself to infection & the kid to trauma for that extra 1-2 degrees. Can't they just ADD?

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.
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.

Specializes in Emergency room, med/surg, UR/CSR.
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! :coollook:

and where do you get them? I'm all for doing something that is less traumatizing to a child!

Thanks, Pam

veetach

450 Posts

Specializes in Emergency Room/corrections.
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?

Specializes in ER, ICU, L&D, OR.

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.

Specializes in ER, ICU, L&D, OR.

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.

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.
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.

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.
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.

Specializes in ER, ICU, L&D, OR.

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 orifice

Specializes in ER, ICU, L&D, OR.

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 orifice

Erin RN

396 Posts

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.

mommatrauma, RN

470 Posts

Specializes in ER.

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...

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