Rectal temps in peds

  1. 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
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  2. 33 Comments

  3. by   athomas91
    it is the most accurate...
    the tympanics are accurate if positioned correctly...but how do you know if it is aimed directly at the tympanic membrane...there is no way to be sure...
  4. by   joules300
    Rectal temps are my facilities temp of choice. No more tympanics at all. I will do a axillary for a kid with a lac or sprain though.
  5. by   Repat
    We just got a directive to take rectal temps on our ADULTS if oral isn't possible. Axillary is no longer acceptable. Tell you what - it hasn't happened....
  6. by   Rena RN 2003
    our policy is any child 3 or less gets rectal temp regardless of the c/o. i have known nurses to take axillary if the c/o is a lac or sprain as previously mentioned.
  7. by   veetach
    our policy is that any child under age 1 gets a rectal temp.
  8. by   Jolie
    I've never worked ER, but it strikes me as odd that rectal temps seem to be the norm in ER's, while no pediatrician I know uses them in the office, even when evaluating acutely ill children, and most discourage parents from taking them at home.

    Properly done, axillary temps are quite accurate, and even tympanic thermometers can provide information on trends, which is what is really important. Unless a child's fever is so high as to render him lethargic, I would not risk a rectal temp.

    I grant that it is very rare, but one must only care for a single child with a perforated intestine to believe that rectal temps are unnecessary and potentially dangerous. Many newborn nurseries have given them up in favor of saafer means of checking for anal patency.
  9. by   NicuNsg
    Rectal under 1 year of age, unless they are hem/onc...rectals are big no-no's, all other are oral or axillary. Tympanic are not accurate, it is not only positional for the operator, but if the child has an ear infection it will not read correctly. The pediatrician do not even recommend them for home use to the parents.
  10. by   Loving Life
    We do rectal unless contraindicated under 2-3 years. No rectal temps on our pediatric
    heme onc patients.
  11. by   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!
  12. by   Shed13911
    I work in a pedi triage call center. We have all parents do a rectal temp for infants less than 12 weeks of age because it is imperative that we be accurate. Due to their limited immune system, they may either have a fever or may actually drop their temps below normal which can also indicate sepsis. On these babies, we have found that the rectal temps can be almost the same as or very near to the axillary temps. Usually you can adjust the axillary temp up 1 degree on children above 12 weeks of age. Fever for an infant of this age is 100.4R or above. They are sent in to the ER right away for a work up.

    I have seen trends over the past few years that the tympanic temps can be off several degrees based on the technique of the user. I never trust tympanic temps and would rather see an axillary temp/oral if they are older.
    Also, tympanics are not as accurate on the younger infants due to the short ear canals as they may not have good contact and therefore, not be as accurate!!
    Last edit by Shed13911 on Mar 17, '04
  13. by   Erin RN
    Quote from Jolie
    I've never worked ER, but it strikes me as odd that rectal temps seem to be the norm in ER's, while no pediatrician I know uses them in the office, even when evaluating acutely ill children, and most discourage parents from taking them at home.

    Properly done, axillary temps are quite accurate, and even tympanic thermometers can provide information on trends, which is what is really important. Unless a child's fever is so high as to render him lethargic, I would not risk a rectal temp.

    I grant that it is very rare, but one must only care for a single child with a perforated intestine to believe that rectal temps are unnecessary and potentially dangerous. Many newborn nurseries have given them up in favor of saafer means of checking for anal patency.

    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
  14. by   purplemania
    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?

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