[jadamsrn]

Ok, here's the scoop. Friday morning I was giving report to the ICU nurse on this grandma who came in extremely short of breath and we ended up tubing. I thought that I had given an EXCELLENT report. I told her that this lady had a fever of 39.2 and I had given rectal Tylenol. Then she asked me what the repeat temp was, and I said I hadn't checked one because no one was able to help me roll her and get a rectal. The ICU nurse said, really snarky-like, "What, you can't do oral temps down there?" I asked her to repeat her question, and she replied "Oh never mind, just bring the patient up."

Now, I've been checking my books and I haven't come across anything saying that you couldn't get an oral temp on a patient with an endotracheal tube, but I always thought it was standard to get a rectal as it would be more accurate. Am I way off base? It seems like you can do a thousand things the right way, and the ICU always acts like intelligence is altitude based - we're complete idiots in the ER because we're on the ground floor and they became ICU nurses and work on the 7th floor because nuclear astrophysics wasn't challenging enough for them.

[michellemybelle]

At the ICU I worked in, all temps were done tympanically. I would assume that an oral temp would not be accurate because with oral intubation, the mouth is not able to get a good seal around the probe and it would be very hard to get the probe placed correctly between all the tape around the tube. Just my thoughts!

[PoppaD]

<sigh> some ICU nurses just have to ask stupid questions because of their own insecurities...

As for an answer to your question: IMHO a rectal Temp is the best temp to rely upon. My facility has started using a Foley Cath Set that comes with a Temp probe attached to a three way foley. I routinely monitor my temps in this fashion.

I'm sorry to hear about your experience with that ICU nurse :-( I am a CVICU nurse and just the other day I had a nurse ask about which vessels had been bypassed during the pt's CABG. As if it really mattered to us at the bedside!

Originally Posted by jadamsrn

Ok, here's the scoop. Friday morning I was giving report to the ICU nurse on this grandma who came in extremely short of breath and we ended up tubing. I thought that I had given an EXCELLENT report. I told her that this lady had a fever of 39.2 and I had given rectal Tylenol. Then she asked me what the repeat temp was, and I said I hadn't checked one because no one was able to help me roll her and get a rectal. The ICU nurse said, really snarky-like, "What, you can't do oral temps down there?" I asked her to repeat her question, and she replied "Oh never mind, just bring the patient up."

Now, I've been checking my books and I haven't come across anything saying that you couldn't get an oral temp on a patient with an endotracheal tube, but I always thought it was standard to get a rectal as it would be more accurate. Am I way off base? It seems like you can do a thousand things the right way, and the ICU always acts like intelligence is altitude based - we're complete idiots in the ER because we're on the ground floor and they became ICU nurses and work on the 7th floor because nuclear astrophysics wasn't challenging enough for them.

[Preemienurse23]

During clinicals and at work we would take the temp in the between the teeth and the gums. I have never done or seen a rectal temp done on an adult and I have floated to all the ICUS at my old hospital. We didn't rely on axillary temps at all, and we didn't have tympanic thermometers.

[MarySunshine]

I'm an ICU nurse. We almost always just carefully put the probe all the way under the tongue in intubated patients. It's usually accurate. I do understand your reasoning and it's not poor reasoning, but in my experience oral temps are acceptable UNLESS the patient is really uncooperative or there is some other obstacle to you being able to get the probe well under the tongue. I agree that the nurse was rude to you and there wasn't any need for her to be snarky like that.

[RazorbackRN]

If in the rare occasion that we don't have a Criticore foley in, then we insert a rectal probe sensor for a con't temp.

[nursenpnk]

I currently work in the ICU and we use temp a dots to take rectal temps, occasionally if we have a patient that is able to close their mouth we may try oral, but rectal seems to be the mainstream on my unit. Looking over research it seems that tympanic can be accurate if used correctly, oral tends to vary with placement ect and rectal can also be varied by stool ect.

[meandragonbrett]

via bladder temp or axillary

[ERRNTraveler]

the new temporal artery thermometers are great, too, and they are supposed to be just as accurate as a rectal temp.

[ERJUNKIE4LIFE]

I was taught that you can take an oral temp on a pt that is tubed. As long as it between the cheek and gum and under the tongue. You're not going to gag the pt. I had somebody question me about it when they saw me doing it. I believe there's an article on the AACN website somewhere. I found while in nursing school. But just to prove a point a rectal and oral were done and they were off by .1 or .2.