temp probe placement

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    when i first started in nicu, i learned that over the liver was the best place for the temp probe since that area will have the closest reading to core body temp. the place i work currently avoids over the liver! what do you all do out there???
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    We just sort of put it wherever it is uncovered and out of the way of the other probes and leads. It's challenging on a tiny baby... I've even seen them on the chest of tiny babies. On big babies we put it anywhere on the belly.
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    Anywhere on the trunk will work, just make sure that it isn't covered at all.
    And this means by a corner of a diaper, etc. Otherwise your temp control will be totally off and you can end up with a very cold kid. Not good.
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    My fav spot is where the waistline would be, but slightly posterior. I do like to use the diaper to help secure the probe. I get an almost perfect corelation with the ax. thermometer reading either prone or supine. Never over the stomach. The temp of the formula during feeding can alter the reading. Try drinking a big glass of cold water. Then put your hand over your stomach!!! My son showed me that one day. (he's pretty trim). Placing the probe in the axilla works well of fat babies.
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    Quote from Picksomething
    My fav spot is where the waistline would be, but slightly posterior. I do like to use the diaper to help secure the probe. I get an almost perfect corelation with the ax. thermometer reading either prone or supine. Never over the stomach. The temp of the formula during feeding can alter the reading. Try drinking a big glass of cold water. Then put your hand over your stomach!!! My son showed me that one day. (he's pretty trim). Placing the probe in the axilla works well of fat babies.
    I didn't think of that! I was just taught to put in on an uncovered non bony area (avoid ribs, sternum, scapula ect...) I don't know why over the liver area would be a problem. If anyone has info on this I'm curious!
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    placing the probe in the axilla works well of fat babies.[/quote]

    actually, placing the probe in the axilla is contraindicated due to the presence of brown fat there...you can get a false high reading if the baby's core temp is low & they are burning brown fat to warm up, thus making the axillary temp read higher.

    also, to clarify what i wrote previously, the liver is supposedly an area with increased blood flow/metabolic activity which makes the temp coorelate closer with the core temp. therefore, it is the preferred place for a temp probe. has anyone else heard of this or has any further info?
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    Hannahrn-We have always been required by our medical director to place the temp probe over the liver for the reason you stated. It makes sense when you think about it. It makes me crazy when I find temp probes on a baby's side or leg or shoulder or just about anywhere else when they are on a radiant warmer. You can almost guarantee you'll fricasee a 500 grammer if you put the temp probe anywhere but the abdomen. Extremities generally are cooler and the heater puts out so much heat to heat up the leg that the core temp can skyrocket.

    We use a set temp for the radiant warmers and isolettes of 36.6 and adjust up or down as needed.
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    I had always heard the liver placement reasoning as well. I have been a NICU nurse now for 1.5 years and noone at my unit will believe me that the axilla is not the best place to put the probe. Is there research or anything in writing to proove I am not insane!!!
    Thanks
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    Whether your baby is in an isolette or on a radiant warmer, the temp probe should be on an exposed surface area-abdomen if supine or side-lying or lower back below the rib cage if the infant is prone or side-lying. It should always have a reflective cover over it and the baby should never lie on it. While I can't give you any documentation on why it should not be placed in the axilla, to me it makes sense. A probe secured to the armpit might work IF you can assure the infant will always keep his arm in the same position. The axillary temp will change significantly if the arm is abducted to the side vs being adducted or raised up over the head. Just try taking a baby's ax temp holding his arm to his side then try again by placing the thermometer in the pit with the baby's arm out to the side. With a bigger baby you might not see much difference, but you can see a wide range with a 1kg baby or smaller. A premie benefits from a steady temperature-cold-stress and overheating are both very dangerous for the micros. Are you putting temp probe covers over the probes in the axilla? Do they stay in place very well? I hope I don't sound like I'm being critical-not my intention. This is just so different from what we do.


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