Thermoregulation and regularity of temp checks?

  1. 0 Hi all

    Just wondered what people's practice was regarding temperature taking. We are told to promote minimal handling and therefore some people are taking it for gospel that they can't touch baby to record temperature- at the minute we record axilla temp usually with cares for a baby who has been with us a few days. Initially it is important particularly when a new preemie comes in or on humidity etc etc to check temp much more often than just with cares. However I understand that babies need to be left to get some settled sleep however knowing the complications of hypothermia and hyperthermia I am reluctant to leave temp recording for as long as some of the older nurses in our unit do, sometimes going as long as 12 hours without a temp!! I was thinking if suggesting to my manager about the potential for using the skin temp ( we have a transport incubator that does this and as far as I'm aware our other incubators allow this) or a nasal temperature probe attached to a monitor to allow us to get a real time temp reading making titration (particularly on humidity or phototherapy) much easier.
    Any thoughts or ideas would be appreciated
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  3. Visit  MistyM profile page

    About MistyM

    MistyM has '1' year(s) of experience and specializes in 'Adult Trauma and Neuro ICU, NICU'. From 'England'; Joined Feb '13; Posts: 16; Likes: 1.

    15 Comments so far...

  4. Visit  umcRN profile page
    3
    You have babies in isoletts without continuous temp monitoring? That seems extremely dangerous. All babies in an isolette or a warmer have a temp probe in place. It's not always 100% accurate but you can get trends. For instance if you get a temp of 36.8 axillary with your cares and at the same time your skin temp is 36.4 then you know you have a slight variation. You can still watch that number to know if the baby is getting too hot/cold. Does this mean your isoletts don't automatically adjust their internal temp to what the babies need? Our isoletts will start alarming if the baby is getting to hot or cold. Does not seem appropriate at all...
    Jory, poppycat, and Luckyyou like this.
  5. Visit  KelRN215 profile page
    0
    I am not a NICU nurse but it seems very odd to me that babies wouldn't be on more frequent temp monitoring in the NICU... considering that when they transfer to the floor they'll have temps q 4hr. Granted, I'm basing my thoughts on my experience in a pediatric hospital where the babies in the NICU tend to have congenital anomalies and end up having surgery and being transferred to the floor... I realize that there are some NICUs that are mostly full of preemies who go home straight from the NICU but it still seems odd to me... even in the newborn nursery with healthy newborns, they monitor temps more frequently than q 12hr!
  6. Visit  NicuGal profile page
    0
    We do ours with hands on care. But, if they are sick enough to warrant minimal hands on (q6-12hrs) then they are on ISC.

    Once they are feeding and off ISC it is with feeds (q3-4) or if they are q2 or cont feeds every 4 with hands on care.

    You should have a routine care protocol in place.
  7. Visit  MistyM profile page
    0
    Quote from umcRN
    You have babies in isoletts without continuous temp monitoring? That seems extremely dangerous. All babies in an isolette or a warmer have a temp probe in place. It's not always 100% accurate but you can get trends. For instance if you get a temp of 36.8 axillary with your cares and at the same time your skin temp is 36.4 then you know you have a slight variation. You can still watch that number to know if the baby is getting too hot/cold. Does this mean your isoletts don't automatically adjust their internal temp to what the babies need? Our isoletts will start alarming if the baby is getting to hot or cold. Does not seem appropriate at all...
    No the babies are not continuously monitored and as for the isolettes we adjust these according to the axilla temp, which is why I would like to implement a continuous form of temp monitoring. It will be easier, safer, and we don't have to disturb baby to keep poking it with the temp probe. Am I correct in thinking most of you use the skin dot that just sticks on? I used to work in an adult environment and they used nasal probes I was wondering if the use of a nasal probe on a baby would be a bit too harsh although we do use NG tubes..
  8. Visit  NicuGal profile page
    0
    The only other type of temp monitoring we do is esophageal with our cooling kids, I haven't seen nasal used in at least our unit. Remember, babies are obligatory nose breathers so you don't want a lot of things in there.

    We use skin probes mostly and then when they are at a certain weight/age we switch to NTE.
  9. Visit  MistyM profile page
    0
    Thanks for your help! I will bring it up with my ward manager next time I see her!
  10. Visit  umcRN profile page
    0
    yes we use skin probes on ALL babies and our isoletts adjust depending on what the babies need. This just seems so unsafe to me!
  11. Visit  NicuGal profile page
    0
    Do you even use them when they are dressed and gainer growers? We have an NTE chart we follow until we wean them out of the isolettes.
  12. Visit  umcRN profile page
    0
    Quote from NicuGal
    Do you even use them when they are dressed and gainer growers? We have an NTE chart we follow until we wean them out of the isolettes.
    If they have weaned out of the isolette and can hold their temp dressed & swaddled then no, but if they get cold more than two temp checks in a row it's back on the warmer.
  13. Visit  babyNP. profile page
    0
    I've seen this happen at a couple of hospitals I used to do agency at, although my facility does continuous monitoring. One was a county hospital and the other was an up-scale NICU. It seemed to work for them, but it did make me super nervous of cooking the babies. They just adjusted the temperature inside manually with each set of cares.
  14. Visit  MistyM profile page
    0
    Asked my manager about this and was informed that there had been some incidences of infants being "burned" by the temperature dot that was stuck on the skin from prolonged contact and that was the main reason they stopped using it for continuous monitoring. That and the fact that the new isolettes don't have the facility. It's just temp with cares and manually adjust the temp according or if a low birth weight preemie then more regular temps perhaps with feeds but mostly own clinical judgement.
  15. Visit  NicuGal profile page
    1
    I've never heard of an isolette without ISC capability or of a baby being burned by a probe. Is she sure it wasn't a warmer left on manual and it cooked the kid and heated up the disc so much it burned, although that would be hard to do too if people were paying attention. And if you get micronates, you should certainly be using a temp probe...too hot they can get an IVH amongst things! Same for cold. NTE is a standard of care across the board. Something just doesn't sound right.
    Jory likes this.


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