Axillary temps; how accurate/inaccurate are they?

z's playa · Dec 27, 2004

That's stupid. We were taught that an axillary temp was indicated when the oral path was compromised. ie: the pt just drank, smoked, or ate.

Does that mean all the temps taken on children are inaccurate? :rolleyes:

purplemania, BSN, RN · Dec 27, 2004

Axillary temps, like oral temps, are accurate if technique is correct. Just be sure to indicate how you obtained temp regardless of route. I think you did the right thing and it showed critical thinking. You got better info on the patient. The Doc was just being a ---- M.D. (majestic deity)

MrsWampthang, BSN, RN · Dec 27, 2004

I had the probe pushed tightly into the arm pit so I feel that the temp was pretty accurate. And in regards to children, we have one doc that blows a gasket if we don't do rectal temps on all babies, he says nothing else is accurate on a baby. SHEESH! I asked my ed corridinator about the temp and she also said axillary temps weren't accurate but that I had done the right thing. Does anyone know of any sites that have research regarding temps?

Thanks, Pam

z's playa · Dec 27, 2004

After reading this thread it made me think of the way triage nurses (over here at least) take a tympanic temp. They don't bother to do it right. Ever. It's barely in my ear. I realize they are sensitive instruments but I wonder how many temps they've read inaccuratly at the initial assesssment.

Now I'm not saying ALL triage nurses AROUND THE WORLD do a tympanic wrong. Nothing against triage nurses EVERYWHERE. Just letting you know about the 15 or so up here. Before nursing school I just ignored it not knowing any better but now....I notice.

GingerSue · Dec 28, 2004

I'm studying right now from Jarvis, Carolyn, "Physical Examination and Health Assessment" 4th Edition, 2004 in the chapter on vital signs. On page 179 she says that the axillary temperature is safe and accurate for infants and young children when the environment is reasonably controlled." A few pages later, in the section on Infants and Children she writes (page 195)" The axillary route is safer and more accessible than the rectal route; however, its accuracy and reliability have been questioned (Cusson et al, 1997). When cold receptors are stimulated, brown fat tissue in the area releases heat through chemical energy, which artificially raises skin temperature. Studies on preterm infants show only small differences between axillary and rectal temperature measurement, which may be because brown fat is not present until 34 weeks' gestation (Bliss-Holtz, 1995). "

She explains page 194 that the TMT use with newborns has remained questionable. Cusson et al (1997) found that the temperature of the environment has a significant effect on temperature measurements. The superheated environment of the radiant warmer and particularly the incubator resulted in a significant elevation of tympanic membrane temperature over rectal, inguinal, or axillary measurement...They recommended the inguinal route. However, for infants in room-air bassinets, the TMT thermometers were recommended because the differences between tympanic and rectal or axillary measurements were much less (Cusson et al, 1997).

She explains that according to Lanham et al (1999) results of tympanic temperature measurement in children under 6 years were unacceptably low, and that some children with fever would be missed by this method. Their study did not support the use of TMT to detect fever in children under 6 years of age. And in a study of healthy newborns, Sganga et al (2000) found that tympanic thermometers had a lack of correlation with other methods, making them a poor choice for healthy newborns..

Jarvis says that the inguinal route is safer than the rectal site. Its results may be closer to core temperature than the axillary site because the inguinal area has a rich supply of blood vessels, it lacks the brown fat tissue that interferes with axillay temperatures.

She says use the rectal route with infants or with other age groups when other routes are not feasible.

Earlier (page 180) she explains that the TMT is favored by some clinicians over the usual rectal and oral thermometers because of its speed, convenience, saety,reduced risk of injury and infection, and noninvasiveness. She says it is efficient and quick - 2 to 3 seconds.

Hope that's some help.

BeenThereDoneThat74, MSN, RN · Dec 28, 2004

in peds heme/onc, there are no rectal temps ever!!! there are many babies, and unwilling children (or ones who are drooling severely secondary to mucositis), where an oral temp is just not going to work. so, what's left? axillary.

there is always that 'conversion' issue. some insist that an axillary is one degree below (and rectal is one degree above) oral. most are docs don't care. a temp is a temp. and we've had issues where people covert it wrong: we use celsius, and if it's 37.5 c axillary, some think it's really 38.5 c (that's a bit more than a f degree). :rolleyes:

GingerSue · Dec 28, 2004

Jarvis is saying tha the inguinal route is safer than the rectal site, that its results may be closer to core temperature than the axillary site.

BeenThereDoneThat74, MSN, RN · Dec 28, 2004

some food for thought: i had a patient with a high temp, and the patient's room was very warm. i told the attending, and she (who is indian) said, "do you think everyone in india have temps because it is always hot there? :chuckle :chuckle

z's playa · Dec 28, 2004

I'm studying right now from Jarvis, Carolyn, "Physical Examination and Health Assessment" 4th Edition, 2004 in the chapter on vital signs. On page 179 she says that the axillary temperature is safe and accurate for infants and young children when the environment is reasonably controlled." A few pages later, in the section on Infants and Children she writes (page 195)" The axillary route is safer and more accessible than the rectal route; however, its accuracy and reliability have been questioned (Cusson et al, 1997). When cold receptors are stimulated, brown fat tissue in the area releases heat through chemical energy, which artificially raises skin temperature. Studies on preterm infants show only small differences between axillary and rectal temperature measurement, which may be because brown fat is not present until 34 weeks' gestation (Bliss-Holtz, 1995). "
She explains page 194 that the TMT use with newborns has remained questionable. Cusson et al (1997) found that the temperature of the environment has a significant effect on temperature measurements. The superheated environment of the radiant warmer and particularly the incubator resulted in a significant elevation of tympanic membrane temperature over rectal, inguinal, or axillary measurement...They recommended the inguinal route. However, for infants in room-air bassinets, the TMT thermometers were recommended because the differences between tympanic and rectal or axillary measurements were much less (Cusson et al, 1997).
She explains that according to Lanham et al (1999) results of tympanic temperature measurement in children under 6 years were unacceptably low, and that some children with fever would be missed by this method. Their study did not support the use of TMT to detect fever in children under 6 years of age. And in a study of healthy newborns, Sganga et al (2000) found that tympanic thermometers had a lack of correlation with other methods, making them a poor choice for healthy newborns..
Jarvis says that the inguinal route is safer than the rectal site. Its results may be closer to core temperature than the axillary site because the inguinal area has a rich supply of blood vessels, it lacks the brown fat tissue that interferes with axillay temperatures.
She says use the rectal route with infants or with other age groups when other routes are not feasible.
Earlier (page 180) she explains that the TMT is favored by some clinicians over the usual rectal and oral thermometers because of its speed, convenience, saety,reduced risk of injury and infection, and noninvasiveness. She says it is efficient and quick - 2 to 3 seconds.
Hope that's some help.

Hey!!! That's the book I'm studying from too!!! Gotta love Jarvis. I still can't believe you wrote all of that down! :chuckle

Antikigirl, ASN, RN · Dec 28, 2004

I agree with purplemania...he was being a MD! LOL! Part of being a nurse is dealing with this...and you did exactly what we are trained to do. I will add though, I was wondering what the patient was doing drinking water in the ED...but then again I don't know the full story (yeah like patients don't drink water behind your back in the ED...LOL!).

So long long ago, in a ED far far away...a large gent came in! He was head to toe covered in paint and was in resp arrest! I guess the guy chose to use a paint sprayer in a small inclosed room with no ventilation whatsoever, and his friends found him passed out with no idea as to how long he was out!

So here I was...a bright eyed nursing student, trying to blend in the walls like the nurses told me to do. I watched as 3 nurses tried to get a IV on him, while the ER doc was screaming at the top of his voice..."Get me a pulse ox NOW!". Seeing as there were 2 nurses (yep...that room was all nurses!) were scrubbing as hard as they could with paint thinner on his fingertips, and the doc was still screaming...I took some initiative! I grabbed his shoe..tore it off..grabbed his sock..tore it off...grabbed the Pulse ox and put it on his toe (which thanks to the shoes and socks was not covered in paint!)...no not the most effective, but as I saw it..it would more than likely shut him up, and we could get a reading from the furthest extremity! (same thing basically...one route was not an option..so I used another, perhaps not as accurate to some, but it worked for all extensive purposes given the situation).

He shut up suprisingly, and the nurses could get back to doing what they needed to (because nothing was getting done while the doc was throwing a hissy fit!). Afterwards the doc talked to me and said "that was pretty good, not typical or all that accurate, but at least you used your brains" (within ear shot of all the other nurses...didn't make me popular I assure you!!! I felt like a lamb in a tiger cage!!!). I thanked him as expected...but was thinking in the back of my head..."yeah right you *(@*^&%_)".

Yeah..these things happen..and I just typically smile with that "yes doctor" smile saying nothing and go about my business and wait until the next one gets hissy! LOL!!!!!!

prmenrs, RN · Dec 28, 2004

All we ever take in NICU is axillary. There is a tradition of getting one rectal temp on admission, to make sure there IS a rectum, and that it's patent. Some folks carry that too far. If there's meconium @ delivery, I guarantee there's a patent rectum, but I've seen nurses get a rectal temp.

Premies shouldn't have TMTs, their ear canals are too small; newborns have fluid, vernix and god knows what else in their ear canals, which makes the tympanic membrane unavailable for the job. Rectal temps can be dangerous. (There was actually an outbreak of peritonitis documented once in which more than one infant died. Turns out some nurses stick that thermometer half way to their tonsils.)

We teach moms to do axillary temps only.

I think you did the right thing. He's a jerk.