Omnibed tempe probe question

[NICURRT2RN]

We are currently having a debate in my NICU regarding manual mode and skin temp probes in the Omnibeds. In my old NICU, we would switch from servo to manual, dress and swaddle the baby, and leave the skin temp probe on for a while to monitor temps. In my new NICU, we remove the temp probes as soon as we switch from servo to manual with the reasoning that the temp probes are inaccurate once the kids are dressed and swaddled. Is it true that the skin temp probes are only accurate without clothes and swaddling?

Also, I had a kid dressed and swaddled on pre-heat under the radiant warmer because she was running a little cooler, and attached a temp probe just to monitor. The next nurse removed the temp probe for the same reason as above - that it wasn't accurate because the kid was dressed and swaddled. What do you guys think? What is your practice in your NICU?

One last thing...do you guys place your probes axillary or abdomen/flank?

Thank you!

[NICU Guy, BSN, RN]

We remove the temp probe once we turn it to "Air Temp" mode. The point of do this is to transition to normal heat regulation. Our temperature is regulated based on the room temperature. You don't walk around the house with a temp probe on your body and the furnace regulates the house according to your temp probe.

Once the baby reaches 1.5 kg, we put clothes on them, swaddle, and turn the bed to Manual. At the next assessment, if they have maintained their temp, the air temp is lowered slightly. This is repeated until the air temp is 27.0 C. After 5 days of maintaining temp and weight gain, they are moved to a crib.

I place the probe on the abdomen with the probe exposed, facing the top of the isolette. If the baby is on their side with left side facing up, then the probe in on the left side of the abdomen. If the baby is laying on the probe, it will give an inaccurate reading. It is measuring the underside of the baby that is warmer than the top of the baby that is exposed to the air in the isolette.

[adventure_rn, MSN, NP]

On 3/22/2020 at 11:19 PM, NICURRT2RN said:

One last thing...do you guys place your probes axillary or abdomen/flank?

I want to answer this piece first, because it determines the answer for the rest of your question.

Different places have very different practices with regards to the temp probes. The official answer from the company is that the probe should always go on the flank or the abdomen (ideally over the liver), not in the axilla. However, they do both work as long as you stick to a consistent mechanism (abdomen or axilla, not switching back and forth between both...more on that later).

The axilla and the abdomen/flank are very different measurements, and they behave differently in different circumstances. Placing the probe on the abdomen/flank will give you a skin temp, which is obviously not the same as the baby's core temp (hence why your warmer can read a skin temp of 36 but the baby's axillary temp is 37). Because the abdominal/flank probes read skin temp (not core temp), they're very sensitive to environmental factors, like swaddling or rolling on top of the probe (like @NICU Guy mentioned).

I like to think of it this way: Skin temp probes really don't tell you much about the patient condition. No provider is going to ask you, "But what was their skin temp?" Rather, the purpose of skin temps is to give you a trend, and that trend is how we set the skin-control beds. You leave a skin probe on the baby after you swaddle them, but it will likely give you a very different reading because swaddling will affect the skin temp. You can follow the trends before you swaddle and after you swaddle, but you can't really compare the pre- and post-swaddle numbers to one another.

Conversely, placing the probe in the axilla correlates very closely with the actual manual axillary temp so long as the baby's arm tucked over it (as you would do with the thermometer). It tends to read fairly accurately regardless of whether or not the baby is in a naked in a warmer or fully clothed and swaddled, as long as the baby's arm is tucked down next to the body. Therefore, unlike the abdominal skin probes, you can compare the pre- and post-swaddle axillary probe numbers (since the core axillary temp should remain the same).

So...circling back to the axilla/abdomen question: you can do either, and the both work. However, the entire unit needs to pick a practice and stick with it. Either everybody needs to do axillary, or everybody needs to do abdominal. If you switch back and forth between the two, the baby is going to get really cold when you switch from abdominal to axillary, then then really hot when you switch from axillary to abdominal. The numbers themselves aren't as important as maintaining a reliable, consistent trend.

I have worked in places where there are two temp probes, one attached to the bed that we place on the abdomen, and one attached to the Phillips monitor that we place in the axilla. That way, when we swaddle, we can take the skin probe off of the abdomen but still have a consistent way to trend the axillary temps.

TLDR: you can compare the pre- and post-swaddle trends with an axillary temp probe, but not with a skin temp probe.

[babyNP., APRN]

When I worked as a nurse at a children’s hospital all the kids had probes no matter what- culture based I assume. It was a foreign concept to me when I moved as a provider to the community setting but it seems to work out just fine.

Something interesting I noticed on radiant warmers. At the children’s hospital, nurses put the probe on the abdomen or axilla based on nurse preference (again I think this was just unit culture that I was taught). Even accounting for about a degree difference on the abdomen and axilla, I found that the babies had warm toes when I used the abdomen location vs the axilla location. I hate cold feet so I ended up switching to abdomen only in my practice...