Taking an infant's temp.

fergus51 · Feb 10, 2006

Getting "the most" accurate isn't always worth it if it means risking bowel damage. If people are doing that routinely on every baby all the time that's unecessary.

wooh, BSN, RN · Feb 10, 2006

i work on a pediatric floor in a well known hospital and the only temps we do is a rectal temp.

i work in a well known pediatric hospital and we rarely do rectal temps. like i said earlier, axillary on infants, temporal or axillary on the kids.

Mags4711, RN · Feb 10, 2006

I have been in NICU for 26+ yrs. We don't do rectal temps period, anymore. ...I think rectal temps are barbaric and should only be done in extreme circumstances (an extremely cold or hot infant or child, etc).

I work in a Level III NICU that is in the VO (Vermont Oxford) network. For those who do not know, the VO is a non-profit network of nearly 500 hospitals worldwide that are committed to improving care for newborns. VO is now requesting an initial rectal temp at birth, then subsequent ones can be axillary. The rectal temp is simply the most accurate temp you can get (there is not a baby SwanGanz on the market yet ). The digital thermometers on the market now has a temp sensing tip that is less than 1/4 of an inch long. You do not have to insert the probe any farther than the sensor. Even a 500 gram baby is big enough to have that done safely.

Just to play devil's advocate, for those who think a rectal temp is "barbaric" or "antiquated" how do you feel about giving rectal Tylenol or a suppository? The temp probe is a lot smaller than those are.

fergus51 · Feb 10, 2006

I wouldn't give suppositories with every set of vitals. That's what's crazy to me (doing rectal temps again and again). There are times when its necessary and that isn't every 4 hours routinely.

jillyk*rn · Feb 10, 2006

axillary or oral temps at my childrens hospital. i don't even recall the last time a rectal temp was taken. don't like the ear thing, especially in peds, because it seems all the kids have otitis and it makes it inaccurate anyway. :nurse:

Mags4711, RN · Feb 10, 2006

I wouldn't give suppositories with every set of vitals. That's what's crazy to me (doing rectal temps again and again). There are times when its necessary and that isn't every 4 hours routinely.

I never said that we do them with every set of vitals:rolleyes:. I said that we do them with the first set on admission. As I mentioned, I was playing Devil's Advocate when I asked about giving suppositories. So many in this thread said how a rectal temp is barbaric or old-fashioned or antiquated, they didn't say "repeated rectal temps." Our ED (a level I peds ED) does rectals as the first temp as well. It has been proven time and again to be the most accurate temp (other than SG's). Years ago, before the quick digital thermometers we have now, of course it was dangerous to put a glass rod in a little one's orifice and hold them down for five minutes. Today it is less that 15 seconds.

Should they be done routinely? No, probably not. But on admission or if an axillary temp is really wacky repeatedly, I think they are valid. :nurse:

EricJRN, MSN, RN · Feb 10, 2006

We don't do rectal temps in our NICU. The main concern is not bowel perforation, but vagal stimulation. We already do enough to the babies that can increase vagal tone (ET/OG tubes, etc).

fergus51 · Feb 10, 2006

I never said that we do them with every set of vitals:rolleyes:. I said that we do them with the first set on admission. As I mentioned, I was playing Devil's Advocate when I asked about giving suppositories. So many in this thread said how a rectal temp is barbaric or old-fashioned or antiquated, they didn't say "repeated rectal temps." Our ED (a level I peds ED) does rectals as the first temp as well. It has been proven time and again to be the most accurate temp (other than SG's). Years ago, before the quick digital thermometers we have now, of course it was dangerous to put a glass rod in a little one's orifice and hold them down for five minutes. Today it is less that 15 seconds.
Should they be done routinely? No, probably not. But on admission or if an axillary temp is really wacky repeatedly, I think they are valid.

I think most people would agree with that. I've said we do rectals if the axillary is wacky, just not routinely. I think routinely is what's archaic.

Personally though I don't even know why a rectal on admission is necessary if the axillary or temporal or oral is normal and I wouldn't let that be done to my child without a good reason.

The reason I said I wouldn't give a suppository with every set of vitals was just to explain why I see rectal temps and suppositories differently. We do temps every 4 hours so no one I know would recommend doing it rectally as a routine.

elizabells, BSN, RN · Feb 10, 2006

I'm doing postpartum clinical right now - always axillary, at least on healthy babies. We check for anal patency visually, but if they don't pass mec in the first 24 I suppose they check another way - I haven't seen that happen yet.

Mags4711, RN · Feb 10, 2006

I think most people would agree with that. I've said we do rectals if the axillary is wacky, just not routinely. I think routinely is what's archaic.
Personally though I don't even know why a rectal on admission is necessary if the axillary or temporal or oral is normal and I wouldn't let that be done to my child without a good reason.
The reason I said I wouldn't give a suppository with every set of vitals was just to explain why I see rectal temps and suppositories differently. We do temps every 4 hours so no one I know would recommend doing it rectally as a routine.

Now I gotcha

We never did them until about two weeks ago when the request came from the Vermont Oxford neonatal network for an initial rectal temp.

Brownbetty · Feb 10, 2006

Initial temp rectal. Temp underarm after that. If the infant seems to be hypothermic or hyperthermic via an axillary temp we double check with a rectal especially if the infant has other symptoms that tell us they are getting sick.

jayne109, RN · Feb 10, 2006

In the ER where I work, we get a temp out in triage axillary then when they get back to the ER Room , we do it rectally. I have seen a kid with a 98 ax temp have a temp of 104 rectally. THat is the way we do it and that is what our doctors prefer. If the child can hold the probe under their tongue, then oral is okay.