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Temperature Checking on the Wrist

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So I was a non-practicing nurse in the Philippines for a decade and then suddenly became a company nurse due to the pandemic. I would like to seek help if there's anyone here who knows a published reliable source on the accuracy or even validity of taking temperature on people's wrist because what I learned from nursing school is that pulse rate can be measured on the wrist and not the body temperature. 

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Studies on the accuracy of infrared thermometers generally show no clinically significant difference between using the forehead vs the wrist, although one found that the wrist was more accurate.  So long as there is a relatively shallow artery then it should work appropriately, whether it's the temporal, carotid, radial, etc.

Aside from the fact that temperature screening is of little use in screening for COVID, the forehead isn't always an option.  I ride my bike to work and scanning my forehead is pointless.  

Nunya, BSN

Specializes in NICU/Mother-Baby/Peds/Mgmt. Has 39 years experience.

17 hours ago, MunoRN said:

Studies on the accuracy of infrared thermometers generally show no clinically significant difference between using the forehead vs the wrist, although one found that the wrist was more accurate.  So long as there is a relatively shallow artery then it should work appropriately, whether it's the temporal, carotid, radial, etc.

Aside from the fact that temperature screening is of little use in screening for COVID, the forehead isn't always an option.  I ride my bike to work and scanning my forehead is pointless.  

However, if the directions say that the thermometer can only be used on the forehead then you can't really legally use it on the wrist.  

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

1 hour ago, Nunya said:

However, if the directions say that the thermometer can only be used on the forehead then you can't really legally use it on the wrist.  

You can actually, the FDA labelling defines how the manufacturer can market a product, not how it can be legally used.  

With a product like this, typically a manufacturer will stick to obtaining FDA approval based on testing on a focused labelled use.  In this case, it might include obtaining label (marketing) approval based on testing a single artery since end-users will likely figure out that it will work the same on other shallow arteries particularly when backed up by post-approval studies.  This saves them the extra expense of conducting testing on multiple sites when that won't actually limit it's use.  

The labelled use and instructions are related to our practice liability in that the approved labelling includes some amount of benefit vs risk evidence, but it doesn't define our liability and regulatory compliance since that's based on the total overall evidence not just what was included in the FDA approval process.  

Nunya, BSN

Specializes in NICU/Mother-Baby/Peds/Mgmt. Has 39 years experience.

On 11/3/2020 at 4:50 PM, MunoRN said:

You can actually, the FDA labelling defines how the manufacturer can market a product, not how it can be legally used.  

With a product like this, typically a manufacturer will stick to obtaining FDA approval based on testing on a focused labelled use.  In this case, it might include obtaining label (marketing) approval based on testing a single artery since end-users will likely figure out that it will work the same on other shallow arteries particularly when backed up by post-approval studies.  This saves them the extra expense of conducting testing on multiple sites when that won't actually limit it's use.  

The labelled use and instructions are related to our practice liability in that the approved labelling includes some amount of benefit vs risk evidence, but it doesn't define our liability and regulatory compliance since that's based on the total overall evidence not just what was included in the FDA approval process.  

If there was ever a lawsuit related to accuracy/harm to a patient because if an inaccurate reading I sure wouldn't want to try to explain that even though the directions say for forehead use only I thought it would be fine on the wrist. Is that likely to happen? Maybe not, but I'll bring lawsuits for a kinds of crazy things and after a friend told me testifying in one was the scariest thing she ever did I was convinced that I didn't want to do it. 

Unlabeled use is very common in the medical field.

As far accuracy- I have my tempchecked on the way in to work.  More accurately, I have the temperature checked on a small spot of skin between my eyebrows.  I have no doubt that the thermometer is accurate when it says that the small spot of skin is 34 degrees.  Wrist temps are probably about the same.
 

Nunya, BSN

Specializes in NICU/Mother-Baby/Peds/Mgmt. Has 39 years experience.

18 hours ago, hherrn said:

Unlabeled use is very common in the medical field.

As far accuracy- I have my tempchecked on the way in to work.  More accurately, I have the temperature checked on a small spot of skin between my eyebrows.  I have no doubt that the thermometer is accurate when it says that the small spot of skin is 34 degrees.  Wrist temps are probably about the same.
 

Other than drugs, what things are used that they aren't supposed to be used for? And if they care harm to a patient how exactly would you defend that?

On 11/6/2020 at 2:28 AM, Nunya said:

Other than drugs, what things are used that they aren't supposed to be used for? And if they care harm to a patient how exactly would you defend that?

Well- drugs are a pretty major thing in a hospital, and probably, by far, the most likely to cause harm.

I once hooked suction to a 60 cc cath tip syringe (think G tube flush) in an effort to get a recessed penis out of it's gopher hole.  My manager pointed out that it was an unlabeled use of equipment.  I reasoned that the other choice was a blind foley placement with a high chance of causing a potential lethal infection.  
I have also used suction on the outlet of a breathalyzer while a tech sealed a drunk's lips on the inlet tube.

If something did go wrong, I would defend myself by pointing out that in the ER, un-labelled uses are common, and there is a lot of judgement that comes into play. 

I would also do a literature search to justify that it is a common practice in certain circumstances.

 

A few things come to mind.

 

  • Pediatric foley for nasal foreign body removal.
  • Catheter secure for monitor wire management.
  • Rubbing alcohol for nausea (I don't, but some do)
  • Hot water in a glove for a heat pack.
  • Latex glove finger as a one way valve for needle decompression.
  • PT blowing into a syringe as a valsalva.
  • Coke for declogging a G-tube.
  • Wrapping a neonate in a plastic wrap or plastic bag not labelled for such.
  • Tourniquet for lowering a piggy back set up.
  • BP cuff as a pressure bag.
  • Kelly clamps for every thing.
  • Umbilical tape for ring removal.
  • Something other than umbilical tape for tying off a cord because all the umbilical tape got used for ring removal.

 

Edited by hherrn