Thermometers

[RNwhohasgoats]

I have looked through posts and see that those with my same question are recommended to use ear thermometers... however I don't have any in my clinic. 

I have 3 IR thermometers and a Welch Allyn oral/axillary. At the beginning of the year my trainer told me it was best to use the Welch Allyn because it was most accurate, so I didn't even think of using the IR ones. Well my trainer has high school kids and I have K-3rd graders who are terrible at placing the thermometer in the right place. I used the axillary (what a pain in the booty with hoodies and no shirt underneath, etc) and then one day decided to use the forehead one...  oral was only showing 99.2 and I took it with the IR and it said 100.2, 100.3, 100.1 etc on repeated attempts. Now I've been wondering, how many kids have had fevers that I didn't realize?! Or is the fever with the IR probably not even accurate?

I have also had a problem with the oral thermometer giving vastly different results depending on which side of the tongue I put it under.

Now I don't know which one to use so I've been using BOTH on every kid. ?

about 75% of the time the temperatures are within .5 of a degree, but then a good amount of my (later diagnosed) influenza A students have been showing a fever with the IR and no fever with the oral. 

Except yesterday I sent a kid home with 99.1 on oral and 100.1 on IR and dad said that his temperature was 98.9 as soon as he got home and never got any higher. 

Sorry this was so long. Thoughts?! Help?!

[k1p1ssk, BSN, RN]

I agree that the oral temps are difficult on the littles, and so I typically start with an IR temp. I trust the IR thermometers when they throw a normal temp, but as soon as it is reading in "fever territory", I do an oral or axillary with my Welch Allyn to back it up. A good example was yesterday - a student with a stomach ache came in and their IR temp was 100.9, but she was wearing a beanie and looked fine. I double checked the oral temp and she was 98.9. Later in the day, another kiddo with nausea threw me a 102.9 on the IR, and 102.5 oral. To ensure good placement, I ask the kids to open up and lift their tongue up; I place the thermometer and ask them to keep the probe under their tongue, close their mouth and pretend the probe is a straw - but again, to keep it right where I put it. For the littles, I distract them by showing them the screen on the thermometer and pretending the little line on the thermometer screen that spins is a "magic worm" in the thermometer that is looking to see if they are too hot. 

For the axillary temps with the big sweatshirts, I actually go in through the neck/collar; I've found that you can still access the armpit this way and the shirt collar will actually provide leverage and hold the probe in place if you do it just so. This frees up a hand, too, so you can hold their arm in place. You just have to be careful that their sweatshirt/shirt sleeve is not interfering with the probe. It's pretty easy to pull down on the shirt sleeve to clear the way, though!

I've never had great luck with the temporal or otic thermometers. I've gotten gonzo numbers on them too many times, and I just don't like them... 

[Keeperofbandages, LPN]

I use the Welch Allyn Otic thermometer for my kids K-8.

[raebabelvn, LVN]

I have IR and oral. For orals... tell the kid to open their mouth as big as they can - do not say anything about their tongue. Once their mouths are open, it retracts the tongue a bit and you can place it in that back pocket. Do not let them close before you place it where it needs to be. Then tell them to close their mouth like they're drinking out of a straw. Works about 95% of the time. I have trouble with some of my developmentally delayed or medically fragile kids. IR is my first go to. If I suspect the temp is off, I'll take an oral temp. 

[arlingtonnurse]

I have the Veraplus IR non contact.  I have noticed the student's temple will often register a temp when the forehead does not.  Although the instructions say to use the forehead, would you just disregard the higher reading?

[aprilmoss]

I have an ancient Welch Allyn dual (oral/rectal) unit that's not been out of the cabinet in years.   The one that gets used chiefly is the Welch/Braun ear thermoscan.   We did pick up a few IR ones to do "mass" forehead checks of people on the way into the building during the height of COVID.   Those are stuck in a drawer somewhere in the front office these days.

Of course, there's been times I've thought about threatening my frequent flyers with the red probes on the old WA.

 

[RNwhohasgoats]

On 12/8/2022 at 9:35 AM, k1p1ssk said:

I agree that the oral temps are difficult on the littles, and so I typically start with an IR temp. I trust the IR thermometers when they throw a normal temp, but as soon as it is reading in "fever territory", I do an oral or axillary with my Welch Allyn to back it up. A good example was yesterday - a student with a stomach ache came in and their IR temp was 100.9, but she was wearing a beanie and looked fine. I double checked the oral temp and she was 98.9. Later in the day, another kiddo with nausea threw me a 102.9 on the IR, and 102.5 oral. To ensure good placement, I ask the kids to open up and lift their tongue up; I place the thermometer and ask them to keep the probe under their tongue, close their mouth and pretend the probe is a straw - but again, to keep it right where I put it. For the littles, I distract them by showing them the screen on the thermometer and pretending the little line on the thermometer screen that spins is a "magic worm" in the thermometer that is looking to see if they are too hot. 

For the axillary temps with the big sweatshirts, I actually go in through the neck/collar; I've found that you can still access the armpit this way and the shirt collar will actually provide leverage and hold the probe in place if you do it just so. This frees up a hand, too, so you can hold their arm in place. You just have to be careful that their sweatshirt/shirt sleeve is not interfering with the probe. It's pretty easy to pull down on the shirt sleeve to clear the way, though!

I've never had great luck with the temporal or otic thermometers. I've gotten gonzo numbers on them too many times, and I just don't like them... 

I always tell them to do that too, and I always place it under tongue and tell them to keep it where it is under the tongue and cover it like a blanket, and pretend it’s a straw under the tongue, etc etc. And then I can feel them push it forward or bite it or stick their tongue out of their mouth, or I know the reading is low so I ask them to open their mouths and sometimes it’s a mess in there LOL.

so then when my oral says 99.1 and my IR says 101.2, do I really know that they held it properly in their mouth while their mouth was closed? ? So a lot of times when that happens. I just take their temperatures a few more times before I make my decision. Which is annoying. 

I do like the distraction with the thermometer idea, I will definitely be doing that now! Thanks!

as for the hoodies — Oh I try that first always, but I have a lot of kiddos who wear ones where I can’t get to it that way IDK. They are small with tight/form fitting ones I guess? And I have a tiny, busy clinic that I don’t want to show their belly off to their classmates that would happen. I like to avoid the pits for that reason 

[RNwhohasgoats]

On 12/8/2022 at 5:34 PM, raebabelvn said:

I have IR and oral. For orals... tell the kid to open their mouth as big as they can - do not say anything about their tongue. Once their mouths are open, it retracts the tongue a bit and you can place it in that back pocket. Do not let them close before you place it where it needs to be. Then tell them to close their mouth like they're drinking out of a straw. Works about 95% of the time. I have trouble with some of my developmentally delayed or medically fragile kids. IR is my first go to. If I suspect the temp is off, I'll take an oral temp. 

I have found the straw thing confuses them and even if I tell them to keep the thermometer where it is, (which doesn’t really help LOL, kids..) when I mention the straw for some I will get a low temp and they’ve holding it above their tongue like a straw ??‍♀️ so then I don’t know how many have fevers that were showing normal just bc it was over the tongue! Kids!

[CommunityRNBSN, BSN, RN]

On 12/9/2022 at 8:00 AM, arlingtonnurse said:

I have the Veraplus IR non contact.  I have noticed the student's temple will often register a temp when the forehead does not.  Although the instructions say to use the forehead, would you just disregard the higher reading?

I have wondered this too.  I was at work and felt unwell, so I used ours (I don't know what brand it is, but it is labeled for forehead). I did my temple first, and it showed around 100. Then my forehead read normal. Later that evening, when I was back home and still feeling unwell, I used my oral thermometer and it showed a fever. I really feel pretty sure I was feverish when I was at work, so the temple reading was more accurate than the forehead-- but of course I can't prove that!