GGC Paediatric Guidelines
- Disposable indwelling latex free temperature probe (compatible with Paediatric Critical Care Phillips monitoring system) E.g. Henleys - REF4491H or GE Disposable probe 400 series (fig 1)
Fig 1 - Sachet of Optilube™ or similar water-based lubricant
- Disposable apron
- Adhesive tape/dressing or Clinfix® – to secure probe in position
- Disposable gloves
Temperature management : rectal temperature (PCCU)
Warning
Objectives
Temperature measurement is a commonly used assessment parameter when caring for acutely and critically ill children. In the critically ill child an abnormal temperature may reflect changes in their physiological status. Therefore, temperature measurement and temperature trends must be accurate and consistent, as decisions about therapeutic intervention may be based upon it.
Pulmonary artery temperature measurement was considered to be the ‘gold standard’ for measuring core body temperature. However, in practice this is too invasive and not a practical method of thermometry. Instead, body temperature is usually measured from a site, or ‘shell’ sites that are thought to reflect the core temperature. The site and measuring device chosen is based upon a number of factors including age, clinical condition, degree of accuracy required, safety and ease of use. It is responsibility of the nurse to determine the best method for monitoring patient temperature and to use the temperature monitoring device correctly. Whichever site/equipment chosen, the nurse must be aware of the benefits and limitations of each.
This nursing procedural guideline is intended as a resource for nursing staff involved in caring for children in the Paediatric Critical Care Unit that require monitoring and measurement of body temperature. The guideline has been constructed after literature search and review of sourced textbooks, Medline and CINAHL, and external nurse expert peer review and opinion.
See also recommendations and further information at end of this guideline.
Scope
This nursing procedural guideline is intended to be followed by nurses involved in caring for the highly dependent or critically ill infant or child requiring body temperature monitoring within the Paediatric Critical Care Unit at the Royal Hospital for Children, Glasgow.
Audience
All nursing staff involved in the measuring and monitoring of temperature in the Paediatric Critical Care unit should be familiar with this nursing procedural guideline.
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PROCEDURE: |
RATIONALE |
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Provide age appropriate explanation to child (where applicable) and/or parents |
To ensure the child (and parent) understand need for and consent to indwelling rectal probe use. |
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Before inserting probe wash hands thoroughly with appropriate antibacterial skin cleanser and don disposable apron and gloves |
To minimise the risk of cross infection. |
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Check disposable temperature measurement probe packaging is sealed and does not appear ‘used’ or opened. Check expiry date on probe packaging prior to use (fig 1). |
To ensure that the probe is sterile, unused, not broken, suitable for use and to minimise the risk of cross infection. Temperature probe may no longer be sterile if out of date. |
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The disposable single-patient use probe (lubricated) should be placed 2-3cm past the sphincter into the rectum (depending upon child or infant’s age or size).
Once in correct position the probe should be secured to the infant or child’s leg with non-irritant tape or Clinfix®. (fig 2)
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To ensure the probe is the best position to obtain a more accurate rectal temperature. There may be an increased risk of rectal ulceration and perforation in infants if the probe is in too far. Securing the probe will help ensure it does not slip further in or out of the rectum thus affecting the temperature measurement and trend. |
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The rectal temperature will be displayed continuously via the monitor and will automatically be recorded on the hour. Each hour the nurse should check and validate (if accurate) the child’s temperature |
The Clinical Information System will record whatever temperature is being monitored. It will not take account of other factors which may lead to an inaccurate recording. For example, if the probe has slipped out. It is vital that the nurse checks the temperature ‘recorded’ and adds comments or events where applicable. |
