Thermometry, temperature records sheet by Dr.sourav Das

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Thermometry, temperature records sheet

• Department of General Surgery No. 1 of PSMU

• DAS SOURAV_GROUP-LD17_38, DATE- 10.05.2023

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Temperature management

• Introduction

• Temperature management remains a significant
  component of hospital care for all neonatal and
  paediatric patients. Body temperatures outside
  normal ranges may be indicative of underlying
  disease processes or clinical deterioration, and
  should be identified within a timely manner.
  Maintaining a stable body temperature within
  normal ranges assists in optimising metabolic
  processes and bodily functions. Therefore,
  minimising environmental factors within the
  hospital setting which may result in unnecessary
  body temperature fluctuations is further
  important. 

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• Aim
• To assist healthcare professionals in undertaking
  the appropriate assessment and potential
  management of neonatal and paediatric body
  temperatures, at The Royal Childrens Hospital.
• Definition of Terms
• Normothermia Body temperature within normal
  values.  Exact normal temperature ranges differ
  between individuals and can be influenced by some
  genetic and chronic medical conditions. It is
  important to ascertain the baseline for
  individual patients in order to identify abnormal
  body temperature deviations. 
• Pyrexia An elevated body temperature due to an
  increase in the body temperatures set point.
  This is usually caused by infection or
  inflammation. Pyrexia is also known as fever or
  febrile response.  Some causes of fevers do not
  require medical treatment, whilst other causes
  need to be identified and treated. 

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• Hyperthermia An elevated body temperature due to
  failed thermoregulation. This occurs when the
  body produces and/or absorbs more heat than it
  can dissipate. 
• Heat stroke A presentation of severe
  hyperthermia. Thermoregulation is overwhelmed by
  excessive metabolic production and environmental
  heat, in combination with impaired heat loss.
  This is uncommon within an inpatient setting.
• Low temperature A lowered body temperature,
  where the body loses heat faster than it can
  produce heat. 
• Hypothermia An abnormally low body temperature,
  where the body temperature drops below a safe
  level. Both low temperatures and hypothermia can
  be caused by environmental factors, metabolic
  complications, disease processes, or can be
  medically induced. 

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Temperature Ranges
Classification Neonates Paediatrics
Low temperature (or hypothermia) lt36.5C lt36C
Normothermia 36.5 - 37.5C 36 - 37.5C
Low grade fever (or normothermia) 37.6 - 37.9C 37.6 - 37.9C
Fever (or hyperthermia) 38C 38C
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Assessment

• Body temperature should be measured on admission
  and four hourly with other vital signs, unless
  clinically indicated for more frequent
  measurements.  Body temperatures falling outside
  normal ranges should be monitored and further
  managed where appropriate until normothermia is
  achieved.  When assessing body temperatures, it
  is important to consider patient-based and
  environmental-based factors, including prior
  administration of antipyretics and recent
  environmental exposures.  Body temperature
  should always be evaluated in the context of
  other vital signs and overall patient
  presentation.

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Methods of body temperature measurements

• Due to temperature variation between body sites,
  ideally the same route should be used for ongoing
  patient observations, as to allow for accurate
  temperature trend evaluation. Document the route
  used in EMR.   
• 0-3 months Axillary Route Axillary digital
  thermometer is the preferred method for this age
  group, in most cases. 
•    Procedure
• Place thermometer tip in the centre of the armpit
  over the axillary artery, ensuring skin is dry
  and intact prior to probe placement. 
• Place the patients arm securely against their
  body.
• Turn thermometer on. For a more accurate reading,
  wait gt3 minutes with thermometer in situ before
  obtaining a measurement.

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• 0-3 months Rectal Route (if requested) In
  special cases, a rectal temperature may be
  required for a more accurate assessment of body
  temperature. This should be performed only if
  approved by medical staff, with ANUM
  involvement.  Rectal measurements should be
  avoided within the oncology population and in
  patients with low platelets, coagulopathy, or
  perineal trauma and pelvic area surgery, due to
  the increased risk of bowel perforation. 
•    Procedure
• Place plastic sheath over thermometer.
• Dab a small amount of lubricant on end of
  thermometer.
• Carefully insert thermometer 2cm into the
  infants anus (1cm for pre-term infant).
  Over-insertion may cause bowel perforation.
• Turn thermometer on.
• Wait for 5 seconds post Celsius sign flashing
  before taking a recording. 
• Remove and clean thermometer with alcohol.

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• gt3 months Tympanic RouteTympanic thermometer is
  the preferred method for this age group. 
•    Procedure
• Gently insert probe into ear canal until the
  canal is entirely sealed off, ensuring the tip is
  facing the eardrum.  
• Press the thermometer button and wait for the
  beeps.  
• If ears have been covered (eg. headphones/beanie),
  remove items and wait until ear canal is cooled
  before taking measurement. If a patients ear
  canals are too small to properly insert the
  tympanic probe, consider an axillary thermometer
  route instead. 

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• NotesIf the patient has been exposed to cold
  conditions, allow for adequate time for patient
  to equilibrate to room temperature before
  measuring body temperature.  Both axillary and
  tympanic routes measure temperatures lower than
  true core body temperature.  Temperature
  measurement frequency may differ in
  sub-speciality areas, such as within the
  Emergency Department, critical care and
  peri-operative areas. Please refer to specific
  department guidelines for further information. 

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At Risk Patient Groups

• The following patient populations are at an
  increased risk of being unable to maintain
  normothermia 
• Neonates and young infants 
• Peri and post-operative patients
• Burns patients
• Trauma patients 
• Neurologically compromised patients

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Management

• Preventative Approaches

Mode Definition Clinical Scenario Preventative Management
Evaporation Heat loss occurring during conversion of liquid to vapour Sweat, incontinence Wet or oozing dressings Keep patient dry Remove wet clothing, replace wet dressings if appropriate
Convection Transfer of heat from the body surface to the surrounding air via air current Air drafts in room Relocate patient away from draughts, close door
Conduction Transfer of heat from one solid object to another solid object in direct contact Cold blankets, cold weighing scales Cover cold surfaces with pre-warmed towel or blanket
Radiation Transfer of heat to cooler solid objects not in direct contact with the body Nearby cold windows or walls Relocate patient away from cold surfaces Close blinds on window
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Special Considerations

• The following patient populations may require
  more specific interventions and/or differing
  management when body temperature falls outside
  traditionally normal values
• Febrile Neutropenic patients 
• Therapeutic hypothermic patients 
• Therapeutic hypothermic neonates 
• Patients with chronic conditions causing lower
  baseline body temperatures Some patient
  populations have conditions that affect their
  basal metabolic rates and thus, have unique
  normal temperature ranges. It is important to
  ascertain these individuals normal temperature
  fluctuations in order to identify abnormal
  readings and manage appropriately.  

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• Perioperative and Postoperative Patients
• Preoperatively 
• Ensure temperature is taken on admission and
  patients are appropriately dressed and warm
  preoperatively. 
• Provide a warm blanket as appropriate. 
• Consider forced air warming (Bair Hugger) for
  patients undergoing extensive surgery. 

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• Recovery
• Ensure temperature is taken on admission to PACU
• Initiate active warming via forced air warming
  (Bair Hugger) if neonatal patient temperature is
  lt36C (if not in Ohio/Isolette) or paediatric
  patient temperature is lt35.5C.
• Temperature should be taken every 5 minutes
  whilst a patient is receiving active warming.
• If overheating or burns occur, stop active
  warming and seek anaesthetic review (treating or
  in charge). Cool patient if appropriate. Document
  event via EMR and complete VHIMS.

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• Discharge temperature is 36.6C for neonatal
  patients and 36C for paediatric patients. 
  Ensure clinical indicators are completed and
  active warming interventions are documented in
  EMR. 
• Patients with chronic conditions which cause
  lower baseline body temperatures should return to
  their baseline prior to transfer to ward. This
  baseline temperature should be discussed with
  parents/caregivers and communicated to the
  receiving ward or day surgery. 

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• If the post-operative temperature is lt36C but
  35.5C, the patient is rousable and all other
  vital signs are stable and within normal range,
  they can be transferred to the ward.  If
  clinically indicated, forced air warming can be
  made available for ward to continue to use. This
  should be discussed with parents/caregivers and
  communicated to admitting ward.

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• THANK YOU