Nursing Procedure: Measuring and Monitoring Temperature
in the Highly Dependent or Critically Ill Infant or Child –
Tympanic temperature
Covidien Genius™2
Lead Manager:
Responsible Director:
Author(s):
Approved by:
Date approved:
Date for Review:
Replaces previous version:
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Elaine Johnstone, Lead Nurse
Dr. N. Spenceley, Clinical Director, Critical Care
Jeanette Grady, Clinical Nurse Educator
PICU/HDU Clinical Guideline Group
Jan 2016
Jan 2018
August 2013
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 1 of 8
Issue Date: Aug 2013
1.
Introduction
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 is considered 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
CINHAL, and external nurse expert peer review and opinion.
See also recommendations and further information at end of this guideline.
2. 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.
3. Roles and responsibilities
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.
4. BODY OF POLICY OR PROCEDURE
Equipment:
Infrared Ear Tympanic thermometer(E.g. Covidien Genius™ 2)
Appropriate size probes
Disposable probe covers
Disposable apron
Non-sterile gloves
Staff that have not used tympanic thermometry before are advised to check any
manufacturer operating instructions and relevant training before first use. Genius™2
training information and presentation is available at:
http://akamai.covidien.com/sfdistribution/vtn/flash/thermometry/EMEA.html
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 2 of 8
Issue Date: Aug 2013
PROCEDURE:
RATIONALE
Provide age appropriate explanation of To ensure the child (and parent)
procedure
understand and consent to the
procedure.
Wash hands thoroughly with appropriate To minimise the risk of cross infection.
skin cleanser and don disposable apron
and gloves.
Choose
tympanic
temperature To ensure consistency in temperature
measurement device required and readings. Switching between sites and
document which type chosen (E.g. changing from one type of thermometer
Covidien Genius™ 2)
to another can produce misleading
results.
Where possible use same type of
equipment and same ear each time.
Document if infant or child in heated
environment (E.g. incubator)
There may be differing measurements if
temperature measured in exposed or
non-exposed ear or if in a superheated
environment.
Anatomical differences between the two
ears can result in a difference of up to
1◦C.
Remove thermometer from base unit and If lens is cracked or dirty then it may
check probe lens and tip is clean, intact result in an inaccurate reading.
and clear of any material.
The probe tip may be wiped before use The thermometer lens must be free from
using dry lint free swab or lens wipe. If fingerprints, soiling and/or smudges for
soiled, an Isopropyl wipe may be used. proper operation.
(Covidien 2006). N.B. Allow to dry prior
to use.
Push the probe tip firmly into a new The disposable probe cover protects the
disposable cover contained in a cassette tip of the thermometer probe and is
in the thermometer base unit. (For needed for the unit to function correctly.
Genius™ 2)
A disposable thermometer tip cover can
help minimise the risk of cross infection.
Dashes will appear on the thermometer This indicates the thermometer has
screen indicating mode.
performed a system reset and is ready to
use
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 3 of 8
Issue Date: Aug 2013
Ensure probe cover is correctly fitted on If probe cover is not fit correctly or holes
the probe tip, with no holes, tears or evident, temperature readings can be
wrinkles on the plastic cover
inaccurate.
Visually inspect infant/child’s ear canal to
ensure clean and dry. Note general
direction of ear. Use a gentle ear tug by
pulling the pinna down and back in
infants and small children, and up and
back for older children.
For an accurate reading it is vital that the
tympanic membrane is ‘visualised’ by the
thermometer tip. The gentle ‘ear tug’ can
help align the thermometer probe toward
the tympanic membrane.
Gently place the probe tip in the outer This prevents ambient air interfering with
third of the ear canal and seal the the temperature reading and causing a
false low temperature measurement.
opening, ensuring a snug fit.
Ensure the thermometer is ‘set’ to correct An inappropriate mode setting may not
mode according to the individual
give an accurate reading.
manufacturers’ instructions (E.g. LCD
screen displays ‘Ear’ and °C).
Press and release triangular SCAN
button.
This commences
scanning.
Ensure thermometer stays in situ until
reading appears and thermometer
‘beeps’.
Movement of the thermometer and probe
may interfere with its ability to ‘visualise’
the tympanic membrane or risk exposing
the probe to the ambient air and can
interfere with temperature recording.
Once thermometer triple bleeps, remove
thermometer probe tip from ear. The
patient temperature and probe eject
icons will be displayed.
the
thermometer
The disposable probe tip cover can be
ejected by pressing eject button, and
then discarded.
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 4 of 8
Issue Date: Aug 2013
The nurse should now read and
document the child’s temperature and
site – i.e. tympanic.
The thermometer should now be
returned to the base unit for storage
Storing the thermometer in the base unit
keeps it safe from damage and allows it
to return to sleep mode.
Note – the Genius™2 goes into sleep
mode after 30-40 seconds of non-use.
If the nurse has not had time to note
temperature, it can be recalled by
pressing and holding the °C button.
Sleep mode conserves function and
optimizes battery life.
RECOMMENDATIONS & PRECAUTIONS:
The blood supply of the tympanic membrane from the common carotid artery is
shared with the hypothalamus. As the ear canal and tympanic membrane have no
inherent metabolic activity, then the temperature of the tympanic membrane should
be primarily determined by this blood supply. This means that the tympanic
membrane temperature should in theory closely represent the hypothalamic
temperature. As such, it is easy to understand why a number of studies find the
tympanic thermometer can be a more accurate reflection of core temperature and a
more accurate indicator of fever.
The tympanic thermometer uses infrared light to detect thermal radiation.
Temperature is measured by inserting the probe into the auditory canal. The
thermometer probe then scans and after a few seconds records the amount of
infrared energy emitted by the tympanic membrane.
The tympanic or aural route has become popular in paediatrics and, provided correct
technique has been used, it has a number of advantages over other methods of
thermometry. Advantages include it being a more accurate reflection of core
temperature, it is non-invasive, is quick and relatively easy to use and is comfortable
for the child. Other advantages of tympanic or aural thermometry are that the
procedure itself is more hygienic, less invasive and safer than other forms of
thermometry.
Despite the increasing widespread use of tympanic or aural thermometry in
paediatrics it is important that the nurse is aware that some studies have highlighted
some limitations in its use. Some studies advise that tympanic thermometers should
be used with extreme caution and only as an indication of temperature. For the
tympanic thermometer to be more ‘accurate’, it must be placed in the ear canal
correctly in order that it can ‘see’ the tympanic membrane. If the probe is not
correctly placed this can result in the thermometer scanning the ear canal instead of
the tympanic membrane and thus give a falsely low temperature reading. This can
be more likely where there are multiple personnel taking temperatures.
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 5 of 8
Issue Date: Aug 2013
Education of all staff using tympanic thermometers is essential to ensure reduction in
user error and negative influence on temperature readings. Some studies have
highlighted the fact that the ear canal in infants and children can be very different
lengths, and as such the thermometer probes may be too large for smaller infants
thus potentially influencing the accuracy of the temperature measurement.
Tympanic temperature readings may also be affected by the ambient temperature
such as from incubators or may vary depending upon whether the ear used has
been exposed to air or on a pillow or mattress.
There are conditions where tympanic thermometry may be contraindicated and these
include the infant or child who has significant ear pathology, a foreign body in the ear
or has moisture in the ear, such as cerebrospinal fluid or blood.
Remember that a tympanic thermometer must be cared for and stored correctly and
some must be recalibrated every 12 months.
If the nurse finds any abnormal temperature measurements using the tympanic
thermometer technique, then the nurse must recheck the temperature and also
consider another method & site of thermometry. Any abnormality must be
documented and reported to nurse-in-charge and doctor.
5. Review
This nursing procedural guideline should be reviewed every two years from date
of approval.
6.
References
Bailey, J Rose, P (2001) Axillary and tympanic membrane temperature recording
in the preterm neonate: a comparative study. Journal of Advanced Nursing, Vol.
34 (4), pp 465-474.
Bock, M Hohlfeld, U von Engeln, K Meier, P Motsch, J (2005) The accuracy of a
new infrared ear thermometer in patients undergoing cardiac surgery. Canadian
Journal of Anesthesia, Vol. 52 (10), pp 1083-1087.
Childs, C Harrison, R Hodkinson, C (1999) Tympanic membrane temperature as
a measure of core temperature. Archives of Disease in Childhood, Vol. 80, pp
262-266.
Covidien (2006) GeniusTM2 Tympanic Thermometer and Base. Operating Use
Guide. Available at:
http://akamai.covidien.com/sfdistribution/vtn/flash/thermometry/assets/scenes/res
ources/content_euro/genius/general/Genius_Operations_Manual.pdf
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 6 of 8
Issue Date: Aug 2013
Covidien (2009) GeniusTM2 Tympanic Thermometer: Training presentation and
Checklist. Available at:
http://akamai.covidien.com/sfdistribution/vtn/flash/thermometry/EMEA.html and
http://akamai.covidien.com/sfdistribution/vtn/flash/thermometry/assets/scenes/res
ources/content_euro/genius/general/TY0692_Step_by_Step_Guide.pdf
Dougherty, L, Lister, S (2004) Observations: Temperature. In: The Royal
Marsden Hospital Manual of Clinical Nursing Procedures. (6th Ed). Blackwell
Publishing, London.
El-Radhi, AS Patel, S (2006) An evaluation of tympanic thermometry in a
paediatric emergency department. Emergency Medical Journal, Vol. 23, pp 4041.
Fisk, J Arcona, S (2001) Comparing tympanic membrane and pulmonary artery
catheter temperatures. Dimensions of Critical Care Nursing, Vol. 20, pp. 24-34.
Fulbrook, P (1997) Core body temperature measurement: a comparison of axilla,
tympanic membrane and pulmonary artery blood temperature. Intensive and
Critical Care Nursing, Vol. 13, pp 266-272.
Gilbert, M Barton, AJ Counsell, CM (2002) Comparison of oral and tympanic
temperatures in adult surgical patients. Applied Nursing Research, Vol. 15 (1), pp
42-47.
Guiliano, KK Scott, SS Elliot, S Guiliano, A (1999) Temperature measurement in
crticially ill orally intubated adults: A comparison of pulmonary artery core,
tympanic and oral methods. Critical Care Medicine, Vol. 27 (10), pp 2188-2193.
Leon, C Rodriguez, A Fernandez, A Flores, L (2005) Infrared ear thermometry in
the critically ill patient. An alternative to axillary thermometry. Journal of Critical
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Loveys, AA Dutko-Fioravanti, I Eberly, SW Powell, KR (1999) Comparison of ear
to rectal temperature measurements in infants and toddlers. Clinical Pediatrics,
Vol. 38, pp 463-466.
Maxton, FJC Justin, L Gillies, D (2004) Estimating core temperature in infants
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Advanced Nursing, Vol. 45 (2), pp 214-222.
Moran, DS Mendal, L (2002) Core temperature measurement: Methods and
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NHS Greater Glasgow Prevention and Control of Infection Manual (2016) Core
prevention policies available at: http://www.nhsggc.org.uk/your-health/publichealth/infection-prevention-and-control/prevention-and-control-of-infectionmanual-policies-sops-guidelines and http://www.nhsggc.org.uk/yourTympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 7 of 8
Issue Date: Aug 2013
health/public-health/infection-prevention-and-control/prevention-and-control-ofinfection-manual-policies-sops-guidelines/standard-operating-procedures-sops/
Pandey, A Ingrams, DR Jones, M Raman, R Marks, ND (2006) Reliability of a
tympanic thermometer in measuring temperatures in children after minor ear
surgery. The Journal of Laryngology and Otology, Vol. 120, pp. 375-377.
Purssell, E While, A Coomber, B (2009) Tympanic thermometry – normal
temperature and reliability. Paediatric Nursing, Vol. 21 (6), pp. 40-43.
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measure and how do they comply with the EU technical regulation? Physiological
Measurement, Vol. 25, pp 699-708.
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esophageal, rectal, axillary, bladder, tympanic and pulmonary artery
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Saxena, AK Topp, S Heinecke, A Willital, GH (2001) Application criteria for
infrared ear thermometers in pediatric surgery. Technology and Health Care, Vol.
9, pp 281-285.
Sund-Levander, M Grodzinsky, E Loyd, D Wahren, LK (2004) Errors in body
temperature assessment related to individual variation, measuring technique and
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Van Staaij, BK Maroeska, M Rovers, AG Schilder, AWH (2003) Accuracy and
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Otorhinolaryngology, Vol. 67, pp 1091- 1097.
A
Communication and Implementation Plan
R.H.S.C. Nursing Policy Group
PICU Clinical Guidelines group
PICU Band 7 nursing staff, Band 6 nursing staff and nursing teams
B
Monitoring
Monitoring the implementation of this nursing procedural guideline should be bny
Lead Nurse, Band 7, Band 6 and Band 5 experienced PICU clinical nursing staff.
Monitoring of any adverse events related to tympanic thermometry should be
documented via critical incident reporting.
C
Impact Assessment
EQIA not relevant to this nursing procedural guideline as there are no
discriminatory practices identified in implementing this guideline.
Tympanic Temperature
Authors: Jeanette Grady
Revision date: Jan 2018
Version: 3.0
Authorised by PERG
Q-Pulse ref: YOR-PICU-018
Page 8 of 8
Issue Date: Aug 2013