Pediatric Community

  • 1.  Rectal temperatures

    Posted 30 days ago

    Would anyone be willing to share your hospital policy on rectal temps in children. Focused mostly on birth to 2 years old. I'm trying to gather data to move us away from a "rectal only" temperature policy for under 2 yo. Also, if you know any great literature supporting not using rectal temps that would be great. Thank you!!!!



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    Crissi Harrison, RN, BSN, ATC, LAT
    Emergency Room Nurse
    Nurse Educator for Emergency Department
    Charlotte, NC
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  • 2.  RE: Rectal temperatures

    Posted 24 days ago

    I imagine it would be hard to find anything that says not to do rectal temps and I haven't seen anything that is recently published about rectal temps being harmful. For patient's that cannot hold a thermometer in their mouth (which is usually around 2 yrs) best practice is to take a rectal temperature for accuracy if illness is suspected or illness symptoms present. We know elevated HR could be a sign of sepsis in pediatrics, so getting an accurate (rectal in those cases) temp that could show a fever is important. Of course, if there has been a history of anything that would contraindicate a rectal temp we don't (rectal bleeding, rectal surgery, neutropenia hx,...). Do rectal temps take longer and are not fun....yes, but they are communicating to us what is happening in the pediatric patient's body that cannot verbally tell us.

    Thank you so much for asking this question! It is so important to get pediatric best practices discussed, seen, and implemented. 



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    Becca Mielke, MSN, RN, CPEN, TCRN

    RN Practice Specialist
    Emergency Department
    Dell Children's Medical Center
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    Original Message


  • 3.  RE: Rectal temperatures

    Posted 14 days ago
    Here are some evidence-based articles that may help guide you if you are considering how to write a policy. I would caution that, with today's litigious atmosphere, some hospital systems are reluctant to mandate certain practices due to the potential for it to used against them if the standard is not followed and there is a poor outcome. Language should be couched for certain procedures to indicate this is the "preferred way".





    Most pediatric EDs still recommend and have policies and guidelines that utilize rectal temperatures as the gold standard in patients less than 3 years with no contraindications for that route (immunocompromised, hepatic disease, imperforate anus). There is recent research indicating the possibility that some of the newer types of infrared thermometers may correlate more closely with rectal, but forehead, ear, and axillary temperature routes are highly dependent in accuracy on the person obtaining them. That is one of the reasons the rectal route is recommended if a child is unable to accurately follow instructions for oral temperature.
    I would like to share our policy but our system does not allow that right now. If you have a policy and procedure committee in your hospital, you might ask them to research the most recent evidence to use as a guideline.
     




    Original Message


  • 4.  RE: Rectal temperatures

    Posted 24 days ago

    Following. We were just informed by a patient's mother that the Childrens Hospital that her daughter visits no longer uses rectal temps. We are looking for some guidance on this topic as well.


    Thank you



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    Michelle Thorp BSN, RN, CEN
    Midlothian VA
    michellethorpENA@gmail.com
    Membership Chair, Virginia ENA
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    Original Message


  • 5.  RE: Rectal temperatures

    This message was posted by a user wishing to remain anonymous
    Posted 23 days ago
    This post was removed


  • 6.  RE: Rectal temperatures

    Posted 17 days ago
    Here are some evidence-based articles that may help guide you if you are considering how to write a policy. I would caution that, with today's litigious atmosphere, some hospital systems are reluctant to mandate certain practices due to the potential for it to used against them if the standard is not followed and there is a poor outcome. Language should be couched for certain procedures to indicate this is the "preferred way".

    Rectal Thermometry to Confirm Fever in Babies Under 3 Months: The Eviden...

    March 2018 ( Download a PDF )
    Most pediatric EDs still recommend and have policies and guidelines that utilize rectal temperatures as the gold standard in patients less than 3 years with no contraindications for that route (immunocompromised, hepatic disease, imperforate anus). There is recent research indicating the possibility that some of the newer types of infrared thermometers may correlate more closely with rectal, but forehead, ear, and axillary temperature routes are highly dependent in accuracy on the person obtaining them. That is one of the reasons the rectal route is recommended if a child is unable to accurately follow instructions for oral temperature.
    I would like to share our policy but our system does not allow that right now. If you have a policy and procedure committee in your hospital, you might ask them to research the most recent evidence to use as a guideline.


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    Penny Blake, MSN Ed, RN, CEN
    CCRN Alumnus
    Press Secretary/EMSC Liaison/ED Pediatric Readiness Coordinator
    Per Diem Clinical Educator NICU and Pediatric Services
    PBHN
    North Palm Beach FL
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    Original Message


  • 7.  RE: Rectal temperatures

    Posted 6 hours ago

    We follow the guidance put forth in ENPC by the ENA: obtain the most accurate temperature measurement, by the least invasive means. We recently changed our guideline which was rectal temps for all patients under 2 years. 



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    Ivelisse Sanchez, DNP, APRN, ACCNS-P, CPN, CPEN
    CNS-APRN Coordinator, Pediatric Emergency Departments
    Advocate Children's Hospital
    Oak Lawn & Park Ridge, IL
    email: ev_sanz@yahoo.com
    email: ivelisse@ecsmediallc.com
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    Original Message