Recording temperature: Disposable thermometersEdited by Deborah Duncan, Lecturer (Education), School of Nursing and Midwifery, Queens University, Belfast
Recording a patient’s temperature is one of the most commonly performed diagnostic skills. Accurate measurement is vital, because the result will form part of a holistic assessment influencing decisions about the patient’s care and treatment (Grainger, 2013). Temperature is an indicator of deterioration and is incorporated in the NEWS2 assessment (RCP, 2017).
A variety of body sites are used for temperature measurement, such as the oral, axillary, rectal, temporal and tympanic sites. There are also different types of thermometers. Use the same method each time you measure a patient’s temperature to allow comparison between recordings. This procedure shows
how to record temperature using a disposable chemical dot thermometer. If you are unfamiliar with the device, or it is a different model to the one you normally use, always refer to the manufacturer’s instructions to ensure that you correctly perform each step. It may be helpful to ask the advice of a knowledgeable colleague. Healthcare professionals are advised against using disposable chemical dot thermometers when multiple temperature measurements are required (NICE, 2019).
See also the procedures “Recording temperature: Electronic thermometers” and “Recording temperature: Tympanic thermometers”.
≥39.1°38.1-39.0°37.1-38.0°36.1-37.0°35.1-36.0°
≤35.)°
≥131121-140111-120101-11091-100
81-9071-8061-7051-6041-5031-40
≤30Alert
ConfusionVPU
DConsciousnessScore for NEWonset of confusion(no score if chronic)
ETemperature°C
NEWS TOTAL
Monitoring frequencyEscalation of care Y/N
Initials
36.8°C
36.5°C
37.5°C
Core temperature 37.0°C
36.0°C
32.0°C
28.0°C
34.0°C
31.0°C
Body temperature at different sites Pyrexia (fever)
Pyrexia (fever) is defined as a rise in body temperature above the normal range for the patient. The body raises its thermoregulatory point in order to fight infection, causing pyrexia with accompanying clinical signs such as shivering. Raised temperatures up to 38°C are defined as a low-grade pyrexia; 38–40°C constitutes moderate to high-grade pyrexia. Monitor elevated temperature at regular intervals and consider the cause. Low-grade pyrexia is a normal reaction of the body to infection, but should be investigated if persistent (Affronti et al., 2010). Follow medical advice and current best practice for reducing pyrexia.
The normal human body core temperature ranges from 36°C to 37.5°C (Tortora & Derrickson, 2017) and is required to maintain normal metabolic activity (Marieb & Hoehn, 2018). Temperature is lower in the skin and the extremities (Marieb & Hoehn, 2018). Factors such as age, gender, exercise and time of day can cause variations in body temperature (Marieb & Hoehn, 2018; Waugh & Grant, 2018). Always look at the trend of recordings, as well as individual figures, and use the data as part of a holistic assessment when planning care.
Vasodilation helps heat to reach the skin where it can be lost to the environment
Hairs become erect, trapping a layer of air
by the skin, which helps to insulate the body
Constriction of blood vessels helps to retain
heat in the body
Responses to low temperatures Responses to high temperatures
To allow the body to cool, blood vessels dilate, allowing heat loss through the skin (Marieb & Hoehn, 2018). Sweating cools the body via water evaporation. The body loses heat via four main methods: convection, conduction, radiation and water evaporation.
The body maintains its core temperature within normal limits by responding to temperature fluctuations. If body temperature drops, short-term responses include shivering and vasoconstriction (Marieb & Hoehn, 2018). Shivering creates heat from muscle movement. Blood vessels under the skin constrict to retain warm blood in the centre of the body and prevent it cooling further.
Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
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Potassium Chloride 0.3% w/v and Sodium Chloride 0.9% w/v Solution for Infusion BP
pH 4.5 -7.0 (approx) Hypertonic
Sodium Chloride 9.0g Potassium 40 Potassium Chloride 3.0g Sodium 154 Water for Injections qs Chloride 194
Osmolarity 388 m)sm/l (approx) Formula per 1000 ml mmol per 1000 ml (approx)
IV administration Read package leaflet before use
PL00116/0337 PA167/52/11 UN-35-01-634 1
POM 07 5 413760 216133 LOT EXP 12BO4E2B 01 2015
Keep out of reach and sight of children Do not remove from overwrap until ready for use Do not use unless solution is clear without visible particles and container undamaged Do not reconnect partially used bags
Contains UN-55 01 -070 40 mmol potassium 1000 ml
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Disposable single-use thermometer Explain the procedure to the patient
Disposable thermometers are plastic strips impregnated with rows of small dots which sequentially react and change colour at progressively higher temperature points. A number is printed against each dot, making it possible to gain an accurate temperature reading. The procedure for use can vary between different brands, such as the time point of reading the dots, so always check the manufacturer’s instructions.
Do not take an oral temperature until at least 20–30 minutes after the patient has eaten or drunk hot or cold foods because this could distort the reading (Whelan & Hughes, 2016). Explain to the patient what you would like to do and gain their consent.
as e tic mixing of any additive is mandatory Do not remove from)ov erwrap until ready for use Discard any unused portion after firstus e Do not reconnect partially used bags for use under medicalsu pervision
Take out a disposable thermometer Place the thermometer in the patient’s mouth
Decontaminate your hands. Ensure that the expiry date on the box of disposable thermometers has not passed and that the packaging of the individual packets is intact. Take hold of a strip of disposable thermometers, fold along the perforations and tear off one sealed packet. Peel back the wrapper to reveal the handle of the thermometer. Remove the device by the handle, not by the end bearing the dots.
Ask the patient to open their mouth. Place the thermometer under the tongue as far back as possible. It does not normally matter if the dots are upwards or downwards, but always check the manufacturer’s instructions.
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Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Place the thermometer in either the right or the left posterior sublingual heat pocket, as the temperature here can be as much as 1.7°C higher than just behind the incisors (Erickson, 1980). Ask the patient to lower their tongue onto the thermometer and close their mouth onto the handle.
Frenulum
36.7°
36.9°
36.3°
36.0°
Sublingual heat pockets
Posterior sublingual heat pockets
Upper incisor
Lower incisor
Tongue
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Reading the thermometer: (b)
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Tempa-DO
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Using the axillary route Keep in place for three minutes
The last dot to have changed colour indicates the temperature. Here is it 37.1°C. Check carefully to ensure that you are reading the scale correctly. If you are not familiar with this device, ask a colleague to check your reading.
Follow the manufacturer’s instructions for placement. This normally involves aligning the strip with the spine (vertically) and supporting the arm close against the body so that the skin is in good contact with the thermometer. Reassure the patient and hold the device in place, usually for 3 minutes (follow the manufacturer’s instructions).
The axillary route provides a lower temperature (by approximately 0.6°C) than an oral recording (Timby, 2016). Use this route for patients where it is not possible or safe to gain an oral or tympanic reading, such as in those who may bite the thermometer or who find other methods distressing. Explain the procedure to the patient.
a s e ticmixing of any additive is mandatory Do not remove fro m)o v er wrap until ready for use D iscard any un used portion after firstu s e Donot reconnect partially usedbags fo r use under medic als u pe rvision
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as e ticmixing of any additive is mandatory Do not remove fro m)over wrap until ready for use D iscard any unused portion after firstus e Donot reconnect partially usedbags for use under medic alsu pe rvision
150 150
200 200
POM 07
5 4 1 3 7 6 0 2 7 7 6 91
07K16E2N 10 2010
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Keep in place for 60 seconds Reading the thermometer: (a)
Keep the thermometer in place for 60 seconds (3M, 2007) or according to the manufacturer’s instructions. Ensure that the patient’s lips are closed around the strip during this period.
Remove the thermometer to read the temperature. Some devices require you to wait 10 seconds to ‘lock in’ the reading. Others require you to read it within 10 seconds of removal because the reading may alter. Always check the manufacturer’s instructions.
≥39.1°38.1-39.0°37.1-38.0°36.1-37.0°35.1-36.0°
≤35.)°
≥131121-140111-120101-11091-100
81-9071-8061-7051-6041-5031-40≤30
AlertConfusion
VPU
DConsciousnessScore for NEWonset of confusion(no score if chronic)
ETemperature°C
NEWS TOTAL
Monitoring frequencyEscalation of care Y/N
Initials
POM 07
5 4 1 3 7 6 0 2 7 7 6 9 1
07K16E2N 10 2015
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pH 5.5 (approx) Isoton icOsmolarity 308 mOsm/l (appro x) Sterile non pyrogen icSingle dose Solution for infusinon
Fo rmula for 250 ml mmol per 250 ml (approx)SodiumChloride 2.25 g Sodium 38W ater for injections Chloride 38
Fo r intravenous administrati onStore out of reach and sight of children. Do not use unless so lutio nis clearand container undama ged Check additive compatibilitywit hb oth thesolution and containe r prior to use thorough and carefula septicmixing of any additive is mandatory Do not remove from)o verwrap until ready for use D iscard any unused portion after firstu se Donot reconnect partially used bags for use under medicals upervision
Record the temperature immediately Make the patient comfortable
Dispose of the thermometer and any other equipment, and decontaminate your hands. Ensure that the patient is comfortable and provide the patient with information about their clinical status as required.
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Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.
Record the temperature immediately in the notes or a NEWS 2 chart. Assess the temperature reading, its trend and other parameters. Consider any actions that may need to be taken, such as informing another member of clinical staff.
