II. Technique: Rectal Temperature

  1. Procedure
    1. Apply vaseline or KY Jelly to rectal thermometer
    2. Patient lies on their side with top leg flexed forward
    3. Children and uncooperative patients should be held by an assistant to prevent movement
    4. One hand spreads the buttocks and exposes the anal region
    5. Thermometer tip gently inserted through anus into Rectum 0.5 to 1 inch depth
    6. Stop insertion if any resistance is met
      1. May use the reading if the depth is at least 0.5 inches
    7. Thermometers typically indicate with sound when the reading has stabilized and Temperature may be read
  2. Advantages
    1. Most accurate, non-invasive method for detecting fever
  3. Disadvantages
    1. Lag core Temperature changes
    2. Variable readings depending on depth or insertion and presence of stool in Rectum
    3. Risk of contagious illness spread
    4. Discomfort for both the patient and the parent performing the Temperature
    5. Case reports of rectal perforation in infants

III. Technique: Oral Temperature

  1. Procedure
    1. Patient sits in comfortable, stable position
    2. Thermometer placed under Tongue and with lips closed around it
    3. Patient instructed not to bite down on thermometer
    4. Thermometers typically indicate with sound or other signal when the reading has stabilized and Temperature may be read
  2. Advantages
    1. Comfortable, easily accessible site for Temperature measurement (reflects the lingual artery Temperature)
    2. More accurate than acillary Temperatures (but less accurate than Rectal Temperatures)
  3. Disadvantages
    1. Altered by eating or drinking with the prior 15 minutes
    2. Adequate reading requires a closed mouth and thermometer held under the Tongue for 3-4 minutes
    3. Not appropriate for uncooperative or unconscious patients
    4. Not appropriate for young children especially under age 2 years
      1. Not able to maintain sublingual positioning, may bite thermometer
      2. Pacifier thermometers are an alternative option in this age, but must stay in mouth for 6 minutes

IV. Technique: Tympanic Temperature

  1. Procedure
    1. Insert thermometer tip into ear canal
    2. Press start
    3. Wait for sound or other signal to indicate Temperature may be read
  2. Advantages
    1. Fast, convenient, comfortable and easy to perform
  3. Disadvantages
    1. Poor accuracy (similar to Axillary Temperature)
    2. Affected by environmental Temperature, Cerumen Impaction and Otitis Media
    3. Not appropriate for under age 6 months

V. Technique: Forehead or temoral Temperature

  1. Procedure
    1. Infrared device placed over temporal artery distribution region
  2. Advantages
    1. Fast and simple
  3. Disadvantages
    1. Most expensive of thermometers
    2. Error prone

VI. Technique: Axillary Temperature

  1. Procedure
    1. Place thermometer snugly against skin in axilla with arm adducted
    2. Thermometers typically indicate with sound or other signal when the reading has stabilized and Temperature may be read
  2. Advantages
    1. Least invasive method
    2. Recommended by AAP for infants (due to home risk of rectal perforation with Rectal Temperature)
  3. Disadvantages
    1. Adequate reading requires thermometer kept within the axilla for 4 minutes
    2. Least accurate method for detecting fever
      1. Not recommended for medical facilities to detect fever and on which to base clinical decision making
      2. One study found Axillary Temperatures were accurate in under 3 months of age
        1. Shann (1996) Arch Pediatr Adolesc Med 150:74-8 [PubMed]
  4. Interpretation
    1. Age <5 weeks old
      1. Rectal = Axillary Temperature + 0.2/week of age (C)
    2. Age >1 month old
      1. Rectal = Axillary Temperature + 1 (Celsius)

VII. Technique: Core Temperature

  1. Devices
    1. Esophageal thermometer
    2. Bladder thermometer
  2. Advantages
    1. Most accurate methods of Temperature monitoring
  3. Disadvantages
    1. Invasive and used only in specific, intensive indications

VIII. Precautions

  1. Avoid wearable thermometers and color change strips due to unreliability

IX. References

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Ontology: Body Temperature (C0005903)

Definition (ICF) Functions involved in regulating the core temperature of the body.
Definition (ICF-CY) Functions involved in regulating the core temperature of the body.
Definition (MSH) The measure of the level of heat of a human or animal.
Definition (CSP) degree of heat in the body of a living organism, temperature is measure of the average kinetic energy of the particles in a sample of matter, expressed in terms of units or degrees designated on a standard scale.
Concepts Organism Attribute (T032)
MSH D001831
SnomedCT 276535009, 1942004, 363815009, 386725007, 105723007
LNC LP65487-8, MTHU001362
English Body Temperature, Body Temperatures, Temperature, Body, Temperatures, Body, Body temperature observation, body temperature, temperature, Body temperature (function) (observable entity), Body temperature observable, Body temperature observable (observable entity), Body temperature, BT - Body temperature, Body temperature (observable entity), Body temperature - observation, Body temperature finding (finding), Body temperature finding, body; temperature, temperature; body, Body temperature, NOS, Body temperature (function), Temperature (Body)
Swedish Kroppstemperatur
Spanish observación acerca de la temperatura corporal, temperatura corporal (función), temperatura corporal - observación, carcterística observable de la temperatura corporal (entidad observable), temperatura del cuerpo, carcterística observable de la temperatura corporal, hallazgo relacionado con la temperatura corporal (hallazgo), hallazgo relacionado con la temperatura corporal, observación acerca de la temperatura corporal (entidad observable), temperatura corporal (entidad observable), temperatura corporal, Temperatura Corporal
Czech tělesná teplota
Finnish Kehon lämpötila
French Température du corps, Température organique, Température corporelle
Russian TEMPERATURA ORGANA, TEMPERATURA TELA, ТЕМПЕРАТУРА ОРГАНА, ТЕМПЕРАТУРА ТЕЛА
Croatian TJELESNA TEMPERATURA
Polish Ciepłota ciała
Norwegian Kroppstemperatur
Dutch lichaam; temperatuur, temperatuur; lichaam, Lichaamstemperatuur
German Körpertemperatur
Italian Temperatura corporea
Portuguese Temperatura Corporal

Ontology: Temperature (C0039476)

Definition (ICF) Degree of heat or cold, such as high and low temperature, normal or extreme temperature.
Definition (ICF-CY) Degree of heat or cold, such as high and low temperature, normal or extreme temperature.
Definition (MSH) The property of objects that determines the direction of heat flow when they are placed in direct thermal contact. The temperature is the energy of microscopic motions (vibrational and translational) of the particles of atoms.
Definition (NCI_CDISC) The property of a body or region of space that determines whether or not there will be a net flow of heat into it or out of it from a neighboring body or region and in which direction (if any) the heat will flow, perceptible by living organism as a somatic sensation of cold or heat. It is a measure of the average translational kinetic energy associated with the disordered microscopic motion of atoms and molecules. Temperature is measured in one of the three standard temperature scales: Celsius, Kelvin, and Fahrenheit. (NCI)
Definition (NCI) A measure of the average kinetic energy of a system of particles. Temperature may be quantified, in the context of thermodynamics, as the potential of one system to transfer thermal energy to another system until both systems reach a state of thermal equilibrium.
Definition (CSP) a specific degree of hot or cold as indicated on or referred to a standard scale.
Concepts Quantitative Concept (T081)
MSH D013696
SnomedCT 703421000, 246508008, 102404009
HL7 TEMP
LNC LP6872-8, LP36617-6, MTHU009008
English Temperature, Temperatures, Temp, temperature, temperatures, TEMP, Temperature (observable entity), Temperature (attribute), Temperature, NOS, *Temperature
Swedish Temperatur
Czech teplota
Finnish Lämpötila
Russian TEMPERATURA, ТЕМПЕРАТУРА
Croatian TEMPERATURA
Polish Temperatura
Norwegian Temperatur
Spanish Temperatura, temperatura (atributo), temperatura, Temperatura Ambiental
Portuguese Temperatura, Temperatura Ambiente
French Température
German Temperatur
Italian Temperatura
Dutch Temperatuur

Ontology: O/E - axillary temperature (C0437727)

Concepts Finding (T033)
SnomedCT 164292006, 141486007
Spanish al examen: temperatura axilar (hallazgo), al examen: temperatura axilar (categoría dependiente del contexto), al examen: temperatura axilar
English On examination - axillary temperature, O/E - axillary temperature (finding), O/E - axillary temperature, On examination - axillary temperature (context-dependent category), On examination - axillary temperature (finding)

Ontology: O/E - rectal temperature (C0437729)

Concepts Finding (T033)
SnomedCT 164294007, 141488008
Spanish al examen: temperatura rectal (hallazgo), al examen: temperatura rectal (categoría dependiente del contexto), al examen: temperatura rectal
English On examination - rectal temperature, O/E - rectal temperature (finding), O/E - rectal temperature, On examination - rectal temperature (context-dependent category), On examination - rectal temperature (finding)

Ontology: O/E - oral temperature (C0555770)

Concepts Finding (T033)
SnomedCT 275874003, 141485006, 164291004
Spanish al examen: temperatura oral (hallazgo), al examen: temperatura oral (categoría dependiente del contexto), al examen: temperatura oral
English On examination - oral temperature, O/E - oral temperature, On examination - oral temperature (context-dependent category), On examination - oral temperature (finding)

Ontology: O/E - tympanic temperature (C1277660)

Concepts Finding (T033)
SnomedCT 315632006, 141491008, 164297000
Spanish al examen: temperatura timpánica (hallazgo), al examen: temperatura timpánica (categoría dependiente del contexto), al examen: temperatura timpánica
English On examination - tympanic temperature, O/E - tympanic temperature (finding), O/E - tympanic temperature, On examination - tympanic temperature (context-dependent category), On examination - tympanic temperature (finding)