Skill List > Temperature Recording: Tympanic Thermometer
Clinical Alert
Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Based on Nicol: Essential Nursing Skills 4E
Adapted by: Beatrice Moran MA LLB(Hons) Higher Cert Ed RGN
Updated by: Tanya Middlehurst MSc BSc(Hons) RN
Last updated: July 2017
Learning Objective
After reading the skill overview, watching the video, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of temperature recording with a tympanic thermometer.

Introduction

Body temperature can be considered as the balance of heat lost from the body and gained by the body (Johnson 2007). A healthy body maintains its temperature within a narrow range using homeostatic thermoregulation mechanisms (Pocock & Richards 2009). Johnson describes the normal range of body temperature as 36–37.5°C (Johnson 2017), but this may vary by as much as 0.6°C according to the site used for measurement and from individual to individual. 

Fluctuations in body temperature occur naturally as a result of circadian rhythms, extremes of age (the young or elderly are unable to maintain an efficient equilibrium in thermoregulation), exertion or exercise, food intake, hormonal balance (e.g., ovulation), medication or alcohol, smoking, or deteriorating physiological function (e.g., shock, infection) (Johnson 2007, Dougherty et al. 2015).

The following terms are used to describe abnormal temperature ranges:

  • Mild hypothermia (32–35°C).
  • Moderate hypothermia (28–32°C).
  • Severe hypothermia (below 28°C).
  • Mild pyrexia (depending on the patient’s normal baseline temperature, 37.2–38.9°C).
  • Hyperthermia (above 40.6°C).

According to Sund-Levander and Grodzinsky, assessment and evaluation of body temperature is one of the oldest known diagnostic methods and still has a huge influence on decisions about medical diagnosis, nursing care, treatment, and requesting laboratory results (Sund-Levander & Grodzinsky 2010). Body temperature is useful in monitoring health and illness as it reflects the ability of the body to manage heat loss and gain (McCallum & Higgins 2012).

There are many clinical indications for measuring body temperature:

  • To ascertain a baseline temperature on admission to enable comparisons in the future.
  • To enable close observation in resolving hypothermia or hyperthermia.
  • Temperature changes can indicate the deterioration or improving state of patients with infections, which will inform decision making such as whether to commence antibiotic therapy or antipyretic medication to promote patient comfort (McCallum & Higgins 2012).
  • To observe and monitor the effect of antimicrobial therapy for infection, before and during a blood transfusion for signs of a reaction.

McCallum and Higgins state that body temperature is one of the four main vital signs that must be monitored to ensure safe and effective patient care (McCallum & Higgins 2012). The National Institute of Clinical Excellence (NICE) recommends temperature measurement as part of the initial assessment in acute illness in adults (NICE 2007). More recently, the Royal College of Nursing has collaborated with the Royal College of Physicians (RCP) to produce National Early Warning Scores for acute illness in the NHS and temperature measurement is a key component of this assessment (RCP 2015). The frequency of measurement will depend on the patient’s condition and recorded temperature (Johnson 2007). Frequency of recording may also be identified in local hospital policy (e.g., frequency of recording while receiving a blood transfusion). Nurses should ensure that both the method of taking the temperature and the site used are consistent, and documented to accurately reflect fluctuations, while also taking into account any other factors that may cause a fluctuation. Any changes above or below the normal limits should prompt appropriate reporting and documentation (McCallum & Higgins 2012, Royal College of Nursing First Steps 2017).

It is important that the procedure is carried out in accordance with local policies and procedures and that the manufacturer’s instructions are followed.

Commonly used noninvasive temperature measurement sites include the mouth, axilla and the aural route using the tympanic membrane (McCallum & Higgins 2012). They go on to say that as temperature measured between these sites can vary greatly, the same site should be used consistently.

Tympanic thermometers measure the temperature by inserting a probe into the outer ear, adjacent to (but not touching) the tympanic membrane. An infrared light detects heat radiated from the tympanic membrane and provides a digital reading. This usually takes only a few seconds, and an audible signal indicates that the reading is complete. This provides an accurate measure of body core temperature as it is close to the carotid artery (Gasim et al. 2013).

Preparation and safety

  • If the patient has been lying on one side, use the other ear to avoid the risk of an inaccurate reading.
  • Wax in the ear may lead to an inaccurate reading.
  • Hands must be clean.
  • Additional personal protective clothing may be necessary if indicated by the patient’s condition.
  • The equipment should be cleaned before and after use according to local policy.

 Procedure

  1. Explain the procedure to the patient and gain consent and cooperation. To obtain an accurate recording the patient should be rested and relaxed.
  2. Switch on the thermometer.
    Rationale – To ensure the equipment is in working order.
  3. Use a non-touch technique to fit a disposable cover.
    Rationale – To prevent cross-contamination from the nurse to the equipment.
  4. Pull the pinna gently towards you and place the covered probe into the ear canal. Ensure a snug fit then press the scan button.
    Rationale – A snug fit is required for an accurate temperature reading (Davie & Amoore 2010).
  5. When the audible signal is heard, remove the probe from the ear. The temperature is shown in the digital display box.
    Rationale – The relevant time has elapsed for an accurate reading of the temperature.
  6. Use a non-touch technique to discard the cover into the locker bag or clinical waste bag.
    Rationale – To avoid cross-contamination.
  7. Document the temperature accurately according to local policy.
    Rationale – To facilitate communication and ongoing nursing care.
  8. Report any variation from previous recordings.
    Rationale – It is vital to report any concerns to the nurse in charge or the doctor.
  9. Return the equipment to the designated area. The equipment should be cleaned according to local policy.
    Rationale – To facilitate future use. If appropriate, plug into the mains to charge.
  10. Wash your hands.
    Rationale – To prevent cross-infection.

 Ongoing care, monitoring and support

  • Ensure patient comfort.
  • Answer any questions regarding the recording.
  • Use a non-touch technique to remove the cover, and discard into clinical waste.
  • Return the thermometer to the charging point or storage area, as appropriate.
  • Document the temperature according to local policy.
  • Report any abnormality. The normal range for adults is 36–37.2°C.

 Documentation and reporting

  • According to the Nursing and Midwifery Council, good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care (Nursing and Midwifery Council (NMC) 2015).
  • Accurate documentation and prompt reporting of any changes in temperature is vital for patient safety. Early Warning Score (EWS) documentation is now widely used in hospitals, which gives parameters and guidance about the appropriate action to be taken if the temperature is above or below the normal (Donaghue & Endacott 2010).
  • Through documentation, registered nurses communicate to other nurses and members of the multidisciplinary team their assessment about the status of the patient. Documentation and reporting must be in line with local hospital policy.
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