An observational study of temperature and thermal images of surgical wounds for detecting delayed wound healing within four days after surgery.

AIM: To elucidate the infrared thermal patterns and temperature readings of the surfaces of surgical wounds for detecting delayed wound healing within four days after surgery. BACKGROUND: The nursing assessment of surgical wounds within the first four days after surgery is commonly based on visual and physical examination. Surgical wounds with delayed healing may be not detected if they do not exhibit signs such as redness or exudate within four days after surgery. DESIGN: This study was conducted using prospective observational design with reference to the STROBE Statement (see Supporting Information Appendix S1) to examine the temperatures of surgical wounds in their natural settings. METHODS: Based on convenience sampling, 60 participants admitted to the colorectal surgical ward for enterostoma closure from January-November 2013 were recruited. RESULTS: Although both infected and noninfected surgical wounds exhibited a significant increase in wound temperature from Days 1-4, the infected wounds revealed a statistically significantly lower temperature than the noninfected ones. Within the infrared thermal images, the infected wounds presented with partial warming of the skin surrounding and along the incision, suggesting that delayed healing could be identified. CONCLUSION: This study demonstrates that delayed wound healing can be detected within the first four days after surgery for early intervention of prevention and treatment before discharge. RELEVANCE TO CLINICAL PRACTICE: This paper provides evidence-based information for healthcare professionals in assessing surgical wounds for delayed healing within the first four days after surgery. The findings herein enable the early detection of delayed wound healing, based on which early intervention of prevention and treatment may be instituted for affected patients before their discharge.

Comparison of temporal artery to rectal temperature measurements in children up to 24 months.

This descriptive study compared temporal artery (TA) and rectal temperature measurements, patient comfort during temperature measurements, and nursing time required to obtain temperature measurements. Study participants (n = 40) included children 0-24 months old with fever higher than 38°C, admitted to a freestanding children's hospital in the Midwest. Statistical analysis of 450 paired TA and rectal temperature measurements revealed a 0.776 correlation, mean difference of 0.03°C, and 94.7% of measurements differing by less than 1.0°C. Patient comfort, measured via the Face, Legs, Activity, Cry, Consolability Scale, was enhanced with TA thermometry compared to rectal. TA thermometry resulted in an 87% savings of nursing time.

Best practice in the measurement of body temperature.

In the last two decades, there has been a significant change in the technology of clinical thermometry. Mercury-in-glass thermometers have been replaced with electronic devices that offer faster readings with minimal inconvenience to the patient. Each user should be aware of the characteristics and limitations of these devices to interpret correctly the temperature reading on the display. The article provides an insight into commonly used clinical thermometers, how they determine each temperature reading and, crucially, how users affect the measurement process.

What is the evidence base for the assessment and evaluation of body temperature?

Measurement and management of body temperature is often based on traditionand personal ideas and beliefs rather than evidence based knowledge. This article summarises the literature to provide a guide to evidence based assessment and evaluation of body temperature in clinical practice.

Tympanic thermometry--normal temperature and reliability.

AIM: Clinical measurements such as temperature are commonly used for screening and diagnosis. However, little is known about the reliability of specific thermometers or measurement techniques. METHODS: This study sought to define normal tympanic temperature and to assess the reliability of tympanic thermometry. Using a cross-sectional survey design, 244 children aged between one and six years at a paediatric outpatients department had their temperature recorded three times in each ear using a Braun Thermoscan thermometer. RESULTS: Mean temperature was 36.65 degrees C with an overall repeatability statistic of 0.78 degrees C, 0.55 degrees C in the left ear and 0.64 degrees C in the right. The level of measurement error did not increase with temperature, or differ between ages. Environmental temperature had only a moderate effect on temperature, and there was no effect from environmental humidity. CONCLUSIONS: Tympanic thermometry using the Braun ThermoScan is a reliable method of temperature measurement, with a temperature change of approximately 0.6 degrees C being significant. Although the effects of environmental conditions were slight, these were in temperate conditions. This study should be repeated for other models of thermometer.

Reliability of body temperature measurements in hospitalised older patients.

AIMS AND OBJECTIVES: To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings. BACKGROUND: Axillary gallium-in-glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well-functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people. METHODS: Patients (n = 107; aged 65-104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium-in-glass thermometer, with (T(nurse)) and without (T(self)) the nurse's assistance; the electronic axillary thermometer (T(el)) and the infrared tympanic thermometer (T(tymp)). The T(nurse) was considered as the reference method. RESULTS: Mean difference and standard deviation (mean +/- SD) in temperature recordings between the different techniques and T(nurse) differed significantly from zero for T(self) (-0.40 SD 0.42) and T(tymp) (+0.19 SD 0.48). No significant differences in temperature recordings emerged between T(nurse) and T(el). In simple linear regression models, the difference between T(self) and T(nurse) significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments. CONCLUSION: Unassisted gallium-in-glass axillary temperature assessment is inadequate, in older patients. The differences between T(self) and T(nurse) are significantly influenced by age and mental decline. T(el) provides adequate accuracy. Relevance to clinical practice. In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium-in-glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).

Tympanic membrane versus temporal artery temperatures of adult perianesthesia patients.

Reaching preoperative temperature stability is a critical discharge criterion afer anesthesia and surgery. Although numerous methods of measuring temperature exist, tympanic membrane (TM) thermometers have replaced oral thermometers in most perianesthesia units. With reliability of tympanic temperature readings being questioned in numerous reports and by many practitioners, the temporal artery (TA) thermometer has gained popularity among perianesthesia nurses for its noninvasive approach and ease of operation. A prospective study was undertaken to determine the ability of the TA thermometer to substitute for the TM thermometer in adult perianesthesia patients.

Sudden increase in skin temperature predicts venous ulcers: a case study.

Venous ulcers affect approximately 2.5 million adults with chronic venous disease (CVD). Venous ulcers are a significant health problem with a reoccurrence rate as high as 72%. There is a critical need for a prediction/prevention model of venous ulcers that includes objective methods to assess the skin. Among individuals affected by CVD, skin temperature is elevated in the lower extremities. This case study of a patient with CVD highlights the potential predictive usefulness and feasibility of measuring skin temperature with an infrared dermal thermometer as part of the standard of care for venous ulcer prevention.

Temperature measurement in children with cancer: an evaluation.

There is little agreement as to the most appropriate thermometer, the anatomical site to carry out temperature measurement in children with cancer, or the type of thermometer preferred by the patients. The authors carried out this study to assess temperature measurement in children with cancer who were admitted for febrile episodes. The body temperatures of children with cancer who were admitted consecutively between January and October 2005 to the paediatric department because of febrile episodes were measured on admission and over the next 24-36 hours using an electronic thermometer sublingually as the standard reference site. These measurements were compared with those obtained with two ear-based thermometers, a forehead thermometer, and from the axilla (representing current practice). The parents were asked about the type of thermometer they used at home and the children were asked about the type of thermometer they preferred. There were 34 admissions during this period, of which 19 (56%) were confirmed as febrile. Altogether, 108 sets of temperature measurements were obtained, producing a total of 540 measurements from these admissions. Measurements with the two ear-based thermometers in febrile children achieved higher sensitivity than that with axillary and the forehead measurements. The ear-based thermometer was the most common type used at home while the forehead thermometer was the one preferred by the children. In conclusion, ear-based temperature measurements in febrile children were more accurate than axillary and forehead temperature measurements. The current practice of axillary temperature measurement needs to be re-considered.

Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science.

Accurate temperature measurement is critical to the assessment and management of temperature fluctuation in the acutely ill adult. Unfortunately, an accurate, noninvasive method to measure core temperature has yet to be established, and current instruments produce a wide range of temperatures for any given patient. This article provides an integrative review of studies comparing selected invasive and noninvasive temperature measurement methods in acutely ill, hospitalized adult patients. Medline and CINAHL databases were searched to locate published studies on temperature measurement in the adult hospitalized patient. A partial list of primary search terms included core temperature measurement, oral temperature measurement, temporal artery thermometry, and tympanic thermometers. Studies that were data based and included comparison of a tympanic, temporal artery, and/or oral noninvasive temperature measurement to a pulmonary artery or esophageal invasive core measurement in an adult population were included in the analysis. The search method produced 223 publications and abstracts for initial review; 23 (10%) met the inclusion criteria. The only study evaluating the use of temporal artery thermometry in the adult population found the instrument to be unreliable. Results also indicate that high-quality evidence supporting the accuracy of tympanic thermometry, the preferred instrument for noninvasive core temperature measurement in many acute care settings, is lacking, and in fact, the most recent high-quality studies evaluating the accuracy of this instrument fail to show support for its use. Evidence does, however, support the use of oral thermometry as an accurate means of temperature assessment in the adult, acutely ill population.

Using Noncontact Infrared Thermography for Long-term Monitoring of Foot Temperatures in a Patient with Diabetes Mellitus.

Foot complications in persons with diabetes mellitus (DM) are associated with substantial costs and loss of quality of life. Increasing evidence suggests changes in skin temperature, measured using an infrared thermographic system (IRT), may be a predictor of foot ulcer development in patients with DM. The purpose of this case study is to describe the long-term IRT findings and overall clinical outcomes of a patient with DM and peripheral vascular disease. Foot temperature measurements using IRT were obtained slightly more than 1 year before and immediately following endovascular treatment of a 76-year-old man, a nonsmoker with type 2 DM, hypertension, and ischemic heart disease with cardiac arrhythmia. Although he was otherwise asymptomatic, the infrared measurement showed an average temperature difference of 2.3˚ C between the left and right foot until he developed a small, trauma-induced wound on the left foot, at which time left foot temperature increased. He was diagnosed with rectosigmoid adenocarcinoma, underwent surgery and chemotherapy, and subsequently was evaluated for peripheral vascular disease. Before undergoing peripheral angiography and percutaneous transluminal angioplasty, IRT evaluation showed a hot spot on the left heel. Immediately following endovascular treatment, the mean temperature difference between the right and left foot was low (0.2˚ C), but a Stage I pressure ulcer was visible on the left heel. Skin breakdown in that area was observed 2 months later, and the wound continued to increase in size and depth. The patient died shortly thereafter due to complications of cancer. In this case study, a series of infrared images of foot skin temperatures appeared to show a relationship with blood circulation and wound/ulcer development and presentation. IRT has the ability to instantaneously measure the absolute temperature of the skin surface over a large area without direct skin contact. However, the devices are very sensitive and prospective clinical studies to determine the validity, reliability, sensitivity, and specificity of these measurements for routine use in patients who are at risk for vascular disease and/or foot ulcers are needed.

Unit-based product evaluation: Part 1: Comparison of pulmonary artery and tympanic membrane temperature.

Although new products go through rigorous study before FDA approval, it is still important to evaluate the product for use with your nursing protocols and patient population. This author describes a product evaluation project conducted in the critical care units at her agency and gives advice on how to set up similar product evaluation studies in your setting.

[Axillary temperature compared to tympanic membrane temperature in children]. / Aksillêre temperatuur vergelyk met timpaniese membraan temperatuur in kinders.

The purpose of the study was to measure the axillary temperature at three, six and nine minutes in a hundred children between the ages of one and twelve years who were selected in a non-random deliberate way, and to compare the measurements with the tympanic membrane temperature (golden standard) which was measured in the test persons at the same time. The results were described by sensitivity, specificity, limits of agreement, and predictive values. From some of the findings of the research it is apparent that the axillary temperature reading increased after measurement of three, six and nine minutes. A maximum temperature reading was reached after three minutes in only 9% of the test persons, in 25% after six minutes and in 66% after nine minutes. From the findings it is clear that the ranges that were used influenced the sensitivity of the measurements, and it would appear that the range 35.5 degrees C to 37.2 degrees C was the best range to measure pyrexia in the age group one to 12 years. The 9-minute measurement then had the highest sensitivity. However, the specificity of measurement in this range was lower. The conclusion was drawn that axillary temperature measurement is an acceptable method, with certain reservations, to use as screening method for pyrexia in emergency divisions or clinics.

Tympanic membrane vs. pulmonary artery thermometry.

Studies that compare tympanic membrane thermometry with other thermometry methods conflict. Research at this facility suggests clinically significant discrepancies, which preclude expanding its tympanic thermometer use.

Tap in on ear thermometry.

In February 1992, nursing departments at The Mississauga Hospital, a 530-bed community hospital in Southern Ontario, purchased First Temp Genius ear thermometers to replace the electronic predictive thermometers then in use. Ear thermometers collect infrared heat radiation from the ear canal with a probe, then convert the radiation to a temperature reading. Although quick and easy to use with patients of all ages, there are nonetheless some issues concerning their use that still must be addressed.