Reference Manual - Exergen Corporation
Contents
1. Oral 96 6 99 5 F 35 9 37 5 C Oronasal 96 6 99 0 F 35 9 37 2 C Axillary 95 5 98 8 F 35 3 37 1 C Esophageal 98 4 100 0 F 36 9 37 8 C Rectal 97 7 100 3 F 36 5 37 9 C Normal Body Temperature BT Normal BT is not a single temperature but a range of temperatures influenced by age time of day and the measurement site General Rule of Thumb On a stable resting patient rectal temperature is 2 F 1 C higher than axillary and 1 F 0 5 C higher than oral temperature On a stable resting patient arterial temperature rectal temperature Expect the Differences Arterial temperature measurement PA Catheter TA Thermometry leads all other methods in identifying fever or defervescence unaffected by activities of daily living It will some times be different from your present methods but accurate 14 Guidelines for Patient Temperature Assessment Fever Definition Clinically fever is defined as a BT 1 8 F 1 C above the mean standard deviation at the site of recording A single oral temperature of 101 F 38 3 C in the absence of obvious environmental causes is usually considered fever An oral temperature of 100 4 F 38 0 C over at least 1 hour indicates a fever state Oral Temperature Risks Oral temperature can be clinically misleading and many febrile patients can have a normal temperature even when tachypnea w2. a bd Arrrrghhh n case youd like to know E e though temperature in your heart is s gt around 99 4 F Your temporal arteries There is a special place on your head where we can measure the same tempera ture as the blood in the mid dle of your heart This is because blood is pumped directly from your heart to your head through little tubes called arteries that carry blood up the sides of your neck up the side of your face just under your skin and stop at at a place on your forehead called your temple Guess what they re called Wow Isn t this the same place your mom touches with her hand when you don t feel good Did you know that the forehead has been used to detect fevers as far back in time that anyone can remember over 2000 years There s a new technology that scans the same place your mom touches and it s almost as gentle It s an infrared thermometer called the TemporalScanner It measures your temperature with a quick and gentle scan across your forehead Most of the time temperature here is around 99 4 F same as your heart Nothing goes in your mouth your ear or your rear and in just a second or two done Now where is the best place to take your temperature Care and Maintenance e Battery A standard alkaline 9V battery provides approximately 15 000 readings To replace loosen the single screw at the bottom of the instrument and remove the battery cover Disconnect the old batt
3. fevers Oral temperature can be mislead ingly lowered by patient activity such as tachypnea coughing moaning drinking eating mouthbreathing snoring talking etc Alarmingly another cause of low oral temperatures is the fever itself For each 0 6 C 1 F temperature elevation the pulse rate usually increases approximately 10 beats per minute there is a 7 increase in oxygen consumption increas ing the respiratory rate approximately 2 cycles per p minute The resulting increase in respiration can further lower oral temperature sufficiently to mask a fever N 310 Figure 1 is of interest as it illustrates fever masking even Tess when clinicians had eliminated all obvious mouth breathers from the study This emergency room study presents the temperature difference rectal minus oral in 310 patients with a wide range of respiratory rates The Straight line of best fit is shown The stippled area demonstrates the traditional normal difference between rectal and oral temperature 0 3 0 65 C The investi Pd F a E m x T a tp i 1 Y P k a hile Ti oe 2g mar p P a EIA a ed E Sees a ae eg jei e le lan a zE es 7 n ee ate E z ji ii JAT _ a p ee ee a eee ee nm C TEMPERATURE DIFFERENCE 9C ee o 40 gators concluded that many patients with tachypnea RESPIRATORY RATE MIN would have oral temperatures in the normal range Figure 1 Temperature Difference Rectal despite the
4. As a site for temperature measurement the temporal artery presents many ben efits it poses no risk of injury for patient or clinician eliminates any need for dis robing or unbundling and is suitable for all ages Table of Contents Table of Contents Important Safety Instructions Product Map Introduction to Temporal Artery Thermometry Familiarize Yourself with the TemporalScanner Using the Instrument Using the Instrument on a New Mother Using the Instrument on an Infant Frequently Asked Questions Disposable Cover Options Accessories Guidelines for Patient Temperature Assessment Comparing with other methods of thermometry Determining a Fever Threshold Body Sites for Temperature Assessment An overview of temperature measuring sites Reproducibility in Temperature Measurement Forgotten Physiology For Kids Only Care and Maintenance of the Instrument Page s Oo CGO N oOo W N 10 13 13 13 14 15 16 17 18 19 20 21 22 23 25 Before Using Familiarize Yourself with the Instrument e To Scan Depress the red button The instrument will continually scan for the highest temperature peak as long as the button is depressed e Clicking Each fast click indicates a rise to a higher temperature similar to a radar detector Slow clicking indicates that the instrument is still scanning but not finding any higher temperature e To Retain or Lock Reading The reading will remain on the display for 30 seconds afte
5. EXERGEN TemporalS canner More accurate than ear gma eras Harvard Medical stam choo study on infants 4 Accurac Compara to rectal multiple hospital y le studies Compared to cold tip thermometers 1 Greenes DS Fleisher Accuracy of a noninvasive temporal artery ther mometer for use in infants Arch Pediatr Med 2001 Mar 155 3 376 381 CO _ C qe C Se Gam Oo Model TAT 5000 Important Safety Instructions READ ALL INSTRUCTIONS BEFORE USING When using the product especially when children are present basic safety precautions should always be followed including the following If you have any additional questions regarding use or care of the thermometer please see www exergen com or call customer service at 617 923 9900 Use this product only for its intended use as described in this manual Do not take temperature over scar tissue open sores or abrasions The operating environmental temperature range for this product is 60 to 104 F 15 5 to 40 C Always store this thermometer in a clean dry place where it will not become excessively cold 4 F 20 C or hot 122 F 50 C The thermometer is not shockproof Do not drop it or expose it to electrical shocks Do not Autoclave Please note cleaning and sterilizing procedures in this manual Do not use this thermometer if it is not working properly if it has been exposed to tempera
6. a is artery area In this case the only option in this behind the ear could be case as the neck area is alternate site as both are not exposed exposed Temperature at the Temporal Artery Area 1 Gently touch probe to center of forehead Pref a 1 Pe j v Depress red button and keep depressed 5 a p 2 Slide probe over the TA area into hairline Ne y f more convenient slide from hairline towards center of forehead 3 Release button remove from head and record Temperature Behind the Ear 1 Gently nestle probe on neck behind the ear Pre v Depress red button and keep depressed ete 2 Maintain skin contact until numbers stop Wea 3 Release button remove from head and record Questions Please call us at 800 422 3006 uejuj Ue uo JaUUeIS e1OdW9 y BuIsn Frequently Asked Questions Frequently Asked Questions What is the TemporalScanner The TemporalScanner is an infrared thermometer designed for accurate completely non invasive temperature assessment by scanning the temporal artery TA tis breakthrough technology How does it work Temperature is measured by gently stroking the TemporalScanner across the forehead and includes a momentary touch of the probe to the neck area behind the ear lobe to account for any cooling of the forehead as a result of diaphoresis The patented arterial heat balance technology AHB automatically measures the temperature of the skin surface over the art
7. a portable blackbody A portable blackbody is a reference heat generator Figure 1 which is a self contained device providing a stable reference target temperature in the clinical temperature range The device is then used to verify the calibration of any Exergen thermometer in question or for quality checks done on a routine basis The verifier operates with either a 9 volt power supply plugged directly into any 120 vac wall receptacle allowing extended use in the laboratory or it can be completely powered by a 9 volt bat tery for portable use on the nursing floors There are two ways to use the portable blackbody to verify the calibration accuracy of the thermometer in question either 1 with a certified master reference infrared thermometer or 2 by using two identical ther mometers as a reference against the one in question 25 SOUBUDd UIeIY pue aed Care and Maintenance Using the Portable Blackbody 1 Turn on the verifier device using either a 9 volt battery or the power supply Make sure the red LED is illuminated Allow device 5 minutes for warm up and stabilization time Allow certified master or the two reference thermometers and the instrument to be tested to acclimate in the same ambient temperature for at least 10 minutes For all instruments make sure the lens at the tip of the probe is clean To clean use an alcohol prep or a swab dipped in alcohol followed by a damp wipe with water to remove a
8. after ingesting hot or cold food or drink after exposure to extremely hot or cold weather and after smoking Ear Temperature The journals abound with citations addressing the lack of reproducibility of ear thermometers In fact Thermoscan instructs the user to take three separate temperature measurements and to select the highest of the three While much of this has to do with the device physiology also plays a large part In such a small area the difference of 30 F 17 C between the room temperature probe and the temperature of the ear being measured results in a noticeable tissue cool down Geriatric patients typically have a lower rate of perfusion than a younger individual and it can take several minutes for the ear to equilibrate following the use of an ear thermometer Rectal Temperature Time and placement is critical for rectal temperature measurement It has long been recommend ed that the measurement be taken for at least five minutes or more for accuracy The measure ment is also dependent on the depth of insertion and just a few centimeters can result in a notice able difference Temporal Artery Temperature Because of the expanse of area being measured and the normally strong perfusion of the artery in particular temporal artery temperatures should be as reproducible as any other method There may be slightly more variability observed in normothermic conditions compared to febrile condi tions but it is minimal Of inter
9. age prepaid 27 SOUBUDd UIeI pue 31e Fr i Symbol for Date of Manufacture ual Symbol for Manufacturer R Type Bf Applied Part Attention Consult Accompanying Documents o On only for part of Equipment asd Do not throw this device away in the trash contact ees Exergen Corp for disposal and recycling instructions IPXO Ordinary Equipment Degree of Protection Against Type Bf Battery Operated cE Shock US 0197 225641 Vf EXERGEN Straight From the Heart EXERGEN CORPORATION 400 PLEASANT STREET WATERTOWN MA 02472 PH 617 923 9900 www exergen com p n 818528 r5
10. as the TA but only during diaphoresis or with head trauma as previously mentioned What are the benefits of using temporal artery thermometry Besides the inherent accuracy of the method TAT presents no risk of injury for patient or clinician eliminates the need for disrobing or unbundling and is suitable for all ages What is arterial temperature Arterial temperature is the same temperature as the blood flowing from the heart via the pulmonary artery It is the best determinant of body temperature and unaffected by the artifactual errors and time delays present with oral and rectal methods How does the TemporalScanner compare to our old method Arterial temperature is close to rectal temperature approximately 0 8 F 0 4 C higher than oral temps Expect larger differences at times however as the dynamics of thermoregula tion favor the temporal artery method High readings Temperatures measured with TemporalScanner may be higher than your current method especially if you are used to oral or axillary temps Oral and axillary temperatures can be misleadingly lowered due to patient activity such as mouth breathing drinking tachypnea coughing talking etc and periods of vasoconstriction during the fever process Any or all of these conditions may even mask fevers that the TemporalScanner will detect Low readings A patient s temperature measured with the TemporalScanner is normally never appreciably lower than oral temperat
11. as unobserved Rectal Temperature Risks Rectal temperature should only be considered as a good approximation of core temperature when the patient s thermal balance is Stable When monitored during or after surgery rectal temperature measurement is not suitable and the possible delay in diagnosis of a thermal abnormality could lead to an irreversible crisis Axillary Temperature Risks Axillary temperature is contraindicated in critically ill adults and its use in the general patient population should be discouraged due to its unreliable correlation with core temperature and its poor reproducibility Temporal Artery Temperature TAT Values On a stable resting patient TAT is 0 8 F 0 4 C higher than an optimum oral temperature and close to a rectal temperature However during febrile episodes the difference can be much higher mainly because of the artifacts of oral and rectal sites Comparison Between Sites Review of published literature reveals mean differences between non IA sites of 0 4 to 3 1 F 0 2 to 1 7 C with the actual differences of up to 6 5 F 3 6 C routinely reported especially in febrile patients References 1 2 3 N Kuzucu EY Measurement of temperature Int Anesthesiol Clin 3 3 435 49 May 1965 El Radhi AS Carroll JE Fever in Paediatric Practice Ch 2 pp 15 49 Oxford Blackwell Scientific Publications 1994 Hughes WT et al 1997 Guidelines for the use of antimicrobial age
12. ce in thermal homeostasis However this early data on hypothalamic temperature was measured by a thermocouple inserted against and often times perforating the tympanic membrane With significant improvements in the methodology more recent clinical observa tions show that the time constant of rectal temperature in critically ill patients may be consid erably longer and in some cases as much as a day 17 ju wuss ssy nzes dw 10 S S Apog Body Sites for Temperature Assessment Under certain conditions rectal temperature is even contraindicated for example severe arterial insufficiency in one or both legs might be associated with falsely low readings or in conditions affecting peripheral blood flow such as cardiogenic shock More common con traindications include neutropenia severe hemorrhoids and recent anorectal surgery A less common but serious complication of rectal temperature measurement is perforation of the rectum which has even occurred in the absence of predisposing rectal pathology Rectal temperature measurement is not well tolerated by either the patient or the care givers and is uncomfortable and embarrassing Rectal temperature is subject to inaccura cies of placement environment and time of insertion And although it is well established that a rectal temperature requires two to five minutes or more to reach optimum measure ment with a glass mercury thermometer in practice many are withdrawn in just one
13. e of blood flow on the neck can be assured is following head trauma either surgical and accidental At such times the neck area behind the ear lobe can be used as a primary site if the forehead is not available If perspiration or head trauma is not present the area on the neck behind the ear lobe may not have sufficient blood flow to be reliable and should not be used as the primary meas urement site If there is heavy perspiration including moisture behind the ears wait until area is dry For use on exercising athletes or other non clinical subjects contact Exergen 21 ABojoisAudg ua 06b10 4 For Kids Only WN i My Did you know you always have a tempera ture Bet you thought you only had a tem a perature when you were sick Absolutely Aa everything has a temperature even icicles es A Brrrrrr When you don t feel well your mom or a nurse might say let s see if you have a temperature but what they really mean is let s see if your temperature is different from normal i tie So when you have your temperature taken don t be fooled Your mom and your doctor already know you have a temperature and are just getting an idea of how things are going inside your body Places to measure your temperature Your bum Babies and little kids get their temperature taken is in their bum Poor little kids how embarrass ing The temperature taken in your bum is the hottest of all the places to take tempe
14. emporal artery make for variability with each separate measurement This can be confusing for clinicians since they expect the same number with each measurement The non reproducibility of the readings however is not a function of the devices but simply a function of physiology The human body is a myriad of small gradients and variability of readings will occur on every method of temperature measurement In addition thermometers are at room temperature nearly 30 F 17 C cooler than the tissue being measured That said it is then easily recognized how time of insertion probe placement and tissue cool down all affect reproducibility of temperature readings no matter what device is employed Oral Temperature Heat Pockets By far the most common method of temperature measurement is sublingual measurements Placement of the probe under the tongue however can result in substantial differences and caused by just a slight repositioning of the probe The standard heat chart commonly used by manufacturers of electronic ther mometers on the right illustrates a difference of nearly 2 F 1 C depending on exactly what area is being touched by the probe Differences from repeated oral temperatures can vary even further as they can superimpose artifactual errors over the thermal gradi ents Patient activities also affect the reading these varying by individual and activity In fact one large manufacturer cautions waiting at least 15 minutes
15. ery and replace with a new one in the same location Replace the cover and tighten the screw Use only high quality alkaline batteries or equivalent Si e Handling The TemporalScanner is designed and built to EEE durability standards in order to provide long and trouble free service However it is also a high precision optical instrument and should be accorded the same degree of care in handling as you would provide other precision optical instruments such as cameras or otoscopes e Cleaning the case The TemoralScanner case can be wiped down with any hospital approved disinfectant including bleach e Cleaning the sensor lens With normal use the only maintenance required is to keep the lens on the end of the probe clean Itis made of special mirror like coated silicon infrared transmitting material However dirt greasy films or moisture on the lens will interfere with the passage of infrared heat and affect the accuracy of the instrument Regularly clean the lens with a cotton swab dipped in alcohol in accordance with the instruction label on the instrument see below Use only light force for cleaning to avoid damaging the lens Water can be used to remove any residual film left by the alcohol Do not use bleach or other cleaning solutions on the sensor lens 3 Fa iiia low i amp Clean centerlens CLEANING INSTRUCTIONS every two weeks with ON THE TAT 5000 we we and alcohol e Sterilization The industrial grade ho
16. ery and the ambient temperature It samples these readings some 1000 times a second ultimately recording the highest temperature measured peak during the course of the measurement The TemporalScanner emits nothing it only senses the natural thermal radiation emitted from the skin How accurate is it It has been clinically proven in premier university hospitals to be more accurate than ear thermometry and better tolerated than rectal thermometry It is a superior method for patient and clinician alike What if the TA area has been traumatized by burns or lacerations or is completely covered with dressings With head trauma surgical or accidental the temperature can be obtained from the alternative site behind the ear lobe As with diaphoresis the perfusion will be high in the presence of head trauma Why measure behind the ear lobe Sweat causes evaporative cooling of the skin on the forehead and introduces the possi bility of a false low temperature Fortunately for the method during diaphoresis the area on the head behind the ear lobe will always exhibit the high blood flow necessary for the arterial measurement 10 Why not use only the area behind the ear lobe Since the arterial branch is deeper behind the ear lobe than at the temple under normal conditions it is less accurate because of its variability But under diaphoretic conditions the blood flow behind the ear lobe is as high as at the TA making it as accurate
17. est the temporal artery area will equilibrate in the shortest period of time compared to any other site For absolute accuracy however it is recommended to wait 30 60 seconds before repeating a temperature on the same side although depending on the individual the time involved can certainly be much shorter The limitation in time is almost entire ly the behind the ear measurement as the perfusion rate per tissue mass is not quite as high as the temporal artery Since the method employs the area behind the ear with every measurement this area is the time limitation 19 sbulpesy jo Ayyiqionpoiday Forgotten Physiology Your Temperature Normal Temperature Normal human temperature is around 98 6 degrees But did you know that only 8 of the people in the world have a nor mal temperature of exactly 98 6 A temperature that is normal for you may even be a whole degree or so above or below normal It is good to know what is normal for you Try taking your temperature at dif ferent times like in the morn ing after a cold shower or a five mile hike Fever Fever is when your body s temperature control is set above normal Fever is a sign that your body is fighting off an infection It is thought that fever does two things Hot Blood or Cold Blood A frog in a 70 degree pond is a 70 degree frog A frog in a 40 degree pond is a 40 degree frog and is moving very slowly if at all A kid in a 70 degree pond
18. face Midline over the TA area the TA is less than 2mm below skin surface whereas as the TA winds down the side of the face it is further from the skin surface Although anatomically correct sliding downwards would result in falsely low readings e It is preferable to hold the instrument sideways as illustrated in Figure 2 Approaching your patient with the instrument straight up and down could be somewhat intimidating e When making the measurement behind the ear as in Figure 3 tuck the thermometer under the ear lobe in the soft conical depression on the neck just below the mastoid This is the place where a dab of perfume is typically applied Using on an Infant e An infant is apt to present bundled with blankets and clothing covering the neck area Fortunately the perfusion rate is normally strong for infants and unless visibly diaphoretic one measurement at the TA is typically all that is required Should you feel the temperature is low then push aside any clothing or blankets covering the neck area for 30 seconds or so and repeat the measurement behind the ear Basics of Using the TemporalScanner JauUUeIS e1OdWwa y buisn Measure only the exposed side Brush hair away if covering ear Brush hair aside if covering the TA area 1 With probe flush on the 3 Lift probe from forehead center of forehead depress and touch on the neck just red button keep depressed behind the ear lobe 2 Slowly sl
19. g slow to a little less than 1 per second the peak temperature has been reached Any of the above indications can be used to assure the peak temperature has been reached Remove the instrument from your palm and release the button and note the reading on the display The reading will be locked on the display for 30 seconds unless you press the button before that time Repeat the above steps and you should get the same or very close to the same number since your hand will usually not appreciably change temperature very quickly JUSWINAJSU 9U UJIM JJOSINO OzZUeYIWe Familiarize Yourself with the Instrument Practice Holding Your TemporalScanner The TemporalScanner is ergonomically designed specifically for its application It s best to hold the instrument with your thumb on the red button much like you would hold a remote control Along with allowing you to easily read the temperature display you will auto matically be using finger dexterity to gently position the probe pro viding comfort and safety for your patient and consistently accu rate temperature readings Things To Know Before Taking Temperatures e Measure only the exposed side Anything covering the area to be measured would insulate it and prevent the heat from dissipating resulting in falsely high readings Brush hair aside if covering the TA or the area behind the ear e Slide the thermometer straight across the forehead midline and not down the side of the
20. ide probe midline 4 Release the button read across forehead to the hair and record temperature line not down side of face Alternate sites when TA or BE are unavailable e Femoral artery slowly slide the probe across groin e Lateral thoracic artery slowly scan side to side in the area midway between the axilla and the nipple e Ax illa insert probe in apex of axilla for 2 3 seconds Questions Please call us at 800 422 3006 Using the TemporalScanner on a New Mother Using the TemporalScanner on a New Mother e Measure exposed skin e Keep the red button depressed throughout measurement Brush bangs aside if present 1 With probe flush on center of forehead depress red button 2 Slowly slide probe across the forehead into the hair line 3 Lift probe from forehead Brush hair away if covering ear 4 Touch probe to neck just behind the ear lobe 5 Release button read and record temperature e Temperature will remain on display for 30 seconds after the red button is released e Sequence can be restarted at any time without waiting for display to clear Questions Please call us at 800 422 3006 Temping Baby in Bassinette Open Crib or with Mom e Instrument should be in same temperature environment as the baby for approximately 20 minutes e Measurement site must be exposed e One measurement preferably at the TA is all that is required Preferred site is the temporal Temporal artery are
21. is a 98 degree kid Akid in a 40 degree pond is still a 98 degree kid although you can bet he s swim ming as fast as he can to get out One difference between kids and frogs is the difference between warm blooded and cold blooded beings People have automatic climate control inside their bodies When the temperature rises the body s chemical actions speed up so that damaged tis sues can be repaired more quickly Also virus or bacteria invaders don t survive well at high temperatures Perhaps fever is the body s attempt to cook them into submission Chills You have a high temperature and cold skin You are hot inside but still you shiver Chills are your body s way of creating a fever The muscle action from shivering produces heat which raises your temperature in an effort to fight off infection When the crisis is over your tempera ture is set back to normal the skin warms and you sweat Their bodies keep themselves at an even temperature by careful ly controlling the rate of burning in their cells Frogs are cold blooded their temperature changes depending 5 on where pt et ed fas they are fant pee pn idadi W ni A Cells begin to bum up are 112 114 3 RE 106 i i tate Dangerous fever a i exercise 101 Excrtement iL rare Some active kids A 4 Ra Wa uted ia ail Pa ono i i i Normal DRO ofa l rie F Cold weather or FA Ea
22. ke the measurement One is a long thin ther mocouple probe usually fitted with cotton at the end that must come in contact the tympanic membrane There is much historical data on the efficacy of tympanic thermometry using con tact thermocouples stemming originally from work done over thirty years ago However this method never gained wide acceptance due to the risk of injury to the delicate membrane The second is an infrared device the Exergen Ototemp 3000SD which is inserted deep into the ear canal and scanned to view the membrane and is used in military and sports medicine Ear Temperature Ear thermometry is a method of measuring the temperature of the external portion of the ear canal For routine clinical use ear thermometry has been preferred as a simpler faster and more convenient alternative to true tympanic thermometry The absolute temperature of the outer ear however is lower and more variable than tympanic membrane temperature It is subject to a cooling effect resulting from the body heat being radiated to the environment and a heat balance method is required in order to produce the requisite accuracy When combined with an arterial heat balance method ear thermometry provides a highly accurate indication of body temperature but those ear thermometers without it have high rates of missed fevers 18 Reproducibility in Temperature Measurement Multiple temperature readings in the same area mouth rectum axilla ear or t
23. l Illustrated TAT 5000 No Cover No Cover Probe Cap Full Sheath Terminal Disinfectant Covers Entire Covers Entire Cleaning at Wipe Between Probe Instrument Patient Patients Model TAT 5000 All Options Accessories 1 Combination Unit PN 134200 2 Instrument Holder shown with security cable PN 134201 3 Cap Dispenser PN 134202 4 Disposable Caps PN 134203 5 Security Cables 8 ft coiled cable PN 124309 8 ft coiled cable Latex free PN 124311 6 ft vinyl covered steel PN 134302 8 ft vinyl covered steel PN 134030 6 Keyless Self Locking Wall Mount PN 124305 7 Keyless Self Locking Wall Mount shown with resposable cap dispenser PN 124306 13 suoi s no p ysy pu nb ly Guidelines for Patient Temperature Assessment Guidelines for Patient Temperature Assessment Comparing with Other Methods of Thermometry Expect the Differences Unless you are using PA catheters or Exergen aural thermometers with AHB for temperature assessment expect to see differences compared to your current ther mometers Arterial temperature measurement leads all other methods in identify ing fever or defervescence and is unaffected by patient activity Accordingly it will be sometimes be different but correct The following chart presents the mean normal temperature at the common temper ature measurement sites under normal resting conditions Arterial 97 4 100 1 F 36 3 37 8 C
24. minute a technique responsible for misleadingly low readings In fact it is difficult to attribute any thermal significance at all to the rectal area It is not known to contain any thermoreceptive elements and its geographical location distances it from both the CNS and the crossroads of circulation at the heart which are the vital informational elements Tympanic Membrane and Ear Temperature A temperature site of more recent onset is the ear It is a compelling site accessible free from bodily fluids and not easily influenced by patient activity This temperature is measured using infrared technology and there are three types of infrared thermometers tympanic ear and arterial heat balance It has however become common practice to refer to any thermometer making the measurement at the ear as a tympanic thermometer Although the terms tympanic and ear may be used interchangeably they actually describe quite different measurements True Tympanic Membrane Temperature The tympanic membrane is deep inside the skull and is not subject to the artifactual errors that can affect oral rectal axillary and ear temperatures True tympanic thermometers pro vide an uncorrected direct reading of the temperature of the tympanic membrane and are preferred for continual measurement during certain surgical procedures and for use in extreme conditions such as military use research and sporting events There are two types of instruments used to ma
25. nted arterial heat balance system to automatically account for the effects of ambient temperature on the skin uoI ONpo UY This method of temperature assessment has been shown to improve results and reduce costs by non invasively measuring body temperature with a degree of clinical accuracy unachievable with any other thermometry method Temperatures are more reliable than with other methods Fevers are identified sooner Treatment can be initiated sooner We trust you will find temporal artery thermometry is simply a better method Why the Temporal Artery The TAT method was developed in response to the clinical requirements for a truly non invasive accurate method of thermometry Oral thermometry is sub ject to many artifactual errors rectal temperature meets with strong resistance from patients parents and even many clinicians Ear thermometers although convenient are sensitive to technique Some brands are known to miss fevers and it s difficult to consider the use of an aural thermometer when 95 of pedi atric visits concern ear infections A site for detecting fevers with roots dating back to centuries before Christ the temporal artery demonstrated the necessary requirements to meet the stringent demands of clinical medicine today it is easily accessible contains no mucous membranes and notably maintains a relatively constant perfusion rate ensur ing the stability of blood flow required for the measurement method
26. nts in neutropenic patients with unexplained fever Infectious Diseases Society of America IDSA Tandberg D et al Effect of tachypnea on the estimation of body temperature by an oral thermometer NE J Med 308 945 46 1983 O Grady NP Barie PS Bartlett JG et al Practice guidelines for evaluating new fever in critically ill adult patients Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America Clin Infect Dis 1998 May 26 5 1042 59 Houdas Y et al Human body temperature Ch 5 p89 Plenum Press 1982 USA UK Exergen Corporation Manufacturer s data on file Review of subject material peer reviewed journals 15 ju wuss ssy JIN eJOdWd JUSI Eg JO SOUIJBPINS Fever Threshold ining a Determ Determining a Fever Threshold for Temporal Artery Thermometry Threshold Defining Fever e A threshold for defining fever is the temperature level above which false positives due to normal variations in temperature including range of normal mean circadian effects other effects metabolic ovulation etc are unlikely Threshold for Fever Workup e Not all fevers require a fever workup A fever workup is an early management tool in assessment of the likelinood of septicemia or bacteremia and initiated whenever an infectious source is suspected The level of temperature triggering such that investigatory workup is sufficiently high to avoid false positives resulting inunnecessary discomfo
27. ny residue Alternately insert the reference instrument s and the instrument being verified into the aperture opening comparing the readings Portable Blackbody Calibration Verifier Power On LED ON OFF Switch Battery Compartment Power Supply Jack oN Using a Certified Master Reference Thermometer in a Portable Blackbody to Verify Calibration Figure 1 26 e Accuracy Limits Comparison between the reference instrument s and the instrument being verified should be within 0 4 F 0 2 C for acceptable limits If not repeat the process In the event they still differ by more than the acceptable limits call Exergen for repair or replacement of the failed instrument Verifier Specifications Power Source 9 volt battery or 9 volt power supply Battery Life Approximately 1 hour continuous use Low Voltage Indicator Red LED shuts off when battery voltage drops below 5 volts Temperature Range 97 104 F 36 40 C Cleaning Wipe down with alcohol or any hospital approved disinfectant Do not immerse Repair If repair is required e Contact Exergen at 617 923 9900 for a Return Materials Authorization RMA Number e Mark the RMA number on the outside of your package and packing slips Include a description of the fault if possible e Send the instrument freight postage prepaid to Exergen Corporation 400 Pleasant Street Watertown MA 02472 e The instrument will be returned freight post
28. pair if error message persists 24 Specifications TAT 5000 o 0 2 F or 0 1 C Clinical Accuracy Per ASTM E1112 Temperature Range 61 to 110 F 16 to 43 C Arterial Heat Balance Range oc o for Body Temperature ee ne E eee Operating Environment 60 to 104 F 16 to 40 C Response Time 0 04 seconds Battery Life 15 000 readings Time Displayed on Screen 30 seconds 2 0 x 8 0 x 1 25 5 cm x 20 cm x 3 cm Weight 7 5 oz 213 gm Complete copper coating on inside of casing Display Type and Size Large bright LED s Industrial duty impact resistant casing Hermetically sealed sensing system stainless steel probe EMI and RFI Protection Construction Method Automatically applied when temperature is within Approximate number of readings when scanning for normal body temperature range otherwise 5 seconds and reading the temperature display for reads surface temperature 3 seconds before turning thermometer off Calibration Verification Procedure All Exergen infrared thermometers are designed to permanently maintain their accuracy and normally recali bration is not required unless the thermometer has been physically damaged or experiences component fail ure In the unlikely event recalibration might be required the thermometer must be returned to Exergen for the procedure However calibration can be verified in the lab or clinical units quite easily using a device known as
29. presence of clinical fever seriously mislead MUS Oral in 310 Patients with a Wide Range of Respiratory Rates The straight ing the clinician line of best fit is shown The stippled area demonstrates the traditional normal differ Rectal Temperature ence between rectal and oral temperature Generally rectal temperature is considered an indicator of 9a 1010 60 deep tissue and critical tissue temperatures but long standing data demonstrate that rectal temperature can be a lagging and unsatisfactory index Fifty years ago Eichna et al reported differences between intracardiac intravascular and rectal temperatures on afebrile patients to be so insignificant that for all practical purposes the temperatures may be considered to be the same Certainly rectal temperature is far less invasive than a pulmonary artery catheter how ever in the same study data on febrile patients support sizeable differences Other comparisons between rectal esophageal and aortic temperatures undertaken on hypothermic patients by different researchers also confirm similar differences Subsequent but equally comprehensive comparisons on healthy volunteers further confirmed not only temperature differences but also quantified significant lags in rectal temperature vs hypo thalamic temperature by times of order one hour This is of interest since the blood as it enters and affects the critical tissue in the hypothalamus should have considerable signifi can
30. r ature Its around 99 6 F most of the time Yee aera ATA z a LA Your armpit When kids get a lit tle bit older they might have their temp taken under the arm instead of the bum This is better but you _ have to keep the thermometer in u S ERIE t your armpit with your arm tight F against your chest for a long time S It s hard to keep it from falling out Ae i A and breaking especially if you fly wonder if flying causes the armpit temperature to be the lowest in your body It s around 97 6 F most of the time b Your mouth Now if you re reading this you re probably a big kid and so you would most likely have your temperature taken in your mouth Not too bad but everyone knows you can trick your mom or your doc tor into thinking you re sick by doing stuff with that thermome ter Bet you already know of ways to do that Most of the time a temperature in your mouth is about 98 6 F Well sort of 22 Your ears Now were down to ears And pees pardon us ears beat rears But having your ear pulled sure isn t fun and when you have an ear infection it even hurts Temperature taken in your ear should be higher than in your mouth but not as high as in your rear Your heart f we were to pick the best place to measure temperature it would be in the center of your heart But that s pretty dangerous and surely not rz be something you would think was fun A
31. r button is released If measuring room temperature the temperature will remain on the display for only 5 seconds e To Restart Depress the button to restart It is not necessary to wait until the display is clear the thermometer will immediately begin a new scan each time the button is depressed e Pulse Timer The thermometer has a built in pulse timer To activate you should touch something gt 90 F 32 C skin press the red button once and release The display will remain on for 30 seconds The Scan One of the most important features of the thermometer is its ability to scan It is a patented feature of the instrument Scanning is critical in obtaining the correct temperature since there are temperature gradients present not only inside the body but across the entire surface of the body The object of scanning is to capture the highest temperature the peak in the area being scanned As long as the button is depressed the thermometer will be continually sampling and recording the highest temperature it measures Test it first on your hand to get comfortable with the concept Depress the red button and keep it depressed Scan the probe over the center area of your palm keeping the probe about a half an inch off the surface to avoid cooling the skin The display will flash SCAN and there will be a soft but rapid clicking sound each time the sensor detects a temperature higher than the one before When the flashing and clickin
32. rly moming Lower limit of survival Cold blooded creatures have no internal temperature control Their rate of metabolism is deter mined by their environment When the outside temperature drops way down all their body processes slow way down Humans and all mammals are souped up hot blooded beings Their metabolisms are speedy but are kept at an even keel So no matter what the temperature is outside the climate on the inside is ever warm and ready for action Excerpts from Blood and Guts A Working Guide to Your Own Insides Allison L Katz Little Brown and Company Boston New York Toronto London 20 Perspiration The TemporalScanner relies on the skin over the temporal artery to help provide an accu rate body temperature In fact it is measuring the inside by measuring the outside Your skin is a sensor controlling body temperature in two ways radiation and evaporation Since most of us don t think about our skin as a sensor this might be a good time to dis cuss a little physiology We live our entire lives with a body temperature that changes only a few degrees This is thanks to a very sophisticated climate control of which the skin is a very important part Sweating goose bumps and heat loss from the skin all help maintain our normal tempera ture keeping us comfortable When your internal temperature rises your brain signals your blood to increase circulation to the skin In this way the body
33. rt and expense for the patient but low enough for early identification and intervention Primary Points e Temperatures measured with temporal artery thermometry may be higher than normally seen with other clinical methods and therefore require an adjustment in both protocol and perception No one value can apply to every temperature measurement site Note old rule of thumb Rectal temperature is 1 F higher than oral temperature and 2 F higher than axillary temperature Recommended threshold for fever workup using arterial temperature assessment is a single temperature gt 101 8 F or a temperature gt 101 2 F sustained for more than 1 hour Adjustment of 1 F is necessary to raise the temperature level normally mandated for fever workups to prevent false positives unnecessary cultures and blood tests etc Physician Recommended Guidelines for Fever Workup Oral amp Temporal Artery in Oral Axillary Calibration l Core amp Temperature Site Tem poral Artery Single value Fever Workup gt 101 8 Recommendation Sustained values gt 1h gt 101 2 gt 1h gt 100 4 Single value gt 101 Sustained values Single value gt 99 Source on file at Exergen Corporation Body Sites for Temperature Assessment An Overview of Temperature Measuring Sites Oral Temperature Oral temperature measurement is by far the most common clinical method in use today and is responsible for masking the greatest number of
34. s internal heat is carried to the surface by the blood where it is lost by radiation If this is not sufficient your sweat glands sprint into action and perspiration is released through the pores This liquid evaporates on your skin and you cool right down When your temperature drops your brain signals that heat must now be saved Less blood circu lates to the skin and sweating stops Since there is a lot of cooling going on when you are sweating both inside and out it is a good idea to wait till your forehead is dry before taking your temperature with the TemporalScanner If your forehead is sweaty the reading would be low Drying your fore head could help shorten the wait but there is another place to measure an accurate tem perature when perspiring It is still on the head but in the little soft depression just behind the ear lobe the place where young ladies are usually taught to apply perfume During perspiration taking a temperature with the TemporalScanner in the area behind the ear lobe has been proven to be as accurate as a temperature taken at the temporal artery area were it not wet Since we sweat first on the forehead then on the hands and feet the chances of the area behind the ear lobe remaining dry for the measurement are excel lent And since we already have increased circulation to the skin during perspiration this area will have the high blood flow necessary for the measurement Another instance when a high rat
35. t Agitated or combative patient Patient s forehead in direct draft from vent or fan e Thermometer in different ambient temperature than patient i e window ledge directly exposed to hot sun or cold weather or in direct line of air conditioning or fan 12 and their solutions e If accessible and dry measure on the area behind the ear lobe only 3 e Consider using the alternate sites femoral artery lateral thoracic or axillary areas e The TemporalScanner should be kept in the same ambient temperature as your patient Each 10 difference in ambient can cause a 1 error in the reading What should I know about the instrument TAT 5000 can be used with either e Probe lens should be shiny clean If disposable caps or full sheath not wipe with an alcohol prep or Q Can be used without disposables tip dipped in alcohol Occassionally if terminally cleaned between patients follow with a damp wipe of water to remove any alcohol residue buildup Can be cleaned with any hospital approved disinfectant alcohol and even bleach solutions Use only alcohol solution for sensor lens A low or high reading outside body temperature range is indicative of the instrument s failsafe mode signifying a mechanical failure bAtt on the display indicates a low So on o battery Replace with a 9 volt alkaline Can be used in either C or F battery Disposable Cover Options Mode
36. ture extremes damaged been subject to electrical shocks or immersed in water There are no parts that you can service yourself except for the battery which you should replace when low following the instructions in this manual For service repair or adjustments return your thermometer to Exergen Never drop or insert any object into any opening If your thermometer will not be used regularly remove the battery to prevent possible damage due to chemical leakage If the battery leaks remove carefully Do not allow bare skin to touch leaking fluid Dispose of used batteries properly Do not wrap them in metal or aluminum foil Wrap them in newspaper before disposing of them Do not burn them Battery may explode if overheated Not suitable for use in the presence of flammable anaesthetic mixtures SAVE THESE INSTRUCTIONS Product Map Product Map Probe Cone Probe Lens a ON Button Automatic turn off in amp 30 seconds when measuring in body temperature range otherwise 5 seconds LED Display Screen Battery Compartment 9 volt battery Battery Compartment Door 9 Volt Battery F C Switch Introduction to Temporal Artery Thermometry The Method Temporal artery thermometry TAT is a completely new method of temperature assessment using infrared technology to detect the heat naturally emitting from the skin surface In addition and of key importance the method incorporates a pate
37. ure Lower temperatures are usually from scanning too fast not keeping the button depressed a dirty lens or a sweaty forehead What else should I know False high readings e Measure only skin that is exposed to the environment Any covering hair hat bandages etc would prevent the heat from dissipating causing the reading to be falsely high 11 SUOI ISONYH poysy Ajjusnbes Frequently Asked Questions False low readings e Multiple readings can cool the skin so if you take another measurement immediately expect a slightly lower reading e Slide the thermometer straight across the forehead not down the side of the face where the TA could be embedded under cartilage or fat e Keep the probe flush on the skin as in the picture on the right If angled you will be measuring ambient air as well as the TA area Memorable solutions e Measure only the side exposed to the environment The TemporalScanner assumes the skin it measures has equilibrated to ambient so a down or covered side could be falsely high as heat is trapped and the skin is unable to equilibrate e Ifthe up side is not the side closest to you try scanning from the hairline towards the center of the forehead e Scan slowly across the TA area if you scan too quickly you can miss the peak Conditions that could affect a reading Bandages or pressure dressings covering the forehead Forehead abrasions burns swea
38. using and design of the electronic components allow for completely safe disinfecting with any accepted solution e Calibration Factory calibration data is installed via a computer which communicates with the TemporalScanner s microprocessor The instrument automatically self calibrates each time it is turned on using this data and will never require recalibration If readings are not correct the instrument should be returned for repair 23 SOUBUDd UIeIY pue 31e Care and Maintenance Instructions for Fahrenheit or Celsius Conversion The TemporalScanner can be used in either F or C To convert from one scale to the other the only tool necessary is a paper clip or the tip of a small screwdriver For F C Conversion F e Loosen single screw on bottom of case and remove battery cover t e Lift battery out of the way Switch e Locate the little switch to the right of the battery as indicated in the drawing and with C the tip of the paper clip or screwdriver slide up or down to the opposite position r e Remove the paper clip or screwdriver e Replace battery and cover DISPLAY DIAGNOSTICS CHART The following chart summarizes the fault conditions and the associated indications High Target a gt 110 F 43 C Low Target lt 61 F 16 C High Ambient gt 104 F 40 C Low Ambient lt 60 F 16 C Low Battery Dead Battery blank a a Processing Error Restart Return to Exergen for re
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