BulletPointsofImportanceinanInserviceforUsingtheExergenTemporalScannerThermometer x Basics: BeginwithbasicssonursingstaffcanseehowtheTemporalScannershouldbeused,butfirstuse yourforefingerratherthantheinstrument: 1. Placeyourforefingerinthecenterofyourforehead. 2. Slideitinastraightlineovertoyourhairline. 3. Liftyourforefingerandtouchthatlittlesoftdepressionyourneckjustbelowyourearlobe. IfyouhadtheExergenTemporalArteryThermometerinyourhand,youwouldhavejusttakenthe fastest,gentlest,mostaccuratetemperatureintheworld! x BasicStepsinUsingtheTemporalScanner: x Scaninastraightlineandyouwillnevermisstheartery–here’swhy: 1. Weallknowthatthetemporalarterycomesupthesideofthefacefromtheexternal carotids,but,itcangodeep,introducingavariableunsuitabletomakinganaccurate measurement. 2. Thesuperficialpartofthetemporalarteryisourtarget.Thisislocatedupintheforehead, about2mmbelowtheskin,literallytrappedbetweentheskinandtheskull. 3. Whileweknowhowdeepthesuperficialpartofthearteryis,itsexactlocationvarieswith eachindividual,whichiswhywescanallowingtheTATtolocateit,somethinglikearadar detector. x Thetouchbehindtheearistoassurethecorrectreadingifthepatientissweaty–here’swhy: 1. Iftheforeheadismoist,theeffectofevaporativecoolingwillresultinalowreading, however, 2. Sincevasodilationis100%assuredwhensweating,andwesweatlastontheneck,unless thepatientiscompletelysweaty,thetouchontheneckjustbehindtheearlobewilloverride theeffectofevaporativecooling. 3. Ifthepatientiscompletelysweaty,eitherreturninabout10minutestotakethetemp,or placeanExergenfilmstripoverthetemporalarteryareaandscanoverthefilm. a. Thefilmbecomesanimpermeablebarriertomoisture,preventinganyeffectfrom evaporativecooling.Thisallowsascantobemadeontopofthefilmstrip,without therequirementtoscanontheneckareabehindtheear.And,thestripwillselfͲ adhereaslongasthetissueismoist. x Infants.Scanningboththeforeheadandbehindtheearisnotrequired–here’swhy: 1. Infantsareinaconstantstateofvasodilationuntiltheyarenearlyayearoldwhentheir vasomotorcontrolsaremature. a. Asvasodilationistheprerequisiteformakingthemeasurement,agentletouch tothetemporalarteryarea,ora2inchscanacrossthetemporalarteryareais allthatisrequired. b. Itiseasiertodepressthebuttonpriortotouchinganinfant'shead x ImportantThingstoKnow 1. TheTemporalScannermeasuresCORETemperature,about1°F(0.6°C)higherthananoral temperature. a. Meannormalcoretemperatureisabout99.4°F(37.4°C)vs.about98.6°F(37°C)for anoraltemperature. b. Feverprotocolwillneedtobeadjustedupwardsifyourcurrentprotocolisbasedon anoraltemperature. 2. TheTemporalScannerisalsoavailableinanoralequivalentcalibration a. Noadjustmentinfeverprotocolisrequired. 3. HighReadingsaretypicallyaresultof: a. Comparingtoanothermethod,typicallyanoraltemperature. b. Theareabeingmeasuredisnotexposed. 4. LowReadingsaretypicallyaresultof: a. Adirtylens–needscleaningeverytwoweekswithaQͲTipdampenedwithan alcoholwipe. b. Curvingdownthesideoftheface. c. Multipletempstakeninrapidsuccessiononthesamepatient. d. Asweatypatient. 5. ExergenhasacomprehensiveClinicalEducationWebsiteatwww.TAthermometry.org. x ImportantThingstoAvoid: 1. Takingmultipletempsinrapidsuccessiononthesamepatient(somethingNEVERdonewith anoralorrectalthermometer.And,here’swhy: a. Thecoldprobecoolstheskin,andskinispartofourmeasurement. b. Waitabout30secondsbeforerepeatingatemponthesamepatient. 2. Relyingontheaccuracyoftouchingthepatient(palpation)todeterminefever.Andhere’s why: a. Yourhandisnotagoodindicatoroffever,itissubjectiveanddependsonthe temperaturedifferencebetweenyourhandandthepatient. b. Whilepalpationwillbecorrectabout98%ifthepatientdoesNOThaveafever,it willbewrongmorethanhalfofthetimeifthepatientdoeshaveafever. 3. Believingtherectaltemperatureovertemporalarterytemperatureiftheydiffer.And, here’swhy: a. Rectaltemperaturehasawellprovenlagtimeinrespondingtoarapidlychanging temperature. i. Lagtimeforadultscanbeseveralhours,welldocumentedsincethe inventionoftheSwanGanzPAcatheterinlate1960. ii. Lagtimeforinfantsasyoungas0Ͳ12monthscanbe60Ͳ90minutes,first quantifiedbyHarvardMedicalSchoolandBostonChildren’sHospitalin 2004. x Alternatesitesformeasurement 1. Theneckbehindtheearlobe: a. Iftheforeheadisinaccessiblebecauseofbandagesduetoheadtrauma, vasodilationintheneckisassured.Justtouchtheneckbehindtheearlobe,press andreleasethebutton. b. Ifbehindtheearlobeiscovered,scanthepartoftheneckthatisaccessible. 2. Thefemoralarteryarea: a. Thefemoralarteryisastrongarterywithalonghistoryasatemperature measurementsite.Tomakethemeasurement,justscanacrossthefemoralartery followingthecreaseofthegroin. 3. Lateralthoracicarteryarea a. Scaninazigzagpatternabout4incheswidefromanimaginarylineinbetweenthe axillaandthenipple,scanningdowntothewaistandbackuptothelevelofthe nipple. x PreventiveMaintenance 1. CleaningtheInstrument:IMPORTANT:DirtyLens=LowTemps a. Thelensdeepinthecenterofprobeshouldbecleanedevery2weekswithaQͲTIP dampenedwithanalcoholpreppad. i. Absolutelynobleachbasedsolutionsorwipesshouldbeusedonthelens, asbleachwilletchthelens,resultinginlowreadings. ii. Thecasingcanbecleanedwithanyhospitalapproveddisinfectant,butonly alcoholcanbeusedonthelens. 2. Battery:A9Ͳvoltalkalinebatterywillprovideapproximately15,000readings,aboutayear ofheavyusage. a. Alowbatterywarningwillbeindicatedonthedisplay. b. Alowbatterywillneverberesponsibleforlow(orhigh)readings. c. Thebatteryislocatedinthecompartmentdirectlyundertheinstructionlabel,and easilychangedafterlooseningthescrewandremovingthecover. ExergenCustomerService:617Ͳ923Ͳ9900x6234;[email protected];[email protected] 2Ͳ1Ͳ10.