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febrile neutopenia and how the temperature is taken

  • 1.  febrile neutopenia and how the temperature is taken

    Posted 24 days ago
    hello all,
    oral mucositis and FN are tandem many times.
    can anyone send their sites policy on how temperatures are to be taken.
    IE: is oral temperature reading contraindicated in the FN patient because the mucosal break down results in a false elevation of the body temperature.
    thank you for the help.
    Victoria

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    Victoria Reesman APRN-BC, OCN, HPCN,CRNI
    Oncology Nurse Specialist
    Department of Nursing
    Maimonides Medical Center
    4802 Tenth Avenue Brooklyn, NY 11219
    T: (718) 283-7989 | M: (917) 499-3968
    F: (718) 635-7455
    E: vreesmanl@maimonidesmed.org
    W: www.maimonidesmed.org
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  • 2.  RE: febrile neutopenia and how the temperature is taken

    Posted 17 days ago
    Hi. For taking the temperature of neutropenic patients, perhaps these two excerpts are relevant:

    From "Approach to fever assessment in ambulatory cancer patients receiving chemotherapy: a clinical practice guideline" http://dx.doi.org/10.3747/co.23.3098 -- includes "A blinded diagnostic test study in neutropenic patients, in which the reference standard was rectal thermometry":

    Key Evidence
    Temperature
    The temperature recommendation has existing guidelines and consensus as its basis. Most of the existing related clinical practice guidelines focus on the management of febrile neutropenia and define fever as a 1-time temperature measurement of 38.3°C or 2 readings of 38.0°C 1 hour apart4,6,7,13–15. Slight variations in definition were noted in two guidelines3,5. Evidence from the review of the primary literature found six studies addressing the predictive value of body temperature. The patients who were involved had already been diagnosed with febrile neutropenia, and the cut-off used in five studies was 39°C16–20. In those studies, temperature was an unreliable predictor of poor outcome. A blinded diagnostic test study in neutropenic patients, in which the reference standard was rectal thermometry, reported sensitivity, specificity, positive predictive value, and negative predictive value of 68%, 98%, 90%, and 92% respectively in detecting fever (≥38°C) with tympanic membrane thermometry. The sensitivity, specificity, positive predictive value, and negative predictive value with oral thermometry were 56%, 98%, 90%, and 89% respectively21.


    From "Accurately Measuring Temperatures In Critically Ill Oncology Patients" https://onf.ons.org/onf/33/2/oncology-nursing-society-31st-annual-congress-podium-and-poster-abstracts

    "Urinary catheter thermometers will allow the temperature to be monitored continuously in the neutropenic and thrombocytopenic patient."

    "The purpose of this performance improvement project is to compare the use of urinary catheter thermometers with oral and axillary methods of measuring critically ill oncology patients' temperatures."

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    Mark Vrabel
    INFORMATION RESOURCES SUPERVISOR
    Oncology Nursing Society
    Pittsburgh PA
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  • 3.  RE: febrile neutopenia and how the temperature is taken

    Posted 2 days ago
    I had not heard that mucositis could elevate a temperature.

    With febrile neutropenia, I often see tachypnea which cools the inside of the mouth. With severe mucositis or lip damage there is additional trauma being done with the oral thermometer, and I've seen a number of patients who stopped closing their mouth fully because of the pain, and that cools the mouth as well. Interventions like humidification, frequent liquid intake, sucking on ice chips, and oxygen masks can cool the oral mucosa. Rigors can make it hard for some patients to breathe through their nose and keep their mouth closed. The oral thermometers usually take a little longer to register than other methods.

    I have no data, but blood clot and sloughing skin I think is mouth temperature rather than internal body temperature.

    We have tympanic and oral thermometers. When I get a discrepancy between an oral and a tympanic temperature, my bias is to go with the tympanic especially if a patient was flushed, tachypneic, diaphoretic, and shaking. I usually consider oral temperatures as more of a risk of being artificially lowered.

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    John Hillson RN
    Hillsborough NC
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