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Application of Thermometric Catheter for Shock Patients

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Application of Thermometric Catheter for Shock Patients
 
Xia Guifen, Zhou Rong. Gu Yufang. Li Jing
(Author's profile: Xia Guifen, Deputy Chief Nurse, Bachelor's degree, Unit: 210011, Second Affiliated Hospital of Nanjing Medical University; Zhou Rong (corresponding author), Gu Yufang, Li Jing Unit: 210011, Second Affiliated Hospital of Nanjing Medical University.)

 
Abstract: [Purpose] To explore the clinical significance of measuring bladder temperature with a temperature-measuring catheter and to find a simple and accurate method for measuring body temperature suitable for shock patients. [Method] Selecting 13 shock patients from our department and simultaneously measuring bladder temperature (UBT), axillary temperature (AT), and central blood temperature (BT) for a total of 65 times. Comparing the differences in temperature at each site and analyzing the correlation between UBT, AT, and BT respectively. [Results] The observed bladder temperature (37.8±0.85)°C of the patient was not statistically different from the blood temperature (37.82±0.87)°C. The axillary temperature (37.38±0.62)°C was statistically different from the blood temperature. The correlation coefficient R between UBT and BT, and between AT and BT were 0.9928 and 0.7731 respectively, indicating that the correlation between bladder temperature and blood temperature was better than that between axillary temperature and blood temperature. [Conclusion] Bladder temperature measurement can accurately, quickly, and safely reflect the body temperature of shock patients. 
Keywords: Shock patients; Bladder temperature; Axillary temperature; Central blood temperature; Measurement
CLC No.: R472.9 Document Code: B doi: 10.3969/j.issn. 1009—6493. 2016. 04. 043 Article No.: 1009—6493(2016)02A一0504—03

Body temperature is a basic vital sign of a patient, which assists doctors in making correct diagnoses for it can reflect the general condition of the patient and the occurrence and development of diseases. Monitoring body temperature is one of the daily tasks of nurses, and clinical practice often uses oral temperature, axillary temperature, and rectal temperature to reflect body temperature. The mouth and rectum are both entrance parts of the body cavity. 
Rectal temperature is often used to reflect deep temperature, and the measurement only requires inserting the thermometer more than 6cm into the anus. Skin temperature refers to the temperature of the outermost layer of the body surface. 
The skin temperature at the extremities is the lowest, and it is closely related to local blood flow, so it reflects the functional state of blood vessels to a certain extent. When skin blood vessels contract, skin blood flow decreases, and skin temperature decreases; otherwise it rises. Critical temperature includes low critical temperature and high critical temperature. When the central temperature drops below 34°C, the temperature regulation function is impaired; when it reaches 33°C, consciousness is lost; when it reaches 30°C, the temperature regulation function is totally lost; when it reaches 28°C, arrhythmia or even death of ventricular fibrillation may occur. When the central temperature is higher than 41°C-42°C, the central nervous system function is damaged, seizures or neuron damage may occur. When it reaches 43°C, the temperature regulation function of sweating and vasodilation stops. At this time, if there are no effective external cooling measures, body temperature will rise quickly and may cause death. The central-rectal-toe temperature gradient: This parameter is a sensitive indicator for monitoring microcirculation status, and its gradient should not be less than 6°C. Due to different degrees of tissue hypoxia and microcirculation disorders in shock patients, there may be differences in temperatures at different parts of their bodies. Multiple domestic and international studies have shown that bladder temperature (UBT) measurement can reflect body temperature well in various situations such as extracorporeal circulation and anesthesia, but this method has not been used in shock patients. In order to prove that bladder temperature (UBT) can reflect the body temperature of shock patients simply and effectively, this study selected 13 shock patients treated by our department from December 2013 to July 2014, and monitored their axillary temperature (AT), bladder temperature (UBT), and central blood temperature (BT) respectively, comparing the correlation between UBT and BT. Below is the report.
1 Data and Methods
1.1 Clinical data: From December 2013 to July 2014, 13 shock patients were admitted to our hospital's ICU, including 12 males and 1 female, aged 47-85 years old, weighing 50-80kg. All 13 patients underwent hemodynamic monitoring, of which 11 had hemofiltration catheters placed and 2 had PICC0 catheters placed. The room temperature was maintained at 23-26°C. 
1.2 The measuring instrument was a mercury thermometer produced by Shanghai Huachen Medical Instrument Co., Ltd., which was used after routine disinfection.
The temperature-measuring catheter was produced by Bard. The PICC0 catheter was produced by Pulsion, the hemofiltration catheter was produced by ARROW, and the monitor was produced by NIHON KOHDEN.
1.3 Research methods
Using self-control method, all patient data were collected into the experiment. In the experiment, blood temperature was used as the reference basis for the control group (during cardiac surgery, blood temperature was monitored by a sensor on the pulmonary artery Swan-Ganz catheter, which is considered to be the gold standard for core temperature measurement). Bladder temperature was observation group 1 and axillary temperature was observation group 2. At different time points, axillary temperature, bladder temperature, and blood temperature were measured simultaneously, and data from each patient were collected in 5 sets.
1.3.1 Blood temperature measuring method
Body temperature is measured through the temperature sensor of a hemofiltration catheter or PICC0 catheter, and the temperature value on the monitor or hemofiltration machine is read and recorded.
1.3.2 Bladder temperature measuring method
The temperature-measuring catheter is connected to the transducer, transmitted through the temperature sensor, and the temperature value on the monitor is read and recorded. 
1.3.3 Axillary temperature measuring method
Before measuring, dry the skin under the armpit, place the mercury end of the thermometer in the armpit and clamp it tightly, and have someone take care of it. After 10 minutes, take it out, read the value and record it. The limb on the side of temperature measurement shall not have rapid infusion, blood transfusion or cold compresses. 
1.4 Statistical Methods
Use stata9.0 software package to perform statistical data analysis, measurement data is expressed as mean±standard deviation (±s), R test and t test are performed. 

2 Results
2.1 Results of bladder temperature, axillary temperature and blood temperature (see Table 1) 

 
Table 1 Comparison of Bladder Temperature, Axillary Temperature and Blood Temperature (n=65.±S) 
2.2 The correlation between bladder temperature and blood temperature R=0.9928 is significantly higher than that of R=0.7731 between axillary temperature and blood temperature. See Figure 1 and Figure 2. 
3 Discussion
3.1 Body temperature is one of the basic points of clinical observation for shock patients. Changes in body temperature often indicate changes in the patient's condition. Hence, monitoring body temperature in shock patients is very important. A significant decrease in effective circulating blood volume and low perfusion of organ tissues are hemodynamic characteristics of shock, resulting in a decrease in peripheral and superficial temperatures such as skin temperatures. The difference between skin temperature and central temperature is a valuable indicator for understanding peripheral circulation perfusion, and the temperature difference should be less than 2°C. When the patient is in severe shock, the temperature difference increases. After effective treatment measures are taken, the temperature difference decreases, indicating that the condition has improved and peripheral circulation has improved. The gradually progressive expansion of the temperature difference is one of the indicators of deterioration of the condition. Therefore, choosing a simple and effective method to reflect the central temperature of shock patients is of great clinical significance for critical care workers.
3.2 Bladder temperature can reflect the central temperature of shock patients well. This study shows that the bladder temperature (37.80±0.85)°C of shock patients is not statistically different from the blood temperature (37.82±0.87)°C, and the correlation between axillary temperature (37.38±0.62)°C and blood temperature is statistically significant (P<0.05). The correlation analysis between bladder temperature, axillary temperature and blood temperature showed that the correlation between bladder temperature and blood temperature R was 0.9928, which was better than axillary temperature 0.7731, so clinically bladder temperature measurement can be used to replace blood temperature to reflect central temperature.
3.3 Bladder temperature monitoring is simple and easy to perform because shock patients need dynamical monitoring of urine output; the measurement process is not affected by factors such as breathing, diet, and environment. It can accurately, quickly, and safely measure body temperature; when measuring, the probe shall be connected to the joint of the temperature-measuring catheter to prevent cross-infection between patients and reduce the workload of nurses. After clinical trials, it is considered that bladder temperature measurement in adult intensive care units is feasible and effective.
In summary, bladder temperature has a good correlation with blood temperature in shock patients, and it is accurate, fast, safe in terms of reflecting body temperature in shock patients.
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(Received date: February 6, 2015; Revised date: January 11, 2016) 
Editor: Sun Yumei

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