Capillary refill

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Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching.[1] It can be measured by holding a hand higher than heart-level and pressing the soft pad of a finger or fingernail until it turns white, then taking note of the time needed for the color to return once pressure is released.[2]

CRT became popularized in the 1980s when Champion et al. proposed a CRT of less than 2 seconds be deemed normal and included CRT in the Trauma Score.[3] The value of 2 seconds for a normal CRT that was proposed by Dr Champion had been arbitrarily chosen by his nurse, and no evidence supporting that value has subsequently been found. [4] CRT has been shown to be influenced by ambient temperature, age, sex, and the anatomical testing and lighting conditions.[5][6] The most reliable and applicable site for CRT testing is the finger pulp (not at the fingernail), and the cut-off value for the normal CRT should be 3 seconds, not 2 seconds.[7]

In newborn infants, capillary refill time can be measured by pressing on the sternum for five seconds with a finger or thumb, and noting the time needed for the color to return once the pressure is released. The upper normal limit for capillary refill in newborns is 3 seconds.[8] Capillary refill time can also be assessed in animals by pressing on their gums as opposed to the sternum which is generally covered with fur or inaccessible.[citation needed] A prolonged capillary refill time may be a sign of shock and can also indicate dehydration and may be a sign of dengue hemorrhagic fever and decreased peripheral perfusion.[9] Prolonged capillary refill time may also suggest peripheral artery disease.[2] It is generally accepted that the test is affected by many different external factors and therefore should not be relied upon as a universal diagnostic measure.[1]

See also[]

References[]

  1. ^ Jump up to: a b King, D; Morton, R; Bevan, C (Nov 13, 2013). "How to use capillary refill time". Archives of Disease in Childhood: Education and Practice Edition. 99 (3): 111–116. doi:10.1136/archdischild-2013-305198. PMID 24227793.
  2. ^ Jump up to: a b "Capillary nail refill test". Archived from the original on 2015-09-24. Retrieved 2014-12-21.
  3. ^ Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS, Prall RH. Assessment of injury severity: the triage index. Crit Care Med. 1980 Apr;8(4):201-8. doi: 10.1097/00003246-198004000-00001. PMID: 7357873.
  4. ^ Baraff LJ. Capillary refill: is it a useful clinical sign? Pediatrics. 1993 Nov;92(5):723-4. PMID: 8414865.
  5. ^ Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med. 1988;17(9):932-5.
  6. ^ Anderson B, Kelly AM, Kerr D, Clooney M, Jolley D. Impact of patient and environmental factors on capillary refill time in adults. Am J Emerg Med. 2008;26(1):62-5.
  7. ^ Monteerarat Yuwarat, Limthongthang Roongsak, Laohaprasitiporn Panai, Vathana Torpon. Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs. Eur J Trauma Emerg Surg (2021). [1] https://doi.org/10.1007/s00068-020-01594-9
  8. ^ Krzysztof S Strozik; Clarissa H Pieper; Jacques Roller (1997-01-13). "Capillary refilling time in newborn babies: normal values". Archives of Disease in Childhood: Fetal and Neonatal Edition. 76 (3): F193–F196. doi:10.1136/fn.76.3.F193. PMC 1720653. PMID 9175951.
  9. ^ David C. Dugdale, III, MD (2009-05-07). "Capillary nail refill test". Retrieved 2010-11-27.CS1 maint: multiple names: authors list (link)


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