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Capillary Refill Time (CRT) Assessment: A Complete Guide for Nurses

This article was written in collaboration with Christine T. and ChatGPT, our little helper developed by OpenAI.

Definition

Capillary Refill Time (CRT) is a quick, noninvasive test used to assess peripheral perfusion and circulation. It is performed by applying pressure to a patient’s nail bed or fingertip, causing it to blanch, and then measuring the time it takes for the normal color to return once pressure is released. A normal CRT is generally considered to be less than 2 seconds.

Related Terms

• Peripheral perfusion: The process of blood flow to the body’s extremities, which is necessary for delivering oxygen and nutrients to tissues.
• Peripheral circulation: The circulation of blood in the smallest blood vessels, including capillaries, arterioles, and venules.
• Shock: A life-threatening condition in which the body’s tissues are not receiving adequate blood flow, leading to inadequate oxygen delivery and waste removal. Prolonged CRT may be an early indicator of shock.

Synonyms, Definitions, and Examples

Synonym	Definition	Example
Capillary refill	The time it takes for blood to return to blanched skin following the application of pressure.	A nurse applies pressure to a patient’s fingertip and observes a CRT of 1.5 seconds, indicating normal peripheral circulation.
Capillary refill test	A test that measures the speed at which blood refills the capillaries after pressure is applied to an area of skin.	During a routine physical examination, a physician checks a patient’s CRT to assess peripheral perfusion.
Capillary refill time assessment	An evaluation of peripheral circulation and perfusion based on the time it takes for blood to return to the capillaries following pressure application.	An emergency room nurse assesses a patient’s CRT after a motor vehicle accident to identify any signs of shock.

Assessment Techniques and Tools

To perform a CRT assessment, follow these steps:

1. Position the patient’s hand at heart level or slightly elevated.
2. Apply pressure to the patient’s nail bed or fingertip with your thumb and index finger until the skin blanches.
3. Release the pressure and observe the time it takes for the skin to return to its normal color.
4. Record the CRT and any relevant observations, such as skin temperature and color.

Assessment Frameworks

There is no specific framework for CRT assessment, as it is typically integrated into broader patient assessments, such as the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach or primary and secondary surveys in emergency care settings.

Assessment Documentation

Proper documentation of CRT assessment should include the following:

• Time of assessment
• Measured CRT in seconds
• Any observed abnormalities or changes in CRT from previous assessments
• Relevant patient history or risk factors that may impact CRT
• Any interventions performed and their outcomes

Legal and Ethical Considerations

Nurses must obtain consent from the patient or their representative before performing a CRT assessment. Additionally, nurses should respect the patient’s privacy and maintain confidentiality when documenting and sharing assessment findings.

Real-Life Examples or Case Studies

• A nurse assesses a patient’s CRT in the emergency department following a car accident. The prolonged CRT indicates poor peripheral perfusion and raises suspicion for shock, leading to prompt intervention and treatment.
• A nurse in a long-term care facility regularly assesses the CRT of a patient with peripheral artery disease to monitor for changes in perfusion and identify early signs of complications.

Resources and References

• Capillary refill time: is it still a useful clinical sign? (PubMed Central)
• Dehydration Clinical Presentation

Conclusion

Capillary Refill Time (CRT) assessment is a valuable tool for evaluating peripheral perfusion and circulation in various clinical settings. Understanding the proper technique, documentation, and ethical considerations is essential for nurses to accurately assess and monitor patient conditions.