The Capillary Refill Assessment (CRA), or Capillary Refill Time (CRT), is a quick, non-invasive bedside test used to evaluate the efficiency of a person’s peripheral circulation. This assessment provides immediate insight into peripheral perfusion, which is the blood flow to the body’s extremities and tissues furthest from the heart. By observing how quickly color returns to a blanched area of skin, clinicians can gauge the patient’s circulatory status, especially when assessing for dehydration, shock, or other conditions that compromise blood volume or flow. Accurate documentation of this finding is necessary for monitoring a patient’s status and guiding subsequent care decisions.
Essential Steps of the Capillary Refill Assessment
The documentation of the CRA begins with generating data points through a standardized physical assessment. The first step involves selecting an appropriate site, typically the nail bed of a finger or toe. In infants or cold environments, the sternum or forehead may be used if extremities are unreliable.
Once the site is chosen, firm pressure is applied for five seconds to temporarily force blood out of the capillary bed, causing the area to blanch (turn white). The pressure is then released, and the practitioner immediately times how long it takes for the normal pink color to return. This action yields the two primary data points for documentation: the specific anatomical location and the measured time in seconds. The extremity must be positioned at or near heart level during the assessment to prevent venous congestion from skewing the time measurement.
Standardized Reporting of Findings
The core of a proper CRA record is the quantitative finding, which must be expressed as a precise measurement of time. The internationally accepted standard for a healthy finding is a return of color in less than two seconds, often documented as “CRT < 2 seconds." If the time is within this normal limit, the qualitative descriptor "brisk" may be used, but it must be paired with the numerical time for clarity. When the time exceeds this threshold, the exact number of seconds must be recorded, such as "CRT 3 seconds" or "CRT 4.5 seconds." For significantly delayed results, terms like "sluggish" or "delayed" can be included as descriptive modifiers. However, the time measurement remains the primary piece of data; for example, a complete entry might read: "Capillary refill delayed at 3 seconds." Using standardized language prevents ambiguity and supports continuity of care across different providers. Documentation should avoid vague or subjective phrasing that lacks a time component, such as simply writing "normal" or "adequate." Even if the refill is within the standard limit, using specific notation, such as "Capillary refill < 2 seconds bilaterally," provides the clearest evidence of an assessment performed. Although physiological factors like advanced age may cause a slightly longer refill time, the two-second threshold remains the clinical benchmark for documentation.
Contextual Documentation and Clinical Significance
Beyond the time measurement, professional documentation requires including the specific context surrounding the assessment. It is important to specify the precise anatomical site that was tested, such as “right index fingernail” or “left great toe.” This detail is crucial because perfusion can vary significantly between different extremities, especially in cases of localized injury or disease.
External factors that may artificially influence the result must also be documented to ensure the finding is interpreted correctly. If the patient is hypothermic, the room temperature is cold, or the patient has edema in the limb, these factors should be noted alongside the measurement. For example, a note might read: “CRT 3 seconds, left ring finger, patient’s hands cold to touch.”
Recording the exact date and time of the assessment is a fundamental aspect of the record. This temporal data allows healthcare providers to trend the patient’s circulatory status over time and determine if a treatment, such as fluid resuscitation, is having the intended effect. Contextual documentation ensures that any changes in the patient’s condition are recognized promptly, allowing for timely medical intervention.