Capillary refill time, increased
Capillary refill time is the duration required for color to return to the nail bed of a finger or toe after application of slight pressure, which causes blanching. This duration reflects the quality of peripheral vasomotor function. Normal capillary refill time is less than 3 seconds.
Increased refill time isn’t diagnostic of any disorder but must be evaluated along with other signs and symptoms. However, this sign usually signals obstructive peripheral arterial disease or decreased cardiac output.
History
Take a brief medical history, especially noting previous peripheral vascular disease. Find out which medications the patient is taking. Does the patient report pain or any unusual sensations in his fingers or toes, especially after exposure to cold?
Physical assessment
Observe the patient’s skin color and check for edema. Then complete the cardiovascular examination. If you detect increased capillary refill time, take the patient’s vital signs and check pulses in the affected limb.
Medical causes
Aortic aneurysm (dissecting)
Capillary refill time is increased in the fingers and toes of a patient with a dissecting aneurysm in the thoracic aorta, and is prolonged in just the toes with a dissecting aneurysm in the abdominal aorta. Common accompanying signs and symptoms include a pulsating abdominal mass, systolic bruit, and substernal back or abdominal pain.
Aortic arch syndrome
Increased capillary refill time in the fingers occurs early in patients with aortic arch syndrome. The patient displays absent carotid pulses and possibly unequal radial pulses. Other signs and symptoms usually precede loss of pulses and include fever, night sweats, arthralgia, weight loss, anorexia, nausea, malaise, skin rash, splenomegaly, and pallor.
Arterial occlusion (acute)
With acute arterial occlusion, increased capillary refill time occurs early in the affected limb. Arterial pulses are usually absent distal to the obstruction; the affected limb appears cool and pale or cyanotic. Intermittent claudication, moderate to severe pain, numbness, and paresthesia or paralysis of the affected limb may occur.
Buerger’s disease
Capillary refill time is increased in the toes in patients with Buerger’s disease. Exposure to low temperatures turns the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Other findings include intermittent claudication of the instep and weak peripheral pulses; in later stages the patient may experience ulceration, muscle atrophy, and gangrene. If the disease affects the hands, increased capillary refill time may accompany painful fingertip ulcerations.
CULTURAL CUE:Be aware that the incidence of Buerger’s disease is highest in men of Jewish ancestry who are between ages 20 and 30 and are heavy smokers.
Hypothermia
Increased capillary refill time may appear early as a compensatory response to hypothermia. Associated signs and symptoms depend on the degree of hypothermia and may include shivering, fatigue, weakness, decreased level of consciousness (LOC), slurred speech, ataxia, muscle stiffness or rigidity, tachycardia or bradycardia, hyporeflexia or areflexia, diuresis, oliguria, bradypnea, decreased blood pressure, and cold, pale skin.
Raynaud’s disease
Capillary refill time is prolonged in the fingers, the usual site of Raynaud’s disease characteristic episodic arterial vasospasm. Exposure to cold or stress produces blanching in the fingers, then cyanosis, and then erythema before the fingers return to normal temperature. Warmth relieves the symptoms, which may include paresthesia. Chronic disease may produce trophic changes, such as sclerodactyly, ulcerations, or chronic paronychia.
Other causes
Diagnostic tests
Cardiac catheterization can cause arterial hematoma or clot formation and increased capillary refill time.
Drugs
Drugs that cause vasoconstriction (particularly alpha-adrenergic blockers) increase capillary refill time.
Treatments
Increased capillary refill time can result from an arterial line or umbilical line (which can cause arterial hematoma and obstructed distal blood flow), or from an improperly fitting cast (which constricts circulation).
Special considerations
Frequently assess the patient’s vital signs, LOC, and affected extremity, and report any changes, such as progressive cyanosis or loss of an existing pulse. Prepare the patient for diagnostic tests, which may include arteriography or Doppler ultrasonography, to help confirm or rule out arterial occlusion.
Pediatric pointers
Capillary refill time may be increased in neonates with acrocyanosis; however, this is a normal finding. Typically, increased capillary refill time is associated with the same disorders in children as in adults. However, its most common pediatric cause is cardiac surgery such as the repair of congenital heart defects.
Patient counseling
Teach the patient about his disease process and signs and symptoms to report. Help the patient develop a plan to modify risk factors, such as quitting smoking. Discuss measures to promote circulation, such as keeping extremities warm and avoiding cold environments.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Paleness
» Next page: Skin, clammy (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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