Bibliographic information
Guideline—
Year of Publication—
Issuing Institution—
Recommendation
New
WHO suggests for patients with suspected or confirmed filovirus disease and clinical signs of shock or circulatory impairment, capillary refill time should be used as part of the assessment of perfusion to guide intravenous fluid management
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- This recommendation applies to children and adults, including pregnant women.
- The assessment of perfusion also includes other markers such as blood pressure, heart rate, urine output, mental status and lactate.
- Use of capillary refill time can also be integrated into assessments using complementary technologies such as ultrasound, depending on availability, training and level of care.
- Use of standardized protocols for capillary refill time assessment will reduce variability in measurements and increase reliability and accuracy. Practical info CRT is an accessible marker of end-organ perfusion. It measures the time for blood to return to the skin capillaries after they have been emptied by applying pressure. It is quick, visual and non-invasive test, although education of health care workers is paramount to ensure correct measurement and interpretation. It is used for recognition of hypoperfusion and for monitoring of fluid administration. What factors affect CRT? CRT can be affected by multiple factors, including room temperature, skin temperature, age, sex, room lighting, procedural technique, presence of underlying vascular disease, and the site of testing. Variability can be minimized through training, education and standardized protocols to mitigate the impact of ambient factors (56, 60). CRT standardization protocol Standardized procedures can enhance reliability and reduce interobserver variability (Fig. 1). To reflect the procedure in the research studies, in infants, children and adults:
- Check the environment:
- Ensure a warm room.
- Choose a site free from skin abnormalities.
- Place the patient’s hand at the level of the thorax/heart.
- Apply firm pressure to the ventral surface of the distal phalanx of the index finger for 10 seconds.
- Remove the pressure.
- Measure the time for the return of pre-existing skin colour.
- Use a chronometer.
- A CRT longer than 3 seconds should be considered abnormal (60). A microscope slide was used to apply pressure in the RCTs as this enables visualization of skin blanching and ensures even pressure. The GDG panel recognized that usual clinical practice does not require a glass slide. To measure capillary refill time in a standardized manner, position the patient’s hand at heart level, approximately at the mid-chest. Apply firm pressure to the ventral surface of the distal phalanx of one finger for 10 seconds, using either your thumb or, when available, a glass microscope slide to confirm blanching of the underlying skin. Release the pressure and record the time required for the skin colour to return to its baseline appearance.