Physical examination maneuver
Physical Exam
Capillary Refill
also known as Capillary refill time | CRT | Nail blanch test
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Video coming September 2026
How to Perform
Hold the patient's hand at about heart level. Press firmly on the pad or nail bed of a finger for roughly 5 seconds until it blanches, then release and count the time for the normal color to return.
How to Interpret
Showing 10 of 15 findings
Dehydration
Capillary refill prolonged (>2-3 seconds) in a child
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Strong
Hemodynamic Instability
Capillary refill time ≥3 seconds before a dialysis session, predicting intradialytic hemodynamic instability
Rule in
Somewhat helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Hypovolemia
Capillary refill time prolonged (greater than 2-3 seconds)
Rule in
Helpful
Rule out
Minimally helpful
Evidence:Limited
Low Cardiac Output
Combination of all 3 findings (cool limbs, capillary refill time >2 seconds, mottling over knees) in an ICU patient, detecting a low cardiac index
Rule in
HelpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited
Mortality
Capillary refill time ≥3 seconds in an ICU patient with septic shock
Rule in
Somewhat helpful
Rule out
Somewhat helpful
Evidence:Strong
Prolonged capillary refill time (measured at presentation, before fluid resuscitation) in a patient with acute circulatory failure
Rule in
Minimally helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Prolonged capillary refill time in a patient with sepsis and elevated lactate after initial fluid resuscitation
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Capillary refill time >3 seconds in an ICU patient with cardiogenic shock
Rule in
Somewhat helpfulNo CI
Rule out
HelpfulNo CI
Evidence:LimitedResearch in progress
Postoperative Complication
Capillary refill time above 4.5 seconds on postoperative day 2 after abdominal surgery
Rule in
Very helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited
Shock
Capillary refill prolonged (>3 seconds)
Rule in
Minimally helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Strong