Assessment of paediatric patients can be challenging, due to many developmental and environmental factors. A complete physical assessment would include the patient’s heart rate, blood pressure, colour, central capillary refill time, respiratory rate, oxygen saturations, work of breathing, level of consciousness, temperature and pain score. However, if the patient is not compliant or the equipment is not appropriately sized this full assessment can be impossible!
One of the most important assessment tools in rapid paediatric assessment is the central capillary refill time (CRT). It is quick, easy to perform and does not require any special equipment. CRT is the time it takes for colour to return to a capillary bed after pressure has been applied to create blanching of the area. A normal CRT should be between 2-3 seconds when applied centrally, such as to the sternum or the forehead. Delayed CRT is indicative of circulatory shock or dehydration, and prompts further assessment and investigations. Difficulties in performing a CRT include poor lighting and a cold environment, so take the time to ensure adequate lighting and temperature before performing the CRT.
If you are interested in updating your knowledge on paediatric assessment, you may be interested in joining us in one of our following courses depending on your area of clinical practice.
For a full list of events and courses please visit https://medcast.com.au/critical-care.
Fleming S, Gill P, Jones C, Taylor JA, Van den Bruel A, Heneghan C, Roberts N, & Thompson M. The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis. PLoS One. 2015 Sep 16;10(9):e0138155. doi: 10.1371/journal.pone.0138155. PMID: 26375953; PMCID: PMC4573516.
King D, Morton R, & Bevan C. How to use capillary refill time. Archives of Disease in Childhood: Education & Practice, 2013 November, doi:10.1136/archdischild-2013-305198.