Clinical exam · General exam and vital signs
Capillary refill time !
- Sign
Press the nail until it turns white and time how long the colour takes to return: it shows how blood reaches the skin.
Updated 2026-11-01
See it in 3D: Skin
What it is
Capillary refill time is how long a nail bed or patch of skin takes to regain its colour after being pressed until it blanches. It reflects peripheral perfusion and vasomotor response. It is quick, free and especially useful in children, in triage and in assessing shock and dehydration.
The anatomy it tests
- It tests the capillary network of the dermis and nail bed and the tone of the arterioles that feed it.
- The distal limbs are first to lose perfusion when the body diverts blood to the heart and brain.
How to elicit it
- Remove nail polish and make sure the hand is not cold; warm room.
- Raise the patient's hand slightly above heart level.
- Press the nail bed of one finger (or the skin over the sternum in infants) for about five seconds until it blanches.
- Release suddenly and count the seconds until the pink colour returns.
- Compare with the other side or another limb if a local arterial problem is suspected.
- Record the time in seconds, the site and skin temperature.
What a positive result means
- More than 2 seconds suggests poor peripheral perfusion: dehydration, hypovolemic or septic shock, low cardiac output.
- Prolonged in one limb only: local arterial obstruction or peripheral arterial disease.
- Improvement with resuscitation is a useful sign of response.
- A normal refill does not exclude early shock or mild dehydration.
Usefulness and limits
- It varies with room temperature, light, age and the pressure applied; agreement between examiners is moderate.
- It is more useful as part of a set of signs than on its own.
Test yourself
Think of the answer, then tap the question to see it.
What is a normal capillary refill time?
Under 2 seconds for the pink colour to return after the nail bed blanches.
Why is the patient's hand raised when measuring capillary refill?
So the return of colour depends on arterial inflow and not on venous filling by gravity.
Which non-disease factors prolong capillary refill?
A cold room or cold skin, older age, a hand below heart level and poor lighting.
What does prolonged capillary refill in one foot only suggest?
A local arterial problem, such as acute occlusion or peripheral arterial disease, rather than shock.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Hydration status: signs of dehydration
- Shock: the clinical signs and the types
- Peripheral pulses and the ankle–brachial index
- Vital signs in children: how they change with age
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Capillary nail refill test: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine (MedlinePlus), 2025); Dehydration in Children - Pediatrics - MSD Manual Professional Edition (Merck & Co. (MSD Manual Professional Edition), 2025).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.