One of the indicators that the cardiac clinic ask about when I am worried about Wren is capillary refill in his feet. That means when you apply a firm pressure to the underside of the foot for a few seconds and then release it, how quickly does the white area go pink again.
Wren had such lovely pink feet after his nap that I pressed his foot for reassurance but the big white spot remained there a while. So I freaked out and squeezed his foot again, tried the left one and so on until I couldn't be sure whether the speed of the refill was normal or not. I squeezed my own foot but that wasn't very diagnostic since my foot is far from my eye and I have no idea whether my refill time is anything like his... I would guess not so I went searching for information online.
The only information I could find was about newborns (who would tend to have slower refill time):
We measured capillary refill time (CRT) in a convenience sample of 137 healthy newborns between 1 and 120 hours of age and 36-42 weeks gestation in the well-baby nursery of a large community hospital. CRT was measured by applying moderate pressure to the dorsum of the right hand and right foot for 5 seconds. Pressure was released and the time for complete refilling of the blanched area noted. Each infant was studied only once. We also measured ambient temperature and the skin temperature of the dorsum of the hand and foot and tested interobserver agreement. Mean CRT was 4.23±1.47 s (SD) (range 1.63-8.78 s) in the hand and 4.64±1.41 s (range 2.15-9.94 s) in the foot (p=0.0001) and did not change significantly in the first 72 hours.
And that "in older pediatric patients it tends to be between 2 and 4 seconds". I have no idea whether Wren is older or not.
Almost 5 seconds seems a super long time - even 4 seconds is okay. I know Wren tends to have slower refill since the hassles with his femoral arteries during the cath so I am reassured. It wasn't that long at all and I will poke him again later to confirm this.
Can I chalk this panic up there with "I can't hear him breathing from across the room"? And can I also ask why the cardiac clinic give me such subjective indicators to watch? I mean, they have never told me what normal perfusion looks like or even shown me what it looks like when there is not a problem 'cos Wren has always had a problem with circulation in the lower extremities. If it was significant where is the stopwatch in my discharge kit? Hrmm? Hrmm? How will I know if it is slower today or is it only serious when it doesn't refill in five minutes? Okay, okay, I am having a moment here.
5 comments:
I have pushed izzys heals for months now and I had the same thought at times. Izzy is my frist child and a heart child. Not that if I had a healthy heart child before her I would have pushed the feet to check on cap refill. How are we supposed to know what normal is? But again we are learning our childs normal so remeber what it is like today and compare to the next day and so on and you will learn his normal and be able to see if there is a diffrence over time.
You won't believe it but I called Jenny at the heart center to ask. It was mainly because a vein above Wren's eye started bulging like something on Arnie's bicep every time he strained. I thought that his upper BP was too high and wanted to know about the cap refill too.
She said that they would like it below 3 seconds but Wren might be a bit higher because of his cath lab side-effects. She didn't think the vein was anything to worry about but thought it sounded peculiar.
How about a simpler approach, since you are mainly concerned about a difference from his upper body? Using Wren as his own "control", is the cap refill time the same in his upper extremities (hands) as his lower extremities (feet)? Hope you have a good night. - Josephine
I am happy you called, always call really calling and asking ?'s is way better than stressing out and wondering.wyndi
Josephine, Wren has always had very quick refill on the hand because of his difference in pressures. Even post-cath he has residual coarc in the arch which affects upper vs lower.
His hand is about 2s (or less) and his foot about 4s.
Its really hard to judge whether this is worse or not.
When i spoke to Jenny she said that the kind of thing they are worried about would not present suddenly and its more important that I watch for sweating, extreme fussiness over a period of days, inability to sleep (yeah) / lethargy, inability to eat. I guess the behavioural stuff. I don't like that as much because I don't want to wait until he's feeling really lousy if there is a way to pick up problems before they reach that point but its only 2 weeks and 3 days till our next checkup and then perhaps I will have a few days of relief if all is well.
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