Femoral Popliteal Bypass Surgery

Reference

Femoral Popliteal Bypass Surgery

Bergqvist, D., & Karacagil, S. (1994). Femoral artery disease. Lancet, 343(8900), 773-778.

Johns Hopkins University. (2014). Femoral popliteal bypass surgery. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/femoral_popliteal_bypass_surgery_92.P08294

Pamouklan, V., & De Collibus, Damien. (2010). Vascular plumbing 101: Management of peripheral artery disease. Podiatry Management, March, 177-184.

Vancouver Coastal Health. (2012). CPD B-200 - Bypass graft: Lower limb. Retrieved from PolicyNet – Vancouver Acute.

Ward, C. (2010). Peripheral arterial disease. Medsurg Nursing, 19(4), 247-248.

Questions

When providing discharge teaching to Tony, you will stress which of the following to help prevent further ischemia to his legs?

1. Manage blood glucose

2. Maintain a safe home environment to prevent injury to his legs

3. Avoid temperature extremes

4. Stop smoking

On Tony's 3rd post-operative day, he complains of nausea at 0830 hrs and states that he does not feel like eating his breakfast. You administer Gravol 25 mg IV as ordered and leave him to rest. At 1130 hrs he is complaining of profuse diaphoresis, pallor, and states he is feeling very unwell. What is likely the cause?

1. Tony is experiencing hypovolemic shock

2. Tony is experiencing hypoglycemic crisis

3. Tony is experiencing diabetic ketoacidosis

4. Tony is experiencing myocardial infarction

On Tony's 2nd post-operative day, it is most important to assess which of the following?

1. Assess Tony's peripheral pulses and monitor for signs of loss of sensory/motor function

2. Assess Tony's pain and administer an opioid analgesic

3. Check the dressings frequently for bleeding

4. Assist Tony to ambulate the evening of surgery to prevent blood clots

On Tony's 1st post-operative day following femoral popliteal bypass surgery, you are unable to palpate pulses in the operative leg. Tony complains of throbbing pain in his operative leg and foot. What do you do first?

1. Elevate the leg and recheck the pulse

2. Administer an opioid analgesic

3. Call the physician immediately

4. Massage the leg and apply warm towels

4. Smoking causes vasoconstriction, which increases the ischemia brought about by peripheral arterial disease.

Femoral Popliteal Bypass

2. Diaphoresis, pallor, and feeling very unwell are signs and symptoms of hypoglycemia. Consider the missed breakfast, and increased glucose demand following surgery, hypoglycemia is a likely event.

(Ward, 2010)

1. The main priority is blood flow to the extremities. Decreased pulses, pallor, cyanosis, or decreased temperature in the operative leg may indicate occlusion of the graft.

3. Occlusion of the graft is a medical emergency. The physician should be notified immediately if pulses cannot be palpated and the patient is having increased pain. The surgeon will need

to take prompt action to prevent ischemic injury to the leg.

Peripheral Artery Disease

(Bergqvist & Karacagil, 1994; Vancouver Coastal Health, 2012)

Adverse Outcomes

See: Ivee - Macrovascular Complications

(Pamouklan & De Collibus, 2010; Johns Hopkins University, 2014)

(Bergqvist & Karacagil, 1994; Pamouklan & De Collibus, 2010; Vancouver Coastal Health, 2012)

Peripheral Artery Disease

ABI = (systolic leg)/(systolic arm)

Normal: 0.9 - 1.1

Mild arterial insufficiency: 0.7 - 0.9

Severe arterial insufficiency: < 0.4

See: Arthi - Angiogram

(Pamouklan & De Collibus, 2010; Johns Hopkins University, 2014)