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Femoral Popliteal Bypass

Julian L. Gallegos, MS, RN, FNP-BC FNP-

Femoral Popliteal Bypass


Surgical technique to relieve symptoms of acute or chronic ischemia of the lower extremities.  Involves using an autologous graft to route arterial blood from the femoral artery around a blocked popliteal artery, reestablishing blood flow in the tibial arteries.


Etiology and Precipitating Factor




Acute Occlusion
Traumatic transection or occlusion Diagnostic procedures such as angiography Disorders associated with embolus formation

Chronic Occlusion
Atherosclerosis Aneurysm of the popliteal artery Chronic Infection Restenosis of previous graft

Potential Complications
Hematoma formation  Infection  Emboli or thrombi  Gangrene  Skin ulcers


Nursing Care Plan


 

Nursing Priority
Maintain arterial blood flow

Patient Outcome Criteria


Within 24hours after surgery and then continuously the patient will have:
 No ischemic pain  Bilaterally equal peripheral pulses

Nursing Care Plan


Interventions 1. Assess and document the appearance of surgical site. Include type of dressing, extent of drainage, and any drainage devices. 2. Note the contour of the surgical site and compare with the opposite side. Observe for masses, ecchymosis, and skin changes. Monitor H/H. Rationale
1.

2.

Baseline assessment permits later comparison of data. A surgical drain may be in place to remove lymph or blood. Drainage should be minimal and bright red initially becoming serous within 24hrs. Disruption of graft anastamosis, hemorrhage of soft tissues, or drainage from severed lymph vessels can induce enough fluid to occlude the graft. Fluid collection causes the skin to become taut, with a dimpled appearance. A mass will be palpable. Surgical fluid removal is necessary if graft occlusion is imminent. Eccymosis indicates arterial bleeding and possible disruption of the anastamosis. Decreased H/H may indicate bleeding also.

Nursing Care Plan


Interventions Rationale 3. Measure the calf hourly for 3. These signs and symptoms the first 4 hours then every 4 suggest anterior compartment for the next 24 hours. syndrome caused by tissue Observe for increased edema and hemorrhage. capillary time; diminished or Emergency fasciotomy may absent pulses; mild pain be necessary to relieve signs beginning in the feet and and symptoms. lateral to the tibia, progressing to pain unrelieved by narcotics; decreased ROM and ABI; or cold, cyanotic skin. Document findings.

Nursing Care Plan


Interventions 4. Position the leg to avoid hyperextension and undue pressure on the graft site. Rationale 4. Hyperextension of the knee or pressure from the body can retard venous flow, increasing tissue edema. Pressure also can diminish arterial flow through the graft. The resulting embolus calls for an emergency embolectomy. 5. The patient is at greatest risk for shunt occlusion immediately after surgery. Factors that decrease blood pressure could cause shunt collapse.

5.

Observe for symptoms of deficient fluid volume or hypotension. Document findings.

Nursing Care Plan


Interventions Rationale 6. Observe for signs and 6. In reperfusion injury, symptoms of reperfusion reperfused tissues typically injury. Maintain adequate demonstrate initial hydration. If cyanosis, improvement, only to coldness, or pain occurs, undergo severe hypoxic check for presence of changes within 2 hours after peripheral pulses. Notify the surgery. Reperfused cells physician of findings promptly produce high levels of free and administer treatment as oxygen radicals, which injure ordered. cells. Adequate hydration lessens the risk of reperfusion injury. The presence of peripheral pulses differentiates arterial reocclusion from reperfusion injury.

Activity Post Op
The patient should not hyperextend their affected extremity.  The patient s activity can gradually be increased based on his or her tolerance.  Patient should be out of bed as soon as he/she can tolerate sitting up in bed to minimize risk for atelectasis.


Nursing Care Plan




If any concerns or unaware of what to do for a patient with complications status post femoral-popliteal bypass graft use: femoralChain of Command (Lead, Manager, CPM) Notify Physician Initiate RRT