Postoperative Protocol - Femoro-Popliteal Bypass

#FemoralArterySurgery #PostOpProtocol #VascularSurgery #MAPControl #HipFlexionRestriction
Dr. Gregory Weir's post-operative protocol for femoral artery surgery, specifically femoro-popliteal bypass, outlines critical immediate care for patient stabilization and graft protection.

Key elements include:
*Blood Pressure Management (MAP):* Strict control of Mean Arterial Pressure (MAP) between 70-100 mmHg. This range ensures adequate blood flow while preventing stress on surgical connections or bleeding. If MAP exceeds 100 mmHg, titrate nitrosine. If MAP is below 70 mmHg, Central Venous Pressure (CVP) guides intervention: Ringer’s bolus if CVP is low (fluid deficit) or noradrenaline if CVP is high (vessel dilation).
*General Support:* Maintain Hematocrit (HTT) above 30% to support oxygen delivery and blood viscosity. Elevate the leg to reduce swelling (edema), preventing graft compression. Ensure oxygen supply and confirm CVP line placement with an X-ray for safety.
*Lab Monitoring:* Daily checks include HTT, Troponin T (TROPT), Urea, Potassium, Electrolytes (UKE), Full Blood Count (FBC), C-reactive protein (CRP), and myoglobin to monitor immediate patient response, blood picture, and inflammation.
*Activity Restrictions:* On day zero, strict bed rest is mandatory; patients must not sit upright or bend at the hip to protect the fragile graft connections. Eating and drinking are permitted. Gradual mobilization begins carefully on day one to avoid risking the surgical site.