The most important assessment for the nurse to make after a client has had a femoropopliteal bypass for peripheral vascular disease would be:
A. Incisional pain
B. Pedal pulse rate
C. Capillary refill time
D. Degree of hair growth
Correct Answer: C. Capillary refill time
Checking capillary refill provides data about the current perfusion of the extremity. Vascular surgery is considered a high-risk procedure and most procedures carry a >5% risk of an acute cardiac event. Direct reconstruction of aorta iliofemoral disease is associated with a 2.8% perioperative mortality while extra-anatomic bypass confers an 8.8% mortality.
Option A: Patients undergoing PVB are at risk for wound infection, bleeding, pneumonia, conduit occlusion, and peripheral nerve damage. These patients often also have a higher prevalence of cerebrovascular and coronary artery disease which significantly increases their risk for stroke and myocardial infarction surgery.
Option B: While the presence and quality of the pedal pulse provide data about peripheral circulation, it is not necessary to count the rate. Postoperatively, the patient’s distal flow to the posterior tibial and dorsalis pedis should be assessed. If the pulses are not palpable, a doppler should be used for identification.
Option D: Indicators for potential adverse outcomes include smoking, pulmonary disease, female sex, diabetes mellitus, previous bypass history, and advanced age. Conduit-related complications can be divided into immediate and long-term. Immediate including acute thrombosis and bleeding. Long-term including infection and occlusion secondary to intimal hyperplasia.
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