Femoropopliteal Bypass

WHAT YOU SHOULD KNOW:

Femoropopliteal (fem-er-o-pop-lih-t-ull) bypass surgery is surgery on a blocked artery in your leg. It is also called a "fem-pop" bypass. Blood cannot flow into the leg when this artery is blocked. The femoral artery is in the thigh and the popliteal (pop-lih-t-ull) artery is near the knee. The blocked part of the femoral artery is bypassed or cut out, and replaced with a man-made graft.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You may bleed more than usual or get an infection (in-fek-shun). You could have trouble breathing, get blood clots, or have problems with your heart or kidneys. Caregivers watch you closely for these problems. If you don't have surgery, the blood may stop flowing in your leg. This could cause you to lose your leg. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before Surgery:

• Arterial doppler: An arterial doppler test is done to check blood flow through an artery. A small metal disc with gel on it is placed on your skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where caregivers feel or hear the blood flowing best. Caregivers may need to check blood flow more than once.
  
  
• Blood Tests: You may need blood taken for tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. It is tested to see how your body is before surgery. You may need to have blood drawn more than once.
  
  
• Blood Transfusion (trans-few-shun): You may need a blood transfusion if your blood count is low. This is called anemia (uh-nee-me-uh). Or, you may need a blood transfusion if you lose a lot of blood during surgery. There are three ways to receive blood.
  
  
  • Autologous (ah-tall-uh-gus): An autologous blood donation is when you donate your own blood to be used by you. You must be able to donate your blood at least three days prior to your surgery. You may need to have surgery as soon as your caregiver finds out about your blocked artery. You may not have time to donate your own blood if you need surgery right away.
    
    
  • Directed: A family member or friend with the same blood type can donate blood for you. This is called directed blood donation because caregivers will save that blood for you if you need it.
    
    
  • Homologous (huh-mall-uh-gus): This is the most common way blood is donated. Any healthy person can donate blood. This blood is used when someone with the same blood type needs a transfusion. Many people are worried about getting AIDS or hepatitis from a blood transfusion. The risk of this happening is rare. Usually the risk of not getting the blood is greater than getting AIDS or hepatitis. If your body doesn't have enough blood, you could have a heart attack or die.
  
  
• Call Button: You can use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call.
  
  
• Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing before surgery. Caregivers may also use the x-ray to look for signs of infection like pneumonia (new-moan-yuh).
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Informed Consent: You have the right to understand your health problem in words you can understand. You should be told what tests, treatments, or procedures may be done to treat your problem. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-Op Care: You may be given medicine right before surgery that makes you feel sleepy and more relaxed. You are taken on a cart to the room where your surgery will be done. Caregivers help you get comfortable on the bed. A belt may be put over your legs for safety. If you get cold, ask for more blankets.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During Surgery:

• Anesthesia (an-iss-thee-zuh): This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep. Ask your caregiver for the CareNotes™ handout about the following types of anesthesia if you want more information.
  
  
  • General Anesthesia: This is medicine given to keep you completely asleep and free from pain during surgery. It may be given as a liquid in your IV. Or, it is given as a gas through a facemask or a tube placed in your mouth and throat. This tube is called an endotracheal (end-o-tra-kee-ull) tube or "ET" tube. Usually you are asleep before caregivers put the tube into your throat. And, the ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Special Tubes: These are tubes that may be put in an artery or vein. These tubes will help caregivers watch how you are doing.
  
  
  • Arterial (r-teer-e-ull) Line: This tube is also called an "art line" or an "A-line." It is placed into an artery, usually in the wrist or groin. The groin is the area where your abdomen (belly) meets your upper leg. The art line is attached to tubing with liquid in it. This liquid helps keep the tubing from getting plugged. The tube may be used for measuring your blood pressure or for drawing blood.
    
    
  • Cardiac Outputs: These are tests that may be done before, during, and after surgery. It helps caregivers learn how well your heart is working. IV liquid is pushed into your Swan-Ganz line very quickly. The Swan-Ganz line then measures how long it takes this liquid to move through your heart. This tells your caregivers how much blood your heart is pumping out.
    
    
  • CVP Line: A CVP line is also called a central line. It is an IV catheter (kath-uh-ter) put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen (belly) meets your upper leg. The head of your bed may be lowered to help the blood vessel fill up. This may make it easier to put in the catheter. The skin where the catheter will be placed is numbed so you won't feel much pain. The IV may be used to give medicines or to measure how your heart is doing before and after surgery.
    
    
  • Pulmonary (pull-mun-air-e) Artery Line: A pulmonary artery line or "PA cath" is one kind of central line catheter. It is a thin tube put in a vein near your collarbone or in your neck. The tube is then guided through your heart and into your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart is doing before, during, and after surgery. Another part of this catheter may be used to give medicine.
  
  
• Surgery Steps: Caregivers clean your abdomen (belly), groin, and legs with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
  • Caregivers make 2 to 3 incisions (cuts) in your leg. One is along your inner thigh and the other is along the inside of your knee. An incision may be made in your lower leg so a vein can be removed for a graft. The vein from your lower leg or a man-made graft (tube) is sewed to your femoral artery above the blocked area. It is then tunneled under the skin and muscles in your thigh to the incision near your knee. The far end of the graft is sewed to the popliteal artery below the blocked area. Blood then flows through the vein or graft around the blocked area.
    
    
  • The incisions is closed with stitches or staples. Steri-strips (thin strips of tape) may be put over your incisions. Bandages are put on your incisions and elastic bandages are wrapped around your leg.
  
  
• After Surgery: You are taken to a room where you can rest while caregivers watch you very closely until you wake up. You are then moved to your hospital room or the intensive care unit (ICU). Do not get out of bed until your caregiver says it is OK. Your family may be allowed to visit you in the ICU for a short visit several times a day.
  
  
• Activity:
  
  
  • You may need to rest in bed. You may be allowed out of bed once you are feeling better usually the day of surgery. If you are not allowed out of bed for awhile, ask caregivers if you can exercise your legs in bed. If your caregiver says it's OK, do leg exercises in bed. You can lift one leg off the bed and draw big circles with your toes. This will help make your legs strong and help you from getting blood clots. Stop if you become tired.
    
    
  • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. Sit or lie down right away if you ever feel weak or dizzy. Then call your caregiver.
  
  
• Day/Night Confusion: You may not know when it is daytime or nighttime if you stay in ICU. This is common for patients staying in this unit. It can be caused by having the lights on all the time. The lights may cause you to feel or act confused. When you are moved to a room on a regular floor, you will become more aware of time.
  
  
• Deep Breathing and Coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (spit) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow firmly against your abdominal incision (cut) when you cough to help lessen the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive (in-sen-tiv) spirometer (sper-om-ih-ter). This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Drains: These are thin rubber tubes that may be put into your skin to drain fluid from around your incision. The drain(s) are taken out when the incision stops draining
  
  
• Eating: You may be able to eat when bowel sounds (stomach growling) are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. Ice chips are usually given first and then liquids (water, broth, apple juice, or 7-up). If you don't have problems after drinking liquids, caregivers may then let you eat soft foods. Some examples of soft foods are ice cream, applesauce, or custard. If you do OK with soft food, you may begin eating a regular diet.
  
  
• Foley Catheter (kath-uh-ter): This is a tube that may be put into your bladder to drain your urine. The bladder is an organ where urine is kept. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you can urinate on your own.
  
  
  • Don't pull on the catheter because this will make you hurt or bleed.
    
    
  • Don't kink the catheter because the urine cannot drain.
    
    
  • Don't lift the bag of urine above the catheter. If you do this, the urine will flow back into your bladder. This can cause an infection.
  
  
• Intake and Output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O."
  
  
  • When you are allowed, drink 6 to 8 (soda pop can size) glasses of water each day. Or, follow your caregiver's advice if you must limit the amount of liquid you drink. If you are on I&O, tell your caregiver how much liquid you drink.
    
    
  • Ask your caregiver if it is OK to flush your urine down the toilet. It may need to be measured before it is thrown away.
  
  
• Medicines:
  
  
  • Antibiotics (an-ti-bi-ah-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria (bak-teer-e-uh). Antibiotics may be given by IV, as a shot, or by mouth.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain Medicine: Caregivers may give you medicine to lessen your pain. This medicine may be given in your IV, as a shot, or by mouth. Tell caregivers if the pain does not go away or comes back. Ask caregivers for the CareNotes™ handout about non-medicine ways to lessen and control pain.
    
    
  • Stool Softeners: You may be given stool softeners to keep you from getting constipated (kon-stih-pa-ted). Constipated means it is hard have a BM. Stool softeners make your BM softer so you do not need to strain when having a BM.
    
    
  • Blood Thinners: This medicine keeps clots from forming in the blood. Clots can cause strokes and death. Blood thinners may be given before, during, and after surgery. These medicines may first be given in your IV. Later the medicines may be taken by mouth or as a shot. Blood thinners may make it easier to bleed or bruise. If you shave, use an electric razor. Use a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding.
    
    
  • Clot Busters: This medicine helps break apart clots that have already formed. It is given in your IV and may be given at the same time as other blood thinners. Clot busters can make you bleed or bruise easily just like blood thinners. Be careful when you are taking clot busters just as you should when taking blood thinners.
  
  
• NG Tube: This is also called a nasogastric (na-zo-gas-trik) tube. This tube may be put in your nose and down into your stomach. The tube is attached to suction (vacuum) which will keep the stomach empty. This tube may help get your bowels working. Sometimes food or medicine can be given through the NG tube.
  
  
• Oxygen: You may need extra oxygen for a day or two after surgery. It may be given through a plastic mask over your mouth and nose. Or, it may be given through nasal prongs (short, thin tubes in your nose). Tell your caregiver if the oxygen is drying out your nose or if the nasal prongs bother you. Don't take off your oxygen without asking your caregiver. If you do, your body may not have enough oxygen.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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