How soon after a femoral to below knee popliteal bypass can patients get out of bed?

Early Mobilization After Femoral to Below-Knee Popliteal Bypass

Patients should begin mobilization between 24-48 hours after femoral to below-knee popliteal bypass surgery, provided they are hemodynamically stable and have no contraindications. 1

Timing of Initial Mobilization

• Start mobilization at 24-48 hours post-operatively as the standard approach for vascular surgery patients who are neurologically and hemodynamically stable 2, 1
• Patients can begin with sitting out of bed for 30 minutes on postoperative day 0-1, progressing to 6 hours per day thereafter 1
• Walking should commence on postoperative day 1-2 under physiotherapy supervision 1

Absolute Contraindications to Early Mobilization

Do not mobilize patients if any of the following are present:

• Arterial puncture site from interventional procedures (requires extended bed rest for hemostasis) 2, 1
• Hemodynamic instability (hypotension, ongoing bleeding, cardiovascular instability) 2, 1
• Low oxygen saturation requiring supplemental oxygen adjustment 2, 1
• Lower limb fracture or injury 2, 1
• Severe edema and pain at initial presentation 3

Progressive Mobilization Protocol

Days 0-2:

• Sitting at bedside for 30 minutes to several hours 1
• Limb movement exercises including active range of motion for all extremities 1
• Remove impediments to mobilization including unnecessary catheters and lines 1

Days 2-14:

• Walking once or twice daily with physiotherapist supervision to improve physical capacity 1
• Continue progressive mobilization with sitting, standing, and walking activities based on functional level 1
• Mobilization should be conducted daily, 7 days per week 1

Critical Implementation Points

• Ensure adequate pain control before attempting mobilization, as pain is the primary barrier to effective early movement 1
• Supervised exercise is superior to unsupervised mobilization, with physiotherapist-directed protocols showing significantly better outcomes 1
• Antiplatelet therapy should be initiated and continued indefinitely unless contraindicated 2
• Monitor for signs of graft thrombosis during early mobilization (absent pulses, acute limb ischemia) 2

Common Pitfalls to Avoid

• Waiting beyond 48 hours to mobilize results in increased complications including atelectasis, pleural effusion, and venous thromboembolism 1
• Mobilizing too early (within first 24 hours) in unstable patients can compromise graft patency and hemodynamic status 2
• Inadequate pain management will prevent effective participation in mobilization exercises 1
• Failing to use compression devices for venous thromboembolism prophylaxis during the immobilization period 2

Venous Thromboembolism Prophylaxis During Mobilization

• Intermittent pneumatic compression (IPC) devices should be applied immediately post-operatively and continued until the patient is fully ambulatory 2
• Low-molecular weight heparin (enoxaparin) should be considered for high-risk patients, or unfractionated heparin for those with renal failure 2
• Early mobilization and adequate hydration are essential components of venous thromboembolism prevention 2

Monitoring During Mobilization

• Assess distal pulses and ankle-brachial indices to ensure graft patency 2
• Monitor for return or progression of ischemic symptoms 2
• Use early warning scoring systems to identify patients at risk for adverse events 1