Endovascular & Vascular Surgery Nursing Guide

Vascular Anatomy & Assessment

Ankle-Brachial Pressure Index (ABPI)

Ratio of ankle systolic BP to brachial systolic BP using Doppler probe.

ABPI Value	Interpretation	Action
>1.3	Calcified vessels	Toe-brachial index instead
0.9–1.2	Normal	Reassure, lifestyle advice
0.7–0.9	Mild PAD	Conservative Rx, risk factor modification
0.5–0.69	Moderate PAD	Vascular clinic referral
<0.5	Critical Ischaemia	Urgent vascular review
<0.4	Tissue Loss Risk	Hospital admission likely

Technique: Apply BP cuff above ankle. Use hand-held Doppler over dorsalis pedis or posterior tibial artery. Record highest ankle pressure divided by highest brachial pressure.

The 6 Ps of Acute Limb Ischaemia

EMERGENCY: Any combination of these signs requires immediate vascular surgical assessment.

Pain
Severe, rest pain

Pallor
White/mottled skin

Pulselessness
Absent Doppler

Paraesthesia
Pins & needles

Paralysis
Can't move toes

Perishingly Cold
Cold to touch

Rutherford Classification

Class	Viability	Doppler	Action
I	Viable	Audible A+V	Urgent workup
IIa	Marginally threatened	Venous only	Urgent revascularisation
IIb	Immediately threatened	Neither A nor V	Emergency surgery
III	Irreversible	Absent	Consider palliation/amputation

Fontaine & Rutherford Classification (PAD)

Fontaine	Rutherford	Symptoms
Stage I	0/1	Asymptomatic / mild claudication
Stage IIa	2	Moderate claudication (>200 m)
Stage IIb	3	Severe claudication (<200 m)
Stage III	4	Ischaemic rest pain
Stage IV	5	Minor tissue loss / ulceration
Stage IV	6	Major tissue loss / gangrene

Venous Assessment — CEAP Classification

Class	Clinical Signs	Nursing Focus
C0	No signs	Lifestyle / screening
C1	Telangiectasia / spider veins	Cosmetic, reassure
C2	Varicose veins	Compression, elevation
C3	Oedema	Compression, diuretics assessment
C4	Skin changes (lipodermatosclerosis)	Wound prevention
C5	Healed venous ulcer	Sustained compression
C6	Active venous ulcer	4-layer bandaging, wound care

Duplex Ultrasound — Nursing Basics

What It Measures

Blood flow velocity (PSV — peak systolic velocity)
Direction of flow (colour Doppler)
Vessel diameter & wall thickness
Stenosis % (velocity ratio >2:1 = 50%+ stenosis)
Thrombus presence (DVT screening)

Normal Waveforms

Triphasic: Normal peripheral artery
Biphasic: Mild arterial disease
Monophasic: Significant downstream disease
Venous: Low-velocity, phasic with respiration

Nursing Role in Duplex

Position patient supine / or prone for popliteal access
Warm room — cold causes vasoconstriction
No arterial puncture of limb for 24h before
Document scan location, time, findings
Report absent signals immediately to surgeon

Interactive Tool: Acute Limb Ischaemia Severity Checker

Acute Limb Ischaemia — Rutherford Severity Assessment

Check all signs present in the affected limb, then complete the additional fields and press Assess.

Onset Time

Doppler Signal (affected limb)

Capillary Refill Time

Endovascular Procedures

EVAR Post-Procedure Monitoring Checklist▶

First 2 Hours — ICU/HDU

BP target: systolic 90–120 mmHg (avoid hypertension — endoleak risk)
HR: sinus rhythm, target 60–90 bpm
Urine output: >0.5 ml/kg/hr (renal perfusion)
Both femoral pulses + bilateral pedal Doppler q30min
Groin wound sites: check for haematoma/bleeding
Pain score — epidural/PCA management
Temperature — warming if <36°C

2–24 Hours

Neuro obs: lower limb movement & sensation hourly (spinal cord ischaemia)
Abdominal assessment: distension, bowel sounds q4h (ileus)
Renal function: U&E at 6h and 24h (contrast nephropathy)
CXR if respiratory compromise suspected (pleural effusion)
Duplex scan at 24h — confirm graft position, check for endoleak
Heparin protocol per surgeon order
IV fluids: 1–1.5 ml/kg/hr crystalloid for 12h post-contrast

ENDOLEAK SIGNS: Sudden back/flank pain, haemodynamic instability, or expanding aneurysm sac on imaging. Report immediately — may require re-intervention.

SPINAL CORD ISCHAEMIA: Lower limb weakness/paralysis post-EVAR (esp. thoracic EVAR). Raise MAP to >90 mmHg, drain CSF if lumbar drain in situ, call neurosurgery.

Carotid Artery Stenting (CAS)

Pre-Procedure

Dual antiplatelet (aspirin 75–100 mg + clopidogrel 75 mg) — confirm loading dose given
Baseline neuro obs: NIHSS/GCS, cranial nerve examination
Baseline BP both arms, cardiac monitoring
IV access — 2 large-bore cannulae
Allergy check: contrast, heparin, protamine

Post-Procedure — Neuro Monitoring

Neuro obs EVERY 15 MINUTES for 2h, then 30 min for 2h, then hourly for 24h.

GCS — report any drop of 2+ points immediately
Facial asymmetry, slurred speech (FAST assessment)
Upper/lower limb power & sensation bilaterally
Pupils — size, reactivity, equality
BP target: systolic 100–160 mmHg (avoid hypo- & hypertension)
HR: watch for bradycardia (carotid body stimulation)

Hyperperfusion Syndrome: Severe ipsilateral headache, seizure, focal deficit 24–72h post-CAS. Strict BP <150 mmHg. Call neurology.

Peripheral Angioplasty & Stenting (PTA)

Access Site Care — Femoral

Document sheath size (4–8Fr), insertion time, heparin dose
Maintain bed rest with limb straight until sheath removed
Sheath removal: ACT <180s or 4h after last heparin bolus
Manual compression: 15–20 min firm pressure (or closure device)
Post-removal: check q15min ×4, q30min ×4, hourly ×4
Pedal pulses Doppler assessment each check

Radial Access Site

TR Band or Radistop compression device — 2h minimum
Allen's test pre-procedure (collateral circulation check)
Monitor for radial artery occlusion (SpO2 on that finger)

Post-PTA Discharge Teaching

Dual antiplatelet — do not stop without vascular team advice
Walking programme: 30 min/day to stimulate collaterals
Return to ED: cold, pale, painful limb = emergency
Duplex surveillance at 3, 6, 12 months

Renal Artery Stenting

Indications

Fibromuscular dysplasia (young women) — first-line angioplasty
Atherosclerotic RAS with resistant hypertension
Flash pulmonary oedema / ischaemic nephropathy

BP Monitoring Post-Procedure

Continuous monitoring for 24h — ABP line or q15min NBP
Significant BP drop expected — have vasopressors available
Hold antihypertensives pre-procedure (per surgeon)
Document BP trend — may take days-weeks to normalise

Contrast Nephropathy Prevention

IV 0.9% NaCl: 1 ml/kg/hr from 6h pre to 12h post
N-acetylcysteine 600 mg PO BD ×2 days (evidence limited but low risk)
Hold metformin 48h before and after (lactic acidosis risk)
Hold NSAIDs, aminoglycosides, ACE-I/ARB on day of procedure
Use iso-osmolar contrast (iodixanol preferred in CKD)
Serum creatinine at 24h and 48h post-procedure

Iliac & Femoral Revascularisation

Iliac Angioplasty/Stenting (TASC Classification)

TASC	Lesion	Preferred Treatment
A	Short stenosis/occlusion <3cm	Endovascular
B	3–10cm, ≤2 stenoses	Endovascular
C	Complex, bilateral, long	Surgery preferred
D	Chronic total occlusion, diffuse	Open surgery

Post-Iliac Stent Nursing

Both femoral pulses post-procedure — bilateral assessment essential
Watch for blue toe syndrome (distal embolisation from stent)
Abdominal pain — rule out haematoma or aortic injury
Urinary output — bilateral renal perfusion concern with aorto-iliac work

Open Vascular Surgery

AAA Open Repair (Aortic Aneurysm)

Aortic Cross-Clamp Complications

Renal failure: Suprarenal clamping — warm ischaemia time limit <30 min
Spinal cord ischaemia: Lower limb weakness post-op — urgent MAP optimisation
Cardiac strain: Sudden afterload increase during clamping — have vasodilators ready
Mesenteric ischaemia: Abdominal pain, rising lactate, bloody diarrhoea post-op

Paralytic Ileus Management

NG tube if vomiting — aspirate q4h, document losses
NBM until bowel sounds return (usually 3–5 days)
IV fluids — strict I&O charting
Early mobilisation encourages peristalsis
Avoid opioids where possible — use epidural/regional analgesia

Renal Failure Post-Repair

Urine output target: >0.5 ml/kg/hr minimum 1 ml/kg/hr preferred
Daily U&E, creatinine — trend monitoring
Avoid nephrotoxins: NSAIDs, aminoglycosides, contrast
Nephrology referral if creatinine rises >25% baseline
Dialysis criteria: refractory hyperkalaemia, acidosis, fluid overload

Carotid Endarterectomy (CEA)

AIRWAY EMERGENCY: Wound Haematoma — Expanding neck haematoma can compress trachea within minutes. If airway compromise: remove all wound clips/sutures at bedside immediately, call emergency team, prepare for re-intubation.

Neuro Observation Protocol

GCS q15min ×2h, q30min ×2h, hourly ×12h
FAST: Face — Arm — Speech — Time
Cranial nerves: facial nerve (VII), hypoglossal (XII — tongue deviation), vagus (X — voice hoarseness)
New neurological deficit: CT head within 30 min, vascular surgeon to assess

Post-CEA BP Management

Target systolic: 100–160 mmHg (avoid extremes)
Hypertension → hyperperfusion syndrome risk: labetalol/GTN prn
Hypotension → patch thrombosis / inadequate cerebral flow: fluid bolus, vasopressors
Bradycardia: carotid body/sinus manipulation — atropine 0.6 mg IV prn

CEA Neuro Observation Chart▶

Time	GCS	Pupils	Limb Power	Speech	BP/HR	Wound
0h (baseline)	15	E R/L	5/5 bilat	Normal	—/—	Dry
+15 min
+30 min
+1 h
+2 h
+4 h
+6 h
+12 h

Report immediately: GCS drop ≥2, new weakness/speech change, unequal pupils, neck swelling, HR <50, SBP >180 or <90 mmHg.

Femoral-Popliteal Bypass

Graft Types & Surveillance

Graft	Patency 5yr	Notes
Autologous vein (GSV)	~70%	Gold standard — check vein mapping pre-op
PTFE above-knee	~50%	Used when no suitable vein
PTFE below-knee	~30%	Higher thrombosis risk

Distal Pulse Checks — Protocol

Doppler assessment: DP + PT pulses hourly for 4h, then q4h
Document as present/absent/diminished + wave quality (triphasic/biphasic/mono)
Absent pulse post-op: immediate vascular surgeon notification
Capillary refill, skin colour, warmth each check

Graft Surveillance Programme

Duplex at 6 weeks, 3 months, 6 months, then annually
Peak systolic velocity >300 cm/s or velocity ratio >3.5 = critical stenosis
Educate patient: new claudication/rest pain = urgent presentation

Amputation Nursing (BK & AK)

Below-Knee (BK) vs Above-Knee (AK)

Aspect	BK Amputation	AK Amputation
Rehab potential	Higher (knee preserved)	Lower (greater energy cost)
Prosthesis fit	Patellar-tendon-bearing socket	Quadrilateral/ischial containment
Mobility goal	Often community ambulant	Household-to-community

Stump Care

Wound check daily: dehiscence, infection, haematoma
Rigid dressing or compression bandage to shape stump (figure-8 technique)
Elevate for 24–48h post-op, then avoid prolonged elevation (hip contracture)
Prone lying 30 min BD (AK) to prevent hip flexion contracture
Skin integrity: avoid pressure on bony prominences

Phantom Limb Pain Management

Gabapentin / pregabalin: first-line neuropathic pain
Amitriptyline: adjunct, especially night pain
Mirror therapy: visual feedback reduces phantom pain (30 min OD)
TENS, graded motor imagery
Psychological support — body image adjustment, grief counselling

Prosthesis Rehabilitation: Physiotherapy starts day 1. Stump shrinkage takes 3–6 months. First prosthesis fitting typically 6–8 weeks post-op (when stump mature & wound healed).

Post-Procedure Care

Femoral Access Site Manual Compression Protocol▶

Sheath Removal Prerequisites

ACT <180 seconds (check with bedside ACT machine)
OR 4 hours after last IV heparin bolus
Surgeon order confirmed
IV access patent, resuscitation equipment available
Patient cooperative, pain managed

Compression Technique

Locate femoral pulse, position fingertips 1–2 cm above sheath insertion site

Apply firm pressure as sheath withdrawn in one smooth motion

Maintain compression 15 min (diagnostic) / 20–30 min (therapeutic after heparin)

Verify haemostasis before releasing — pedal pulse check

Apply pressure dressing, bed rest 2–4h with limb straight

Complications — Recognition & Response

Complication	Signs	Action
Haematoma	Visible bruising, expanding swelling	Re-compress, mark border, monitor size
Pseudoaneurysm	Pulsatile lump, systolic bruit	Duplex — ultrasound-guided thrombin injection or compression
AV Fistula	Continuous machinery murmur, distal oedema	Duplex confirmation, surgical referral
Retroperitoneal bleed	Back/flank pain, haemodynamic instability, falling Hb, no groin swelling	EMERGENCY — CT abdomen, surgical review
Limb ischaemia	Cold, pale, pulseless limb	Immediate vascular surgical review

Retroperitoneal Haematoma — Deceptively absent groin swelling. Suspect in haemodynamically unstable patients. Hypotension + back pain = CT scan emergent.

Neurovascular Observations

Post-endovascular procedure: 5 Ps assessment HOURLY for 4 hours, then q2h, then q4h.

The 5 Ps Assessment

Parameter	Normal	Abnormal — Report
Pain	Controlled, not worsening	New severe/worsening pain
Pallor	Pink, normal skin tone	White, mottled, cyanotic
Pulse	Palpable/audible Doppler	Absent/diminished vs previous
Paraesthesia	Normal sensation	Pins & needles, numbness, tingling
Paralysis	Full movement toes/foot	Weakness, inability to move

Also Assess

Skin temperature (warm = good, cold = concerning)
Capillary refill: <2 seconds normal
Oedema — new/worsening unilateral oedema

Contrast Nephropathy Prevention

Risk Factors for CIN

CKD (eGFR <60) Diabetes Dehydration Heart failure Large contrast volume Nephrotoxic drugs Age >70

Prevention Protocol

Hydration: 0.9% NaCl 1 ml/kg/hr — 6h pre to 12h post procedure
N-acetylcysteine: 600 mg PO BD on day before and day of procedure
Hold nephrotoxins: NSAIDs, aminoglycosides, ACE-I/ARBs on procedure day
Hold metformin: 48h before and after (lactic acidosis risk with contrast)
Iso-osmolar contrast: Iodixanol preferred over high-osmolar agents
Minimum contrast volume: Surgeon to use lowest effective dose

Monitoring Post-Contrast

Serum creatinine at 24h and 48h — CIN defined as ≥25% or 44 µmol/L rise
Urine output hourly for 12h
Electrolytes — hyperkalaemia risk in AKI

Dual Antiplatelet Therapy (DAPT) Post-Stenting

Indication	Regimen	Duration
Carotid stent	Aspirin 100 mg + Clopidogrel 75 mg	Minimum 1 month, often 3–6 months
Peripheral stent	Aspirin 100 mg + Clopidogrel 75 mg	1–3 months, then single agent lifelong
Iliac stent	Aspirin 100 mg + Clopidogrel 75 mg	1 month minimum
Renal stent	Aspirin 100 mg + Clopidogrel 75 mg	4 weeks

Never stop DAPT without vascular surgeon advice. Abrupt cessation = stent thrombosis risk (life/limb-threatening). If surgery needed, discuss with vascular team — aspirin usually continued.

Patient Education

Take both tablets daily — even if no symptoms
Bleeding risk: report heavy bruising, black stools, haematuria
Dentist/surgery: always inform about antiplatelet therapy
PPI (omeprazole 20 mg) prescribed to reduce GI bleeding risk

Heparin Infusion Management

UFH Infusion Protocol (Therapeutic)

aPTT Ratio	Action
<1.5	Increase rate by 20%, recheck aPTT in 6h
1.5–2.5	Therapeutic — no change, recheck in 6h
2.5–3.0	Decrease rate by 20%, recheck in 6h
>3.0	Hold 1h, decrease rate 30%, recheck in 6h

Monitoring & Safety

aPTT every 6h until therapeutic, then daily
Platelet count daily — watch for HIT (heparin-induced thrombocytopenia)
HIT: platelets drop >50% from baseline day 5–14 of heparin — stop heparin immediately, use argatroban/fondaparinux
Antidote: Protamine sulphate 1 mg per 100 units heparin (max 50 mg)
Bleeding protocol: stop infusion, apply pressure, call team

Critical Limb Ischaemia (CLI)

Rest Pain Management

CLI Definition: Rest pain >2 weeks + ABPI <0.5 OR ankle pressure <50 mmHg OR toe pressure <30 mmHg. High 1-year amputation risk without revascularisation.

Pain Management Approach

Positioning: Bed dependency (foot down) to increase perfusion pressure — avoid elevation
Opioids: Morphine PCA or SC for severe rest pain — titrate to comfort
Neuropathic component: Gabapentin, pregabalin, amitriptyline
Epidural analgesia: Consider for bilateral CLI or pre-amputation
Wound analgesia: Topical morphine gel, ibuprofen foam dressings

Vascular Risk Factor Optimisation

Statin therapy — high intensity (atorvastatin 40–80 mg)
Antiplatelet therapy — aspirin or clopidogrel
Blood pressure control: target <140/90
HbA1c target <7% (53 mmol/mol)
Absolute smoking cessation

Tissue Loss & Ulcer Wound Care

Wound Assessment

Size, depth, bed quality (granulating/sloughy/necrotic/infected)
Periwound skin, oedema, warmth
Offloading: total contact cast, Scotchcast boot, removable cast walker
Wound swab if infected (cellulitis, purulent discharge, fever)

Wound Treatment Modalities

Modality	Indication	Nursing Role
Debridement (sharp)	Devitalised/necrotic tissue	Assist, document tissue removed
VAC / NPWT	Deep wounds, pre-graft bed prep	Seal check, canister change q72h
Hydrogel dressing	Dry necrotic wounds, rehydration	Change daily, keep periwound dry
Foam dressings	Exuding wounds	Change when saturated (q2–3 days)
Silver/antimicrobial	Infected wounds	Max 2 weeks, reassess

Dry Gangrene: Keep dry, no wet dressings — promotes auto-amputation or protects for surgical amputation planning. Do NOT debride dry eschar without surgeon instruction.

Revascularisation Decision

Option	Best For	Key Considerations
Angioplasty ± stent	Short segment disease, TASC A/B	Less invasive, faster recovery, repeat possible
Bypass surgery	Long segment, TASC C/D, failed angioplasty	Higher risk, better durability
Primary amputation	Irreversible ischaemia, non-ambulant, infection	Palliation, pain control, rehab focus
Conservative/palliative	High surgical risk, patient choice	Symptom management, hospice

Pre-Revascularisation Assessment

Cardiac risk (ECG, echo — high cardiac mortality in PAD population)
Renal function (contrast planning)
Nutritional status (albumin <30 = poor wound healing)
Ambulatory status, functional goals, patient wishes

Diabetic Foot & Wagner Grading

Wagner Grade	Description	Management
Grade 0	Intact skin, at-risk foot	Prevention, podiatry, footwear
Grade 1	Superficial ulcer	Offloading, wound care, antibiotics if infected
Grade 2	Deep ulcer to tendon/joint	Surgical debridement, IV antibiotics
Grade 3	Deep with osteomyelitis/abscess	IV antibiotics, bone biopsy, surgery
Grade 4	Partial forefoot gangrene	Revascularisation + amputation
Grade 5	Whole foot gangrene	Major amputation

MDT in Diabetic Foot: Vascular surgeon + Orthopaedic + Endocrinologist + Podiatrist + Wound nurse + Dietitian + Physiotherapist + Prosthetist. Weekly MDT foot clinic recommended (DHA standard).

Charcot Foot Recognition

MISSED DIAGNOSIS RISK: Charcot arthropathy is often mistaken for infection/DVT. Key differentiator: hot, swollen, erythematous foot with NORMAL or near-normal plain X-ray in early stages.

Clinical Features

Acute phase: warm, swollen, erythematous foot — neuropathic patient
Minimal pain despite severe deformity (neuropathy)
Bounding foot pulses (paradoxically good circulation)
X-ray: joint fragmentation, bone resorption, midfoot collapse
MRI: bone marrow oedema early; gold standard for diagnosis

Management Principles

Immediate offloading — total contact cast (TCC) for 3–6 months
Non-weight-bearing initially, crutches/wheelchair
Bisphosphonates (IV pamidronate) — reduces bone turnover
Temperature monitoring — resolution when both feet <2°C difference
Custom footwear when chronic/consolidated phase

Compartment Syndrome Post-Revascularisation

SURGICAL EMERGENCY — Reperfusion Injury Complication. Occurs particularly after prolonged ischaemia >6h followed by revascularisation. Requires urgent 4-compartment fasciotomy.

Recognition (5 As)

Agony: Disproportionate pain, especially on passive stretch of muscles
Altered sensation: Paraesthesia, numbness in web spaces
Anxiety: Patient distress, restlessness
Absent pulse: Late sign — do NOT wait for this
Atony: Weakness, inability to dorsiflex/plantarflex foot

Nursing Actions

Compartment pressure >30 mmHg or within 30 mmHg of diastolic BP = fasciotomy threshold
Remove all circumferential dressings/plasters immediately
Limb at heart level — do NOT elevate (reduces perfusion pressure)
Alert surgical team immediately — prepare for emergency theatre
Post-fasciotomy: open wounds managed with VAC therapy until closure (5–10 days)

GCC Context

Diabetic PAD in GCC

IDF Data: GCC countries have among the highest diabetes prevalence globally. UAE ~19%, Saudi Arabia ~18%, Kuwait ~25%, Qatar ~17% of adult population (IDF Diabetes Atlas).

Why PAD is Particularly Severe in GCC Diabetic Patients

Long duration of undiagnosed diabetes — advanced neuropathy at presentation
Predominantly infrapopliteal (tibial) disease — technically challenging to revascularise
High rate of concurrent CKD — limits contrast use and anticoagulation
High BMI and metabolic syndrome prevalence — delays wound healing
Cultural diet: high carbohydrate, refined sugars — poor glycaemic control
Delayed healthcare seeking — cultural reluctance, language barriers

Nursing Focus in GCC Diabetic Foot

Daily foot inspection — teach self/family examination
Appropriate footwear education — avoid sandals/bare feet (culturally common)
Ramadan fasting guidance — medication timing, hydration, glucose monitoring
Arabic language patient education materials

Heat Effects on Vascular Disease

Cardiovascular Impact of GCC Climate (40–50°C)

Dehydration: Haemoconcentration increases thrombosis risk in grafts/stents
Peripheral vasodilation: Heat causes vasodilation — may worsen existing hypotension post-procedure
Oedema: Heat oedema — worsens venous disease and wound oedema
Exercise tolerance: PAD claudication significantly worsened in extreme heat — reduces compliance with walking programmes
Wound dressings: Adhesive dressings peel in sweat — use non-adhesive or cohesive types

Nursing Interventions

Hydration targets: 2.5–3L/day minimum in summer months
Exercise timing: pre-dawn or after Maghrib prayers (coolest times)
Compression hosiery: graduated compression still required — manage with cooling socks
Wound monitoring increased in summer — higher infection risk

DHA/DOH Vascular Nursing Competencies

DHA (Dubai Health Authority) Requirements

Speciality classification: Registered Nurse — Vascular/Endovascular
License categories: RN, Senior RN, Charge Nurse — each with scope requirements
Mandatory competencies: IV access, wound care, monitoring post-procedure
CPD requirement: minimum 30 CME hours/year
BLS mandatory annual; ACLS recommended for vascular units

DOH (Department of Health — Abu Dhabi) Framework

Vascular nursing falls under surgical nursing competency framework
Speciality practice requires documented clinical hours + supervision
Patient safety standards: HAAD-aligned, Joint Commission International (JCI)
National Patient Safety Goals relevant: medication, falls, infection control

SCFHS & QCHP Certification

SCFHS (Saudi Commission for Health Specialties)

Vascular nursing credentialled under Surgical Nursing specialty
MOH Saudi exam: pharmacology, anatomy, clinical management questions
Board exam sections: Medical-Surgical, Critical Care, Community components
Prometric exam: 150 MCQs, 3.5 hours, passing score ~60–65%
Renewal: every 3 years — 45 CME hours per cycle

QCHP (Qatar Council for Healthcare Practitioners)

Prometric-based exam for RN licensure
Vascular/surgical nursing falls under general RN scope
Continuing education: 30 CPD credits per renewal cycle
Qatar national health strategy emphasises vascular disease prevention

Expat Workforce Risk Profile

South Asian workers: high tobacco use, low PAD awareness, delayed presentation
Low-income workers: limited access to preventive care, diabetes screening
Manual labourers: outdoor heat exposure — dehydration and cardiovascular strain
Occupational health screening mandated but inconsistently implemented

Islamic Considerations for Amputation & Prosthesis

Religious & Cultural Guidance

Islamic scholars: amputation is permissible (ja'iz) when medically necessary
Preservation of life (hifz al-nafs) is a primary objective of Islamic law
Patients may request religious consultation (imam) before consent — facilitate this
Prayer (salah) adaptation: sitting or lying prayer is permitted in illness
Qibla direction: assist patient orientation toward Mecca during recovery

Prosthesis Considerations

Wudu (ablution): prosthesis need not be removed for wudu in most scholarly opinions
Tayammum (dry ablution) permissible with wounds/inability to use water
Prosthesis fitting: patient may express concern about completeness for burial (ghusl) — address sensitively
Halal materials: ensure prosthesis materials are not porcine-derived if possible

Nursing Support

Allow family presence for support during difficult news
Ramadan: coordinate wound care timings around fasting/prayer
Gender-sensitive care: female patients may prefer female nurse for limb assessment
Grief and body image: incorporate spiritual support into psychological care plan
Hospital chaplaincy / Islamic social worker referral available in most GCC hospitals

GCC Exam Prep — MCQs (DHA / MOH / SCFHS / QCHP Style)

1. A patient presents with an ABPI of 0.45 in the right leg. Which of the following best describes this finding?

A. Normal peripheral circulation
B. Mild peripheral arterial disease
C. Critical limb ischaemia
D. Calcified non-compressible vessels

Answer: C — Critical limb ischaemia. ABPI <0.5 is defined as critical ischaemia with high risk of limb loss. Calcified vessels give falsely elevated ABPI (>1.3). Normal is 0.9–1.2. Mild PAD is 0.7–0.9.

2. Following carotid artery stenting, a patient develops sudden onset right-sided facial droop and arm weakness. What is the nurse's FIRST priority action?

A. Administer sublingual GTN for blood pressure control
B. Immediately notify the vascular surgeon and activate stroke protocol
C. Increase heparin infusion rate
D. Position patient with head of bed at 90 degrees

Answer: B — Notify surgeon and activate stroke protocol. This presentation is consistent with a stroke or TIA post-CAS. Time-critical intervention (CT head within 30 min) is required. GTN for BP and heparin changes are secondary. HOB 30° is appropriate (not 90°) to avoid cerebral hypoperfusion.

3. A patient 3 days post EVAR develops sudden onset severe back pain and becomes hypotensive (BP 80/50). There is no groin swelling. Which complication should the nurse MOST suspect?

A. Femoral artery pseudoaneurysm
B. Wound infection
C. Retroperitoneal haematoma / type I endoleak
D. Deep vein thrombosis

Answer: C — Retroperitoneal haematoma or endoleak. Haemodynamic instability + back/flank pain without visible groin swelling = retroperitoneal bleed or catastrophic endoleak. This is a surgical emergency. Requires emergency CT and vascular surgical review. DVT does not cause haemodynamic instability.

4. Which Wagner grade describes a diabetic foot ulcer with deep infection involving bone (osteomyelitis)?

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

Answer: C — Grade 3. Wagner Grade 3 = deep ulcer with abscess, osteomyelitis, or joint sepsis. Grade 1 = superficial ulcer. Grade 2 = deep ulcer to tendon/capsule but no bone involvement. Grade 4 = partial gangrenous forefoot.

5. A patient post femoral-popliteal bypass reports increasing calf pain and their foot appears cold and pale 2 hours post-operatively. The handheld Doppler shows no signal over the dorsalis pedis. What is the correct nursing response?

A. Elevate the limb and apply warm compresses
B. Document findings and review in 2 hours
C. Immediately notify the vascular surgeon — graft occlusion suspected
D. Increase analgesia and continue current observations

Answer: C — Immediately notify the vascular surgeon. Absent Doppler signal + cold, pale limb post-bypass = acute graft occlusion until proven otherwise. This is a surgical emergency — re-exploration within 4–6h may save the graft. Elevation would worsen ischaemia. Observation delay is dangerous. Analgesia alone is never adequate management.

GCC Nurse Endovascular & Vascular Surgery Guide · For educational purposes only · Clinical decisions must involve qualified medical/nursing professionals · DHA/MOH/SCFHS/QCHP exam content aligned · Last updated April 2026

Endovascular & Vascular Surgery Nursing Guide GCC Edition

Ankle-Brachial Pressure Index (ABPI)

The 6 Ps of Acute Limb Ischaemia

Rutherford Classification

Fontaine & Rutherford Classification (PAD)

Venous Assessment — CEAP Classification

Duplex Ultrasound — Nursing Basics

What It Measures

Normal Waveforms

Nursing Role in Duplex

Acute Limb Ischaemia — Rutherford Severity Assessment

First 2 Hours — ICU/HDU

2–24 Hours

Carotid Artery Stenting (CAS)

Pre-Procedure

Post-Procedure — Neuro Monitoring

Peripheral Angioplasty & Stenting (PTA)

Access Site Care — Femoral

Radial Access Site

Post-PTA Discharge Teaching

Renal Artery Stenting

Indications

BP Monitoring Post-Procedure

Contrast Nephropathy Prevention

Iliac & Femoral Revascularisation

Iliac Angioplasty/Stenting (TASC Classification)

Post-Iliac Stent Nursing

AAA Open Repair (Aortic Aneurysm)

Aortic Cross-Clamp Complications

Paralytic Ileus Management

Renal Failure Post-Repair

Carotid Endarterectomy (CEA)

Neuro Observation Protocol

Post-CEA BP Management

Femoral-Popliteal Bypass

Graft Types & Surveillance

Distal Pulse Checks — Protocol

Graft Surveillance Programme

Amputation Nursing (BK & AK)

Below-Knee (BK) vs Above-Knee (AK)

Stump Care

Phantom Limb Pain Management

Sheath Removal Prerequisites

Compression Technique

Complications — Recognition & Response

Neurovascular Observations

The 5 Ps Assessment

Also Assess

Contrast Nephropathy Prevention

Risk Factors for CIN

Prevention Protocol

Monitoring Post-Contrast

Dual Antiplatelet Therapy (DAPT) Post-Stenting

Patient Education

Heparin Infusion Management

UFH Infusion Protocol (Therapeutic)

Monitoring & Safety

Rest Pain Management

Pain Management Approach

Vascular Risk Factor Optimisation

Tissue Loss & Ulcer Wound Care

Wound Assessment

Wound Treatment Modalities

Revascularisation Decision

Pre-Revascularisation Assessment

Diabetic Foot & Wagner Grading

Charcot Foot Recognition

Clinical Features

Management Principles

Compartment Syndrome Post-Revascularisation

Recognition (5 As)

Nursing Actions

Diabetic PAD in GCC

Why PAD is Particularly Severe in GCC Diabetic Patients

Nursing Focus in GCC Diabetic Foot

Heat Effects on Vascular Disease

Cardiovascular Impact of GCC Climate (40–50°C)

Nursing Interventions

DHA/DOH Vascular Nursing Competencies

DHA (Dubai Health Authority) Requirements