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Heparin Dose Peripheral Vascular Surgery — FRCA Final MCQ

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ModerateGeneral AnaesthesiaHeparin Dose Peripheral Vascular SurgeryFRCA Final

A 58-year-old man (ASA III) with peripheral vascular disease is having a femoral-popliteal bypass graft. The surgeon requests systemic heparinisation. What is the standard heparin dose for peripheral vascular surgery and what ACT is targeted?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Heparin 150 units/kg, ACT >300 seconds

For peripheral vascular surgery, systemic heparinisation with unfractionated heparin 75-100 units/kg IV is standard before arterial cross-clamping. The target ACT is >200-250 seconds (lower than for CPB which requires >400 seconds). This provides adequate anticoagulation to prevent thrombosis in the graft and distal vessels during the ischaemic period. At the end of surgery, protamine reversal may or may not be given depending on surgeon preference and bleeding. ACT should be checked 3-5 minutes after heparin administration.

Reference: RCOA – 2023 – Vascular anaesthesia module; NICE – 2020 – Peripheral arterial disease