Sternal Percautions Training Notes

Sternal Precautions After Open Heart Surgery

General Precautions

  • No pulling, no pushing: Patients should avoid activities that involve pulling or pushing.
  • Lifting restriction: Limit lifting to no more than 5 lbs (approximately half a gallon of milk).
  • Arm motion: Restrict arm movements if pain is present.
  • Sleeping position: Avoid sleeping with hands behind the head.
  • Heart pillow: Hug a heart pillow to the chest for comfort, to remind them not to use their arms, and to help aid in coughing.
  • Duration: Follow these precautions for 6-8 weeks post-surgery.
  • Importance: These precautions reduce the risk of improper healing of the bone and incision.

Bed Mobility

Getting Out of Bed (Supine to Sitting)
  1. Starting position: Patient is in a supine position.
  2. Arm placement: Have the patient cross their arms across their heart pillow, ensuring elbows do not touch the bed to prevent pushing with the arms.
  3. Knee position: Bend both knees.
  4. Rolling: Roll the patient towards you while keeping their knees bent.
    • Assist by placing one hand on their upper back and the other on the side of their thigh. Avoid pulling the arms.
  5. Leg placement: Once on their side, have the patient move both legs over the side of the bed.
  6. Hand repositioning: Reposition your hands to the patient's upper back.
  7. Sitting up: Instruct the patient not to use their arms but to use their legs to push against the bed to sit up. Assist from the upper back.
Getting into Bed (Sitting to Supine)
  1. Positioning: Ensure the patient is sitting closer to the head of the bed.
  2. Heart pillow: The patient should hug their heart pillow.
  3. Hand placement: Place your hands on the patient's upper back.
  4. Guiding: Guide the patient onto their side.
  5. Rolling: As they contact the bed, have them roll onto their back. This helps bring their legs onto the bed.
  6. Final adjustments: Help the patient fully bring their legs onto the bed or reposition them as needed.

Transfers

Sit to Stand
  1. Scooting Forward: Have the patient scoot to the edge of the bed or chair using their legs. Manually assist by pulling their hips forward if needed.
  2. Positioning: Position yourself on the side of the patient, with one hand on the middle of their back and the other over their pillow and crossed arms.
  3. Support: Firmly but gently squeeze them between your arms to support them while standing.
  4. Instructions: Instruct the patient to bend forward, getting their nose over their toes.
  5. Counting: Use a 1-2-3 count. The patient rocks forward with each count, standing on three.
Stand Pivot Transfer (for patients needing more assistance)
  1. Positioning: Stand in front of the patient.
  2. Knee Blocking: Use your knees to block the patient's knees from buckling.
  3. Hand Placement: Place both hands on the patient's back below the rib cage for good control.
  4. Instructions & Counting: Follow the same procedure for getting up by rocking forward, using the 1-2-3 count, and standing on three.
  5. Pivot: Pivot you and the patient together into the bed or chair.
  6. Proximity: Stay close to the patient during all transfers.
  7. Lowering: Once the sitting surface is behind the patient, slowly lower them into a sitting position.

Walking

  • Footwear: Ensure the patient wears non-slip socks.
  • Gown: Use a second gown to cover their backside.
  • Close Contact: Maintain close contact with the patient to prevent falls.
  • Pace: Walk slowly to avoid overexerting the heart.
  • Assistive Devices: Avoid using assistive devices like walkers, canes, or crutches as they require more than 5 lbs of force through the arms. Cardiac walkers should be used with caution, ensuring the patient is only lightly resting their arms on them for balance.

Common Mistakes (To Avoid)

  • Avoid bad hand placement that causes pulling on the patient's arms. This breaks sternal precautions and risks improper healing.