When can a patient turn to their sides after a Coronary Artery Bypass Graft (CABG) operation?

When Can a Patient Turn to Their Sides After CABG Surgery

Patients can generally turn to their sides 6-8 weeks after CABG surgery when the sternotomy is well healed. 1

Early Post-Operative Period (First Week)

• Patients are typically monitored in the intensive care unit for at least 48 hours post-CABG due to high incidence of arrhythmias and potential ischemic events 2
• During this period, patients should maintain a position that minimizes stress on the sternum to prevent wound complications 3
• Pain management is crucial during this period as patients experience sharp, sore, aching, and tender sensations that can limit mobility 4

Progression of Activity

• Days 1-3: Patients typically experience higher levels of pain that may limit side-turning movements 4
• Days 4-7: Pain intensity decreases significantly, allowing for more comfortable movement, though sternotomy remains vulnerable 4
• Weeks 1-6: Gradual increase in activity is recommended while the sternum continues to heal 1

Factors Affecting Side-Turning Timeline

• Sternotomy healing status is the primary determinant for when patients can safely turn to their sides 1
• Patients with complications such as sternal wound infections (which occur in approximately 19% of rehospitalized patients) may need to delay side-turning 5
• Patients with multiple cardiac risk factors may require a more conservative approach to activity progression 2

Guidelines for Safe Side-Turning

• Before attempting side-turning, patients should ensure:

  • The sternotomy is well-healed (typically 6-8 weeks) 1
  • Pain is adequately controlled 4
  • They have received clearance from their healthcare provider 1

• Technique for safe side-turning:

  • Use a pillow to splint the chest when turning 3
  • Turn as a single unit, avoiding twisting movements of the torso 3
  • Use arms for support but avoid pushing or pulling with the arms in a way that stresses the sternum 3

Special Considerations

• Patients who underwent minimally invasive CABG without sternotomy may be able to turn to their sides earlier, as they don't have the same sternal healing concerns 6
• Patients with complications requiring extended ICU stays (>7 days) may need a more gradual approach to activity progression 7
• Patients discharged with a hematocrit less than 30% have higher risk of complications and may need to be more cautious with activity progression 5

Common Pitfalls to Avoid

• Turning to sides too early can stress the healing sternum and potentially lead to complications 3
• Failing to use proper technique when turning (such as not using a pillow to splint the chest) can increase risk of sternal wound complications 3
• Ignoring pain signals that may indicate potential complications requiring medical attention 4