From the Guidelines
Sternal precautions are guidelines to protect the breastbone after open heart surgery, and according to the most recent evidence, standard sternal wound precautions are unnecessary for thoracotomy patients, but for traditional open heart surgery, precautions typically include avoiding heavy lifting, pushing, or pulling, and not raising arms above shoulder level for 6-8 weeks after surgery. These precautions are necessary because during open heart surgery, the sternum is cut and then wired back together, requiring time to heal properly 1. Following these guidelines helps prevent complications such as the sternum separating (dehiscence) or becoming infected. Some key points to consider when following sternal precautions include:
- Avoiding lifting anything heavier than 5-10 pounds
- Not pushing or pulling with your arms
- Avoiding reaching behind your back
- Not raising your arms above shoulder level for 6-8 weeks after surgery
- Avoiding activities that twist your upper body and instead turning your whole body when changing direction
- Hugging a pillow against your chest when coughing or sneezing to provide support 1. However, it's worth noting that for patients who have undergone minimally invasive procedures, such as thoracotomy, physical restrictions on upper extremity range of motion are relaxed upon discharge, and heavy lifting is titrated to pain tolerance 2. Your healthcare provider may modify these precautions based on your specific situation and healing progress, so always follow their personalized instructions for your recovery.
From the Research
Definition of Sternal Precautions
- Sternal precautions are guidelines provided to patients after median sternotomy to help prevent sternal wound complications, such as infection or wound breakdown 3, 4, 5, 6, 7.
- These precautions vary widely but generally include arbitrary load and time restrictions, such as lifting no more than a specified weight for up to 12 weeks, and may prohibit common shoulder joint and shoulder girdle movements 3.
Purpose of Sternal Precautions
- The primary goal of sternal precautions is to reduce the risk of sternal complications by avoiding excessive stress on the sternum during the healing process 3, 4, 5.
- However, some studies suggest that traditional sternal precautions may be overly restrictive and impede ideal recovery, leading to functional impairments and decreased quality of life 4, 5.
Types of Sternal Precautions
- Traditional sternal precautions: involve arbitrary load and time restrictions, and may prohibit certain movements 3.
- Modified sternal precautions: a less restrictive approach that allows for more individualized activity and exercise 7.
- Keep Your Move in the Tube (KYMITT): an alternative approach that teaches patients how to perform load-bearing movements in a way that avoids excessive stress on the sternum 3, 7.
Limitations and Variations
- Sternal precautions have several limitations, including a lack of universally accepted definition, inconsistent application, and potential to impede recovery 4, 6.
- Significant variation exists in the sternal precautions and protocols used in different hospitals and institutions 6.
- Further research is needed to investigate the effectiveness and necessity of sternal precautions, as well as their impact on patient outcomes 4, 5, 6, 7.