Getting out of bed after open-heart surgery is a significant step in recovery that requires careful technique to protect the healing breastbone. Early mobilization is highly encouraged to prevent complications like pneumonia and blood clots. The central constraint governing all movement is the sternal precaution, which dictates that no activity should place undue pulling, pushing, or straining force on the recently wired sternum. Learning to move without relying on your arms for heavy lifting is fundamental to allowing the breastbone to fuse properly over the estimated eight to twelve weeks required for stability.
Pre-Movement Safety Checklist
Before attempting any movement, ensure your environment and body are prepared to minimize pain and risk. Taking prescribed pain medication about 30 to 60 minutes before mobilization is highly recommended, as it allows the analgesic to reach its maximum effectiveness when you need it most. Pain control reduces muscle guarding and makes movement safer and less stressful on the surgical site.
Next, a quick check of your immediate surroundings prevents unnecessary strain and falls. Confirm that the bed wheels are locked to prevent the bed from shifting as you move. Make sure all necessary items, such as a walker, cane, or stable chair, are positioned within easy, non-straining reach of the bedside.
For the initial attempts, having a trained nurse or caregiver present is strongly advised to provide physical support and guidance. They can help stabilize your balance and assist with coordinating the movement of your legs and torso. This preparation minimizes risk and allows you to focus solely on executing the proper technique.
The Technique for Rolling to the Bed Edge
Moving from a lying position to the edge of the bed requires a controlled maneuver known as the log roll, which keeps the spine and chest in a rigid, aligned unit. Start by bending both knees, planting your feet flat on the mattress to provide leverage for the movement. You must also secure a pillow or a blanket firmly against your chest incision using both hands, a technique called sternal splinting.
To initiate the roll, use your bent legs and feet to gently push your hips toward the side of the bed you plan to exit. Simultaneously, roll your entire body—head, shoulders, and hips—in one synchronized movement, like a rigid log, onto your side. The sternal splinting stabilizes the breastbone, reducing the shearing forces that could occur with twisting or uncoordinated movement.
Once you are on your side facing the edge of the bed, use the momentum of swinging your legs over the edge to help raise your torso. Push yourself up using the elbow and forearm of the arm closest to the mattress, keeping your elbow tucked tightly to your side. This technique uses the strong, large muscles of the upper arm and shoulder while avoiding strain on the sternum.
Transitioning from Sitting to Standing
After reaching the sitting position, pause to allow your circulatory system to adjust before attempting to stand. Dangling your legs over the side of the bed for a minute or two helps prevent orthostatic hypotension—a sudden drop in blood pressure that can cause dizziness or fainting. This adjustment is important post-surgery due to the effects of anesthesia, blood loss, and prolonged bed rest.
When you are ready to stand, scoot your hips to the very edge of the bed so your feet are flat on the floor and slightly behind your knees. Lean your torso forward, bringing your nose over your toes, which shifts your center of gravity forward over your feet. The power for standing should come almost entirely from pushing down through your legs and hips.
Avoid pulling yourself up with your hands on a bed rail or pushing forcefully with your arms against the mattress, as this places dangerous strain on the sternum. If needed, you may use a stable walker or the armrests of a nearby chair for slight support, but the primary force must be generated by the large muscles of the lower body. Once upright, maintain a balanced stance for a moment before taking your first steps.
Recognizing Signs to Stop and Seek Help
While early mobilization is beneficial, monitor your body for signals that the activity is unsafe or too strenuous. If you experience a sudden, sharp increase in pain at the incision site that is not relieved by resting, stop immediately. Profound dizziness or lightheadedness may indicate orthostatic hypotension, signaling that you need to sit or lie down quickly.
Excessive shortness of breath that does not improve with rest is a warning sign requiring immediate medical attention. Other signs include an irregular or rapid heartbeat, or breaking out into a cold sweat. If any of these symptoms persist after stopping the movement, notify your medical team right away.