Open heart surgery often involves a median sternotomy, where the breastbone is divided and then rejoined with wires. A careful recovery is required to ensure the sternum heals correctly. Early, safe mobilization is necessary to prevent complications like pneumonia and blood clots, improve circulation, and increase functional capacity. Moving safely from the bed is a learned technique that minimizes stress on the healing breastbone and promotes a smoother return to daily activities.
Preparing for Safe Movement (Timing and Bracing)
Preparing the body and environment is the first step before attempting to get out of bed. Coordinate pain management so that prescribed oral medication is taken approximately 30 minutes before any planned movement or physical therapy session. This timing allows the medication to take effect, ensuring pain is controlled during activity. Controlling pain promotes better compliance and reduces the tendency to tense muscles or move improperly.
Sternal splinting is necessary to stabilize the chest during movement. This technique involves holding a firm pillow, folded towel, or blanket tightly against the incision site. This bracing provides external support to the sternum when the chest wall muscles are engaged, such as when turning, coughing, or sneezing.
Prior to moving, confirm that any medical tubing, drains, or lines are untangled and will allow for the intended motion. Have a caregiver or nurse nearby for assistance, especially during initial attempts, to maintain safety and ensure the proper technique is used. This preparation minimizes unexpected strain and makes the transition from lying to sitting as controlled as possible.
The Step-by-Step Guide to Getting Up
The safest way to move from a flat position to sitting on the edge of the bed is by using the “log roll” technique. This technique prevents twisting of the torso and keeps the spine and sternum aligned. Begin the movement by bending both knees while keeping the feet flat on the bed, and keep the sternal splint firmly pressed against the chest throughout the entire process.
Next, roll the entire body as a single unit onto the side closest to the edge of the bed. The arms should remain close to the body or folded across the chest to avoid pulling or pushing. Once positioned on the side, slowly swing the legs off the edge of the bed, allowing gravity to assist in lowering the legs toward the floor.
As the legs begin to drop, use the elbow of the bottom arm, keeping it close to the body, to gently push the upper body up into a seated position. The momentum from swinging the legs helps counteract the weight of the upper body, reducing the reliance on arm strength. Sit upright for a moment once the feet are flat on the floor to allow the body to adjust to the change in position. Moving too quickly can cause a sudden drop in blood pressure (orthostatic hypotension), which may lead to dizziness or a fall.
Essential Sternum Precautions and Long-Term Limitations
Sternum precautions are rules designed to protect the breastbone while the surgical division heals, a process that typically takes six to eight weeks. These rules are necessary because excessive force or strain can cause the two halves of the sternum to separate (dehiscence), which can prolong recovery.
The main restriction is avoiding actions that involve pushing, pulling, or lifting with the arms. This includes not lifting anything heavier than a specified weight, commonly limited to 5 to 10 pounds (roughly the weight of a gallon of milk). Patients must refrain from using their arms to push themselves up from a chair or to pull open heavy doors.
Specific arm movements are also restricted, such as reaching both arms up over the shoulders or reaching both arms out to the sides simultaneously. Avoid reaching behind the back or reaching across the body to a significant degree. When coughing or sneezing, support the chest with a pillow or blanket to minimize the jarring force on the sternum.
Driving is restricted for approximately six weeks post-surgery to allow the sternum to heal completely and to ensure the patient is no longer taking opioid pain medication. The concern is that an abrupt stop or airbag deployment could severely compromise the healing bone. Furthermore, passengers should avoid riding in the front seat during the recovery period due to the risk of airbag deployment.