Sternal precautions are a specific set of guidelines given to patients who have undergone open-heart surgery, which typically requires a procedure called a median sternotomy. This surgical approach involves vertically dividing the breastbone to allow the surgeon access to the heart and surrounding structures. The precautions are temporary rules designed to protect the healing sternum from undue stress or force during the initial recovery period. Adhering to these instructions is necessary to ensure the bone can fuse back together without complication.
Understanding Sternal Healing
The median sternotomy procedure creates a wound in the sternum, which is then realigned and secured with strong surgical wires. Bone tissue heals through a process called osteogenesis, where new bone cells must bridge the gap between the two divided halves of the breastbone. This fusion process takes time, requiring the two segments to remain stable and in close contact.
Any excessive force or movement across the chest can strain the wires and the delicate healing bone tissue. If the sternum is subjected to too much pressure, the wires can loosen or the bone fragments can shift, a condition known as sternal dehiscence. This separation can lead to pain, instability, and a significantly increased risk of infection, making adherence to the precautions necessary for a successful recovery.
The Three Core Restrictions
The foundation of sternal precautions rests on avoiding three primary types of movement that generate force across the breastbone, often summarized as the “No P’s”: pushing, pulling, and pressing/lifting. The most specific rule is a weight restriction, advising against lifting, carrying, or pressing with the arms more than five to ten pounds. This limit is often compared to the approximate weight of a gallon of milk or a small bag of groceries.
Activities involving pushing, such as opening a heavy door or pushing oneself up from a chair using the armrests, must be avoided. Pulling movements are also prohibited, including tugging on heavy items or yanking on a pet’s leash. Finally, pressing or lifting, like carrying a laundry basket or picking up a child, applies direct stress to the chest and can jeopardize the sternal repair.
Practical Application in Daily Activities
Translating these restrictions into everyday life requires adopting new body mechanics and techniques for common activities. Getting out of a low bed safely requires the “log roll” technique, which involves keeping the head, shoulders, and torso aligned as one unit to prevent twisting or lateral stress on the sternum. The patient rolls onto their side, then uses their elbow and leg muscles to move their body into a sitting position.
When standing from a seated position, the focus shifts entirely to the leg muscles to avoid pushing off with the hands or arms. The patient should lean forward until their nose is over their toes, transferring the body’s weight over the feet. This allows the powerful quadriceps and gluteal muscles to initiate the stand, preventing the chest muscles from being activated to lift the body weight.
Sudden, forceful movements like coughing or sneezing can place significant pressure on the healing sternum. To counteract this, patients are instructed to “splint” the chest by firmly hugging a pillow or folded blanket against the breastbone before coughing, sneezing, or laughing. This external pressure provides necessary support and stabilization to the incision site.
Incision care during a shower is manageable, but patients should avoid direct, high-pressure spray onto the wound. Patients must also avoid sitting in baths or submerging the chest until the incision is fully closed and cleared by a physician. Driving is typically restricted for at least four to six weeks. This restriction is due to the twisting motion required for turning the steering wheel and the severe threat posed by airbag deployment to the healing sternum.
Duration and When to Seek Medical Help
Sternal precautions are temporary, usually remaining in effect for six to eight weeks following the operation, which is the general timeframe required for initial bone stability. This duration allows the bone to achieve approximately 80% of its ultimate strength. The surgical team will provide specific clearance before any restrictions are lifted, often after a follow-up assessment.
Once the precautions are lifted, activity levels should still be increased gradually as the body continues to recover. Certain signs and symptoms require immediate medical attention as they may indicate a complication with the sternal healing or the incision site. These warning signs include a fever above 101 degrees Fahrenheit, redness, swelling, or excessive drainage from the incision. A sensation of clicking, rubbing, or popping in the chest may also be a sign of sternal instability that needs prompt evaluation.