Sternal Precautions After Open Heart Surgery

Sternal precautions are used after open heart surgery to prevent the breastbone from pulling apart as it is healing. These precautions are meant to protect you and to reduce the risk of infection in your healing sternal incision.

If you have had open heart surgery, then you may require the skilled services of physical therapy in a cardiac rehabilitation setting, where you can work on improving your strength, endurance, and functional mobility. Sternal precautions are also likely to be used during therapy.

A physical therapist working on a man's stomach
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However, they've recently been the subject of debate among some cardiac experts. Read on to find out what sternal precautions are and the latest thinking on how to care for yourself after a sternotomy.

Why Use Sternal Precautions?

Open heart surgery usually requires that your cardiac surgeon divide your sternum (breastbone) to gain access to your heart and surrounding structures. After the surgery, your surgeon must repair your sternum by returning the bone to its proper place. Usually, a strong wire is used to hold the bone together while healing occurs.

During your recovery, your healthcare provider may instruct you to follow sternal precautions—a method to protect your sternum after you've had open heart surgery.

Sternal precautions are adjustments that you need to make in your day-to-day life to help prevent the separation of your breastbone as it heals. Separation of your sternum may slow the healing process of the bone, and sternal precautions also help to prevent excessive pulling on the surgical incision. This may help to keep the skin closed to prevent infection in your incision.

Excessive pulling on your breastbone while it is healing after open heart surgery can cause something called dehiscence, or a separation of the bone. This separation can become an opening for infection to enter into your body.

Sternal Precautions

If you've had open heart surgery, you must follow your healthcare provider's orders, since some healthcare providers use different surgical techniques and have different requirements after surgery. You must fully understand what is expected of you after open heart surgery.

Sternal precautions include:

  • Do not lift more than 5 to 8 pounds.
  • Do not push or pull with your arms.
  • Do not reach behind your back or reach both arms out to the side.
  • Do not reach both arms overhead.
  • Do not bend at the waist.
  • Do not drive a vehicle.

Your sternal precautions may be different depending on your surgeon or the facility in which you are participating in acute cardiac rehabilitation. Some healthcare providers, for example, allow you to reach one arm overhead, and others allow you to lift up to 10 pounds. Be sure to speak with your healthcare provider to understand your specific sternal precautions.

Sternal Precautions With Physical Therapy

Your physical therapist can work with you in cardiac rehabilitation to help you understand and maintain your sternal precautions. You may find that basic functional mobility is difficult while maintaining sternal precautions. Your physical therapist can teach you how to move around while maintaining your surgeon's suggested precautions.

Modifications you may learn include:

  • Scooting in and rising from a chair
  • Walking up stairs without pulling on the railing
  • Rolling in bed
  • Sitting up in bed
  • Using an assistive device, such as a walker or quad cane
  • Performing basic activities of daily living, such as brushing your hair and dressing

How Long Should I Maintain Sternal Precautions?

If your healthcare provider asks you to follow sternal precautions, they should be able to tell you when you no longer need to follow the precautions. In general, your breastbone should be healed within about four to six weeks following your open heart surgery, and sternal precautions should be lifted at that time.

Again, follow the advice of your healthcare provider regarding when to stop following sternal precautions.

Are Sternal Precautions Necessary?

There is some debate as to whether sternal precautions are absolutely necessary to protect your breastbone as it heals after open heart surgery. There is a lack of evidence that indicates you are in danger if you do not follow sternal precautions, and some healthcare providers may recommend performing normal activities based on your own tolerance.

Feelings of crunching or popping in your breastbone are among the signs that your sternum could be moving a bit. If this happens, the activity that caused it should not be performed, and your healthcare provider should be notified.

Some healthcare providers argue that telling you to avoid lifting items and to keep your arms in can lead to fear-avoidance behaviors or avoiding moving because you are afraid of hurting yourself.

Regardless, if your healthcare provider recommends that you follow specific sternal precautions after open heart surgery, you should follow that advice. Your surgery may warrant that type of precaution—even if another person's doesn't. Talk to your physical therapist to make sure you are moving about properly and maintaining your prescribed precautions.

A new approach to precautions during sternotomy recovery, called “Keep Your Move in the Tube,” relaxes traditionally strict sternal precautions in favor of keeping arm motion within a small cylinder (the “tube”) around your torso.

The approach has shown promise in some studies, sending patients home sooner and with better mobility than those treated with standard care. Ask your healthcare provider or physical therapist if this approach may be right for you.

Frequently Asked Questions

How do I get dressed while taking sternal precautions?

Here are a few tips to make dressing during recovery from a sternotomy easier:

  • Choose clothing that is easy to put on and take off.
  • Sit down while getting dressed.
  • To put on a shirt, put your hands through the sleeves up to your elbows. Next, keeping your arms tucked close to your sides, lift your arms up gently until you can duck your head to pull the neck of the shirt over your head.
  • To pull on pants, start while seated. Put your feet into the pant legs, then stand and pull the waistband up bit by bit, with your elbows slightly bent to each side, until you reach your waist.
  • Always remember to keep your arms close to your sides and never pull on your incision.

Why might I hug a pillow as a sternal precaution?

Some hospitals provide heart surgery patients with a pillow—often a heart-shaped one—upon discharge. The pillow is meant to be hugged while coughing or sneezing, which can put significant pressure on the chest and lungs. The pillow is believed to help stabilize the chest during the post-operative recovery period.

Can sternal wires be removed?

Since sternal wires are used to hold the chest wall in place while you’re healing, they are not generally removed after a sternotomy. However, some people experience persistent pain or allergic reactions related to the sternal wires. Removal of the sternal wires has been shown to resolve symptoms in most of these patients and is a generally uncomplicated procedure.

A Word From Verywell

Open heart surgery can be a serious operation, and ensuring you do all the right things after surgery is of utmost importance. Conventional wisdom says that following sternal precautions can help to decrease the risk of complications after surgery. If you have had open heart surgery, be sure to understand what is expected of you in regard to sternal precautions.​

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