Sternal Precautions Help!

[tttaylor]

Hello Everyone!

I am a BSN student graduating in May (hooray!). For my final clinical I am in a SICU and have learned a ton! As part of my grade I am to do a evidenced based project for unit improvement- as the hospital just recently began doing open heart surgery I am working on an educational sheet for the nurses about sternal precautions. Some have completed specialized CV training while others are still working on it. I have gathered together all my studies and EBP about sternal precautions but my NM wants me to do a section about practical tips. The problem is... I don't know any practical tips! I have scoured the internet and have yet to find any stratigies for how to get a patient OOB without supporting under their arms when they have multiple chest tubes and specialized wires. I heard something in previous clinical about using a sheet around the patient? Can any seasoned CV nurses shed some light on this subject?

[turnforthenurse, MSN, NP]

Here is a handout: http://applications.spectrum-health.org/Education/Home/Download?filename=x09963.pdf

When I was doing my preceptorship on a cardiovascular stepdown, we often had patients on sternal precautions. We instructed them to keep their arms close to their body while splinting the area with a pillow (basically hugging the pillow) and if they needed help getting up, wrap a sheet around them (but not under their arms) and supporting their body to assist with getting up.

That was also over a year ago so I don't know if that's considered "evidence-based" anymore.

[LuxCalidaNP]

I wish I had citations for ya...having worked in cardiothoracics and now cardiac telemetry, I have had some experience with sternal precautions. To start, think of the etio of pressure to the anterior chest wall: inspiration, coughing, and upper arm movement and use. Whatever would compromise the healing of the incision, wires, or contribute to pain, you want to avoid, right? So, most units recommend the above-mentioned 1) pillow for coughing, movement, walking, as well as 2) prohibiting using arms to push, pull, or shift weight (e.g. pushing down in bed, pulling oneself up, etc.), 3) lifting anything heavier than 5 lbs (this was an arbitrary weight selected by our surgeon at the time), and lifting arms over the head. Lastly, it is common practice during ACLS of patients who have had a sternotomy, to administer chest compressions with the heels of the palms on either side of the incision, compressing the thorax more evenly, which prevents dehiscence of the incision (which coworkers have told me has happened during codes....yuck.)

[ghillbert, MSN, NP]

Check the cardiac rehab literature too, they are expert at teaching patients to get around during sternal precautions.