2011 Research Poster Abstracts
STERNAL PRECAUTIONS: WHY OR WHY NOT?
Presenter's Name - Last Name First
Laura Goehrs at LHGoers@tmhs.org , Mica Smith at MMSmith@tmhs.org , Christy Parks at CParks@tmhs.org
Purpose
To review literature and determine best practice for physical and occupational therapy treatments to guide clinicians on when to follow sternal precautions.
Methods
An extensive literature review was conducted regarding surgical risks, surgical wiring techniques, upper extremity involvement and functional transitional movements. We conducted two surveys on sternal precautions: one nationwide of clinicians and the second with cardiothoracic surgeons at The Methodist Hospital and St Lukes Hospital in Houston.
Results
After reviewing the literature, the nationwide survey results, and the surgeon survey we have included a few findings: 1. When a patient coughs, it creates a greater force across the sternum versus lifting greater than 8 pounds. 2. If a patient has a BMI >30 or a sternal wound infection, they are at greater risk for dehiscence/sternal instability, regardless of the sternal suturing techniques used. 3. Postoperatively, patients are able to perform upper extremity activity without risk of sternal compromise. 4. From the clinicians’ survey responses, 15 out of 31 hospitals allowed patients to use bilateral upper extremities during transfers but varied on length of time to follow precautions. 5. In the surgeons’ survey, the majority of responses did not express a concern with their patients’ having sternal instability.
Conclusion(s)
From the literature review and survey results, sternal precautions should be individually applied based on the patients’ co-morbidities. We developed and implemented an inclusion criteria ie. BMI > 30, osteoporosis, breast cup size >C to effectively treat post sternotomy patients. These, newly developed guidelines will lead to best practice for physical and occupational therapists during activities of daily living, general strengthening and conditioning.
Clinical Relevance
A sternal precaution decision tree, revised sternal precautions, and a modified upper extremity exercise program were created and implemented to guide and educate clinicians, students, and patients on proper usage of sternal precautions. The Methodist Hospital Cardiothoracic surgeons approved the revised information. The teachings have been implemented for over one year without incident.