Open Heart Surgery

February 10, 2008 at 4:29 pm 23 comments

I really want to see an open heart surgery. Until that happens, I’ll have to be happy with treating patients that have had open heart surgery; the most common of which I see is coronary artery bypass grafts (CABG).

Patients undergoing CABG usually have complicated heart problems and arteries that are blocked. The procedure basically reroutes some of the blood vessels, thus enabling better blood flow to the heart. Chest pain is also reduced.

As occupational therapists, one of the big things we do with open heart patients is review sternal precautions (I just wrote that paragraph on the precautions for this blog post – yay for Wikipedia!). It is amazing how people are so different in this area. For some people, after hearing the precautions once, they automatically start following the precautions with no difficulty. These patients tend to recover much more quickly than patients who do not (that isn’t scientific, just something I’ve picked up on. Then, there are patients who no matter how many times you go over the precautions, they still don’t follow them. It can be very frustrating at times.

While writing this, I was struck by an interesting thought. When working with hip replacements, I almost never have a problem with people not following their precautions. I have the most difficulty with sternal precautions. People with spinal precautions tend to be very good about their precautions, unless they’ve had a minor spinal surgery, such as a laminectomy. If I had to guess, I’d say the reason is that with hip and spine surgeries, doing the things that you’re not supposed to do directly impacts the joint/vertebrae, and is therefore a lot more painful, which is why they usually adhere to the precautions. However, with sternal precautions, patients do not necessarily feel anything wrong with what they are doing, so they’ll be more likely to not adhere to the precautions.

Addendum: Here is the paragraph I wrote on Wikipedia:

Patients undergoing coronary artery bypass surgery will have to avoid certain things to avoid opening the incision. These are called sternal precautions. First, patients need to avoid using their arms excessively, such as pushing themselves out of a chair or reaching back before sitting down. To avoid this, patients are encouraged to build up momentum by rocking several times in their chair before standing up. Second, patients should avoid lifting anything in excess of 5-10 pounds. A gallon of milk weighs approximately 8.5 pounds, and is a good reference point for weight limitations. Finally, patients should avoid overhead activities with their hands, such as reaching for sweaters from the top shelf of a closet or reaching for plates or cups from the cupboard.

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Entry filed under: acute care, hospital, occupational therapy, OT, phys dys, precautions, treatment. Tags: , , , , , , , , .

Why do occupational therapists splint? Continuing Education links

23 Comments Add your own

  • […] 5, 2008 I have previously blogged specifically about sternal and hip precautions but only briefly mentioned spinal precautions.  Every day, I get visitors to […]

    Reply
  • 2. Stefan  |  May 23, 2008 at 12:29 pm

    I was just wondering whether sternal precautions are temporary, so say after a few months, you will be able to do all the things that sternal precautions would prevent normally; or do you have to take sternal precautions for the rest of your life?

    Many thanks,

    Stefan

    Reply
  • 3. aishel  |  May 26, 2008 at 12:14 pm

    Hi Stefan, they’re usually for anywhere between eight and twelve weeks. The precautions are there to make sure the incision does not open up and that it remains safe. Check with you doctor for the exact timeline, but again, the doctors where I work say 8-12 weeks.

    Good luck!

    Reply
  • 4. Lydia Davis  |  November 27, 2008 at 2:23 pm

    My question is in reference to open heart surgery precautions. What is a safe Met level progression for this population following CABG. I work in a skilled nursing faciltiy with a large Med A population. We have a pt. who is s/p a CABG X 4 ~ 4 weeks ago. In my experience, I would not let this persons heart rate exceed 20 beats over his resting. However, I have observed others performing vigorous exercises allowing heart rates to profoundly exceed that limit due to this persons younger age. Any thoughts?

    Reply
  • 5. Elizabeth Cook OTD, OTR/L  |  January 8, 2009 at 7:37 pm

    Lydia, I’m with you. Not over 20 beats per minute over resting.

    An addition to your sternal precautions is that people should not sit behind an airbag.

    Reply
  • 6. julie  |  January 27, 2009 at 7:30 pm

    In regards to open heart surgery, how would you suggest someone (elderly) go from lying to sitting, while still maintaining their sternal precautions (avoiding pushing with their arms to get up)? Is there a preferable side for someone to get out of bed?

    Reply
  • 7. Terry Pisano, COTA student  |  January 31, 2009 at 5:52 pm

    I am a level II COTA student with an assignment to come up with treatment intervention ideas for CABG pts. I was researching the condition and read your articles. Do you have any ideas beyond education that I could use?
    I would apprectiate any help I too am working with the elderly

    Reply
  • 8. Nicole  |  February 9, 2009 at 9:58 pm

    Hello, just wondering if anyone had any suggestions for good cont. ed courses or books on rehab and parkinson’s disease. I am at a stand still right now, and my college text books aren’t giving me a whole lot. Thank you…anything would help.

    Reply
  • 9. kathy  |  April 25, 2009 at 10:19 pm

    regarding sternal precautions s/p CABG, is performing a UE bike without resistance OK if post operative one week?

    Reply
  • 10. heart surgery  |  June 18, 2009 at 3:44 pm

    Heart surgery is now starting to be preferred over angioplasty.

    Reply
  • 11. Occupational Therapy University  |  November 11, 2009 at 1:36 am

    Well,

    The title of this post tells lots of things and it also shows how important this post is for students like me

    Awesome post ,

    Thanks for this wonderful information

    🙂

    Reply
  • 12. UK Therapiist  |  November 13, 2009 at 8:59 am

    This is really very useful posts for students like me. Please keep writing good articles.

    Reply
  • 13. sheree  |  January 20, 2010 at 6:17 pm

    Regarding sternal precautions s/p cabg;is it ok to reach above the head to pull on a knit shirt and is it safe to put your compression hose on by yourself ?

    Reply
  • 14. Christine  |  February 3, 2010 at 11:11 pm

    Sheree: No bending with sternal precautions s/p CABG, no reaching over head (no shoulder flexion/abduction over 90 degrees)

    Reply
  • 15. deirdre  |  December 21, 2010 at 10:37 pm

    What assistive device do you recommend s/p CABG?

    Reply
  • 16. New Grad  |  June 28, 2011 at 7:30 pm

    Hello everyone,

    I am a new grad working in an acute care setting. It was my decision to choose acute care as my first job. I have always had the passion to work in this setting. Acute care always intrigued me as its fast paced and rehab portion is considered crucial. With hospitals now a days trying to d/c pt. ASAP, OT’s role becomes vital is d/c planning process.

    As months go by, I am questioning my decision (not regretting, just questioning) of working in this setting. As someone pointed out earlier, if PT gets their eval done first, OT evals are not always necessary. It is a waste of time. If the pt. is going to comp rehab, they need two disciplines (PT and OT) evals. However, if its a joint pt., whatever PT says goes. There were so many patients that i personally felt could benefit from home OT for home safety assessment and education on home management post d/c but they did not get home OT because home PT is more important. Also, OTs cannot open home health cases.

    It is rare that I hear case managers/social workers asking for OT evals. It’s more like “PT hasn’t seen the pt, we need PT eval”
    Doc. write PT/OT as if its one discipline. I understand as OTs we need to do more education on our roles.

    Recently, I was evaluating a Pt. who was about to be d/c home. It was a cancer pt. with low endurance.PT and I decided to complete eval together. PT told me the pt is high functioning and may not need home therapy. She was right.
    Once I evaled the pt. i felt that pt can def. benefit from Home OT for home safety assessment so i mentioned to the pt and family if there are any home safety concerns? Family reported they dont have any but not sure. I told them maybe we can order home OT. I explained to them that home OT can teach the pt. energy conservation techniques while completing ADL. PT quickly interrupted saying “I can recommend home PT, PTs can do all the home assessment and teach pt. energy conservation techniques”. I was bit surprised and confused. Im not sure what she was trying to imply. I def. wasn’t happy with her.
    I simply gave pt the handout and wished her goodluck.

    There are def. high and low moments in acute care. Some of the low moments are when pt./family members constantly hearing “physical therapy” after i tell them I am Occupational therapist for the 10th time. Drives me crazy because I am a new grad.

    Am i the only one going through this?? How are you guys resolving these types of conflicts?

    Reply
    • 17. liz  |  August 31, 2011 at 7:58 pm

      Im an acute OT as well, I completely understand your frustrations. Luckily, our social worker’s work really well with the therapists here, but we still run into them (esp. the MDs) really just weighing in on PT’s opinion. I sometimes will call up the case manager and tell her my concerns about why pt needs OT so at least they consider it. Our hospital (400 beds) still has a ways to go for educating some of our new docs and interdisciplinary team on the role of OT,it is very frustrating. We are just grouped into a “PT/OT” box when sometimes the pt is just PT appropriate. Especially for low-income families, they end up getting charged for all these services they could have avoided 😦 We just switched over to electronic system so docs have to enter a seperate order for PT and OT thankfully. As only 2 years out, I am still very gung-ho about our profession and wish everyone understood what we really do!

      Reply
    • 18. Erin  |  November 14, 2011 at 8:49 pm

      I don’t know what state/country you ar in but i know were i practice as a PT, that OT cannot (even for a home safety evaluation) be in home without PT or RN in home as well. so in our case the PT does do the assessment because we can be a stand alone discipline in homes and OT only as an adjunct, not saying it is right but is the way policy and procedure is written.
      DR. N

      Reply
      • 19. NOT REALLY THERAPY!!!  |  January 10, 2012 at 7:10 pm

        The reasosn is the OTs are not considered primary providers in home health under Medicare regualtions. OTs can not open a case. TOO MANY PATIENT HAVE COMPLAINED OTS DON’T DO ANYTHINGA NURSE’S AIDE CAN’T ALREADY DO!!! When I worked in trauma at an acute care – large 1000 bed hospital!! I was embarrassed by the OTs- they were either PT TECHS OR NURSE’S AIDES!!! I SAW OTS WALK PTS DOWN THE HALL WHO COULD ALREADY AMBULATE!!! AND THEN BILL MEDICARE AND INSURANCE COMPANIES!! NO ONE MADE AN EFFORT TO SPLINT THE UE TRAUMA PATIENTS AND THERE WERE A LOT. THERE WAS NO BURN PROGRAM, OR NEURO PROGRAM – ALL AREAS OTS COULD EXCEL IN!!!!! AND ADL RETRAINING!!! GIVE ME A BREAK- READ AOTA /MEDICARE REGUALTIONS IF “A PATIENT HAS ONLY A TEMPORARY LOSS OF FUNCTION – SAY GENERAL SURGERY AND THERE IS A HIGH PROBABILITY THE PT WILL RETURN TO THEIR PRIOR LEVEL OF FUNCTION- AFTER A SHORT TIME – THEN OT AND PT IS NOT INDICATED OR BILLABLE – IT IS UNSKILLED AND COULD BE CONSIDERED FRAUD OR AT LEAST ABUSE – READ THE FEDERAL REGISTER AND CMS REGULATIONS. YOU KNOW YOU ARE REQUIRED BY LAW TO KNOW THEM IGNORANCE IS NOT A DEFENSE!!!! WHAT IS SO SKILLED ABOUT STANDING AT THE SINK AND WATCHING A PT WASH THEIR FACE- AND WHO DOES IT IN THE EVEINGS – TECH OR A NURSES’ AID. SO ARE YOU REALLY NECESSARY IF YOU ARE NOT TEACHING A SPECIFIC TECHNIQUE – THEN YOU ARE PROVIDING UNSKILLED MEDICALLY UNNECESSSARY -TREATMENT – WHICH IS CONTIBUTING TO MEDICARE FRAUD AND ABUSE!!! OH – YEA MAY FAVORITE THE OT/PT I OBSERVED WERE SITTING PTS UP ON THE EDGE OF THE BED FOR LESS THAN 5 MINUTES AND BILLING 1-2 UNITS OF CARE – REALLY!!! YOU CAN LEGALLY BILL UNTIL YOU HIT 8 MINUTES AND READING THE CHART DOESN’T COUNT!!!! OR TRANSFERRING THE PT INTO A CHAIR!!!! IF THE TRANSFERS IS SO SKILLED IT NEEDS A PT/OT TO TRANSFER A PT INTO A CHAIR – THEN WHY IS IT NURSE’S OR TECHS WHO PUT THEM BACK!!! AND HAVE YOU EVER HAD ENOUGH GUTS TO ASK HOW YOUR SERVICE IS BEING BILLED- DO YOU KNOW SOME HOSPIATLS BILL IT UNDER MEDICARE B!! AND THE LATEST SCAM – BILLING AND EVALUATE – AS TREATMENT- SAYING THAT THE MINUTE YOU TOUCH A PATIENT – IT IS CONSIDERED THERAPY TREATMENT- WAKE UP OR THE OT PROFESSION MAY BECOME A PROFESSION OF THE PAST. I AM A NURSE AND A FORMER PATIENT OF THIS B_____T!! KIND OF REHABILITATION. AND WOULD YOU PAY $100 TO HAVE SOMEONE TRANSFER YOU IN A CHAIR Or WATCH YOU ROLL OVER IN BED!! GIVE ME A BREAK – YOU ARE NOT FOOLING THE NURSES!!!

      • 20. michelle  |  September 10, 2013 at 5:35 pm

        Of course it has more to do with saving the dollar. As an ot for the past 23 years I have seen multiple changes in the profession and how the systems are run. IT used to be that OT could be in the home environment sans Pt and or Nrsing. However this is just a way to ensure that pts aren’t being over billed or over serviced. That being said then we as a Profession need to say When it is our jurisdiction to be in a home and not PT’s if it is energy conservation and simplification of ADL’s/ IADL’s. When it is ensuring that hip precautions will be followed back precautions etc during the ADL. This is where our lobbyists come in. We need to make sure they know our position on the matter. PT’s are always spitting off their domain it’s time OT’s enumerated theirs. I hope this blog isn’t too late and maybe one of you new grads will take it upon yourselves to be a voice.

  • 21. Don Maurizio  |  October 30, 2011 at 9:59 pm

    Could you elaborate on the airbag issue? I have not heard a timeline for that precaution. Is is 6 weeks, 8 weeks, or ?

    Reply
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