Posts filed under ‘precautions’

Spinal Precautions

I have previously blogged specifically about sternal and hip precautions but only briefly mentioned spinal precautions.  Every day, I get visitors to this blog looking for information regarding spinal precautions, so here they are:

  • No Bending
  • No Lifting
  • No Twisting

The precautions, also known as BLT’s (for Bending, Lifting, Twisting) are usually in effect from anywhere between two and three months.

The bending will depend on where in the spine the surgery took place.  If it was in the cervical spine, don’t bend your neck.  If it was in your back, don’t bend your back.

One should not lift anything more than 5-10 lbs. after a spinal surgery.  A gallon of milk is about 8 pounds (or 8.35 according to a patient of mine who was a firefighter), and is usually a good reference point as to the maximum you can lift.

Twisting is pretty straightforward.  Don’t twist your back (or neck).  The two areas people have trouble with this is when sitting down, one tends to twist and look to see where they are about to sit; and when wiping themselves after a bowel movement.  Be careful!

These precautions apply to most spinal procedures, whether it is just a spinal cord stimulator placement, a laminectomy, ACDF, ALIF, etc.

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March 5, 2008 at 12:16 pm 14 comments

Open Heart Surgery

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.

February 10, 2008 at 4:29 pm 23 comments

Hip Precautions

For one of my Level II fieldworks, I did a three-month internship in an acute orthopedic unit at an area hospital. As such, I saw predominantly hip and knee replacements, as well as several limb-lengthening patients. One day, I was looking something up on Wikipedia about something hip related and noted that there was no article on hip precautions. As occupational therapists, we’re worried about patients being able to complete their ADL‘s while being safe. I figured that I would write an article about hip precautions on Wikipedia, and it hasn’t been edited since I created it, so I’m happy it was well written. Hopefully, it was well described as well.

Here is the article:

Hip precautions refer to certain things that one should not do after having a hip replacement. Since the hip joint is very weak from surgery, doing any of these three things can greatly increase the risk of hip dislocation.

The three hip precautions are:

  • Bend
  • Cross
  • Twist

One should not bend the hip past an angle of 90 degrees (L-shaped). This is especially difficult when sitting on toilet seats, which tend to be low. Therefore, an occupational therapist will educate patients in techniques on sitting on low toilet seats, as well as telling them to obtain raised toilet seats.

Crossing refers to any time one leg crosses the other. Since it is difficult not to cross your legs when sleeping, many doctors will recommend that a patient sleep with abductor pillows, which keep the legs separated.

Twisting refers to putting a lot of weight on one leg and twisting to retrieve an object. For example, if one is cooking a light meal, they should not twist their bodies to retrieve a pot from a high shelf, rather, they should shuffle over sideways, retrieve the pot, and then shuffle back to the starting point.

I’m thinking that I should add a bit about how because of these precautions, patients with hip replacements can’t do basic ADL’s like putting socks on. After all, that is why we give them our wonderful hip kits.

March 16, 2007 at 2:52 am 12 comments


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