Sternal Precautions

What are Sternal Precautions?

• Precautions provided to patients following median sternotomy or cardiac surgeries.
• Precautions depend upon the surgeon and their individual guidelines, but can include:
  • No arm movements above shoulder level (90 degrees of either shoulder flexion or abduction).
    • Or, NO lifting one arm above your head, but can life both hands above your head at the same time.
  • No scapular adduction.
  • No lifting more than 5-10 pounds.
  • No weight-bearing through the upper extremities (including pushing to stand).
  • No pushing or pulling.
  • No reaching behind the back (e.g., no tucking in your shirt, putting your wallet in your back pocket, pulling your pants up from behind or reaching behind for toilet hygiene).

Barriers:

• Many positions require weight bearing on outstretched arms, lying prone, reaching behind your back, or lifting a partner. All of these must be avoided during sexual activity and pose as barriers. There are many other options that permit sexual activities without these movements, and you should educate your clients on those positions.

Specific Suggestions:

• Encourage your client to take their time and allow theirselves to heal and to not feel rushed to resume sexual activity. Due to the sensitivity of the chest area and the delicate structures that are healing, clients should be encouraged to return to sexual activity at their own pace when they feel it is safe.
• It is important to advise them to keep sex at a very low exertion. You could present an RPE scale to help your client understand what low exertion would feel like.
• Effects of medications after surgery
  • Inform your client that certain BP medication cause sexual side effects, including reduced blood flow to sexual organs. Others reduce testosterone production and decrease libido in men. Beta blockers increase fatigue and block nerves that assist with arousal (Hoey, 2018).

Positions for male clients with Sternal Precautions:

Positions for females with sternal precautions:

References

Cahalin, L. P., Lapier, T. K., & Shaw, D. K. (2011). Sternal precautions: Is it time for change? Precautions versus restrictions - A review of literature and recommendations for revision. Cardiopulmonary Physical Therapy Journal, 22(1), 5–15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056839/

N Hoey. (2018, March 13). Safer sex after open heart surgery. [Web post]. Retrieved from https://www.healthcentral.com/article/sex-after-open-heart-surgery

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