Our Summary

This research paper is essentially a review of different strategies for movement after a person has undergone sternotomy, a type of surgery where the chest is cut open to access the heart or lungs. Currently, there are three main strategies for movement after this kind of surgery: sternal precautions (SP), modified SP, and Keep Your Move in the Tube (KYMITT™).

The researchers found out that the practice of SP was mainly based on expert opinion and lacked a solid foundation in evidence. On the other hand, the evidence suggested that the new movement strategies (modified SP and KYMITT™) are safe and allow patients to have more freedom in their activity, which can improve their overall health and confidence.

However, the researchers believe more studies are needed, particularly those that follow patients over time and those that compare the effects of different strategies in multiple hospitals. But based on the current evidence, it seems that the modified SP and KYMITT™ are as safe as the traditional SP and can provide a more patient-centered approach.

FAQs

  1. What is a sternotomy and what are the current strategies for movement after such surgery?
  2. According to the research, how does the practice of sternal precautions (SP) compare to modified SP and Keep Your Move in the Tube (KYMITT™)?
  3. What further research do the researchers believe is necessary in regard to movement strategies after sternotomy?

Doctor’s Tip

A doctor might tell a patient who has undergone sternotomy to follow the recommended movement strategies, such as modified sternal precautions or using the Keep Your Move in the Tube (KYMITT™) technique, to ensure a safe and successful recovery. They may also advise the patient to gradually increase their activity level under supervision and to avoid heavy lifting or strenuous activities until fully healed. It is important to follow the doctor’s instructions to prevent complications and promote healing after surgery.

Suitable For

Patients who have undergone sternotomy are typically recommended sternal precautions to ensure proper healing of the sternum and prevent complications such as sternal dehiscence (separation of the sternum). This includes patients who have had cardiac surgeries such as coronary artery bypass grafting (CABG), valve replacement, or aortic surgeries, as well as patients who have had thoracic surgeries involving the lungs.

It is important for these patients to follow the recommended movement strategies post-surgery to avoid putting excessive strain on the sternum and surrounding structures. The traditional sternal precautions are often recommended for at least 6-8 weeks after surgery, but newer strategies such as modified sternal precautions and KYMITT™ may offer more flexibility and allow for earlier return to normal activities.

Overall, patients who have undergone sternotomy should follow the guidance of their healthcare providers and physical therapists to ensure a safe and effective recovery process.

Timeline

Before sternotomy:

  1. Patient undergoes preoperative assessments, including medical history, physical examinations, and diagnostic tests.
  2. Patient receives anesthesia and is prepped for surgery.
  3. Patient undergoes sternotomy surgery, where the chest is cut open to access the heart or lungs.
  4. After surgery, patient is monitored in the recovery room before being transferred to a hospital room.

After sternotomy:

  1. Patient is given sternal precautions (SP) to follow, which include restrictions on certain movements to protect the sternum.
  2. Patient may experience pain, discomfort, and limited mobility due to the surgery.
  3. Patient receives physical therapy to help with recovery and regain strength and mobility.
  4. Patient gradually resumes activities of daily living, following the guidelines set by healthcare providers.
  5. Patient may experience improvements in their overall health and confidence as they recover from sternotomy surgery.

What to Ask Your Doctor

  1. What is sternotomy and why is it performed?
  2. What are the potential risks and complications associated with sternotomy surgery?
  3. What are sternal precautions and why are they usually recommended after sternotomy surgery?
  4. What is the difference between traditional sternal precautions and modified sternal precautions?
  5. What is the Keep Your Move in the Tube (KYMITT™) approach and how does it differ from traditional sternal precautions?
  6. What are the benefits of modified sternal precautions and KYMITT™ compared to traditional sternal precautions?
  7. How soon after surgery can I start moving and exercising with the modified sternal precautions or KYMITT™ approach?
  8. Are there any specific movements or activities I should avoid following sternotomy surgery?
  9. How long should I continue following sternal precautions or the modified approach after surgery?
  10. Are there any physical therapy or rehabilitation programs that can help with recovery after sternotomy surgery?

Reference

Authors: Wiens K, Hayden KA, Park L, Colwell S, Coltman C, King-Shier KM. Journal: Eur J Cardiovasc Nurs. 2024 Jul 19;23(5):435-440. doi: 10.1093/eurjcn/zvad109. PMID: 38167748