Patient education: How to protect the chest after heart surgery (The Basics)

How is heart surgery done? — 

During heart surgery, doctors might:

●Cut the breastbone, or "sternum"

●Go between the ribs on the side of the chest

Both ways let the doctor access your heart to do the surgery. After surgery, the doctor places tubes around the heart and sometimes the lungs. These tubes drain blood and fluids. They are taken out a few days after surgery.

Why do I need to protect my chest after heart surgery? — 

During heart surgery, the doctor cuts through skin, fat, muscles, and sometimes bone. They need to spread the tissues apart to do the surgery. This can lead to discomfort all around the chest and sometimes the back.

If the doctor cuts the breastbone, they will use wires, screws, and a plate to keep the edges of the bone together. These stay in place, even after your body has healed. The breastbone can take 2 to 3 months to fully heal.

Taking care of your chest after surgery lets the breastbone and other tissues heal. Doctors call this "sternal precautions." It can help with pain and bleeding after surgery.

How do I care for myself at home? — 

Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Take care of your cuts (incisions) – You might have stitches, skin staples, surgical glue, or a special skin tape on your incisions. It is normal to have a small amount of clear fluid draining from the incisions for the first few days after you go home.

•Your doctor or nurse will tell you exactly how long to keep your incisions dry.

•Once you no longer need to keep them dry, gently wash them with soap and water whenever you take a shower. Do not scrub them. Any crusted blood, scabs, or surgical glue will fall off naturally.

•Do not put your incisions underwater, such as in a bath, pool, or lake. This can slow healing and raise your chance of getting an infection.

•After you wash your incisions, pat them dry. Do not put ointments or powders on them, unless your doctor or nurse tells you to. They will also tell you if you need to cover your incisions with a bandage or gauze.

•Always wash your hands before and after you touch your incisions or bandage.

●Take deep breaths – This is important to help prevent a lung infection. Hold a pillow to your chest to help you take deep breaths more comfortably. You can also take pain medicine, if your doctor prescribed it.

●Move carefully – You will need to be extra careful with how you move your upper body for at least 6 to 8 weeks. This lets the tissues heal. Your doctor or nurse might give you specific instructions, but for most people, this includes:

•Do not push or pull with your arms. This means that you should not use your arms to help you get up from bed or chairs. Hold a pillow to your chest when you get up. This will help you remember not to push or pull with your arms.

•Roll to your side before sitting up from a lying down position. When you turn to your side, keep your back straight and your shoulders and hips in a line. Bend your knees. Slowly drop your knees over the side of the bed as you sit up. Do not use your hands to push you to a sitting position.

•Do not lift anything over 10 pounds (4.5 kg). It is OK to do simple household activities like cooking, dishes, folding clothes, or using a computer.

•Avoid too much reaching or twisting. Try to keep your arms near your side, as if there were a band around your upper arms. Move slowly if you have to reach or twist slightly. Do not raise your arms, reach overhead, or reach around behind your back.

•Avoid activities where you move your shoulder a lot. Examples include things like tennis, baseball, swimming, bowling, or golf. Do not use exercise machines with your arms, unless your doctor says that it is OK.

•Do not drive or sit where there is a front airbag for at least 4 weeks after surgery. Your doctor will tell you when it is safe for you to drive again. Always wear a seatbelt, even though it goes across your incision.

•If your breastbone was cut, you might need to take extra precautions for 3 months after surgery. Do not do activities that strain the upper body. Examples include vacuuming, mopping, digging, mowing the lawn, or climbing a ladder.

What else should I do? — 

Practice good posture. Try to sit up straight or lean slightly back. This helps your breastbone heal normally.

Walking is one of the best forms of exercise after surgery. You can walk in your home, outside, or on a treadmill. Make sure that you feel steady enough to walk alone. If you do not feel safe, have someone walk with you. Start slowly, and walk for a short distance. It is OK if you are a little tired after, but you should not be exhausted. Slowly increase the time and distance you walk each day until you walk 30 minutes at least 5 times a week.

Remember to warm up and cool down. Stretching is a good way to do both.

When should I call the doctor? — 

Call for emergency help right away (in the US and Canada, call 9-1-1) if you think that you might be having a heart attack.

Call your doctor or nurse for advice if:

●You are more tired than normal, or have more trouble breathing with activity.

●Your pain is getting worse.

●You notice clicking or popping in your breastbone.

●Your incision becomes warm or red, or opens up.

●You have new drainage from your incision, or the drainage has a bad smell.

●You feel like each side of your ribs moves separately when you breathe.

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