Coronary Artery Bypass Graft (CABG)

Question 1

Complications associated with cardiac surgery via Median Sternotomy

Answer 1

• Myocardial injury
• Blood loss
• Atrial fibrillation
• Pneumonia
• Memory/cognitive impairment
• Subxiphoid incisional hernias
• Brachial plexus injury
• Superficial incisional infections
• Sternal instability/mediastinitis

Question 2

Common lines/tubes s/p CABG

Answer 2

• Peripheral IV or Multi-Med Line (MML)
• Chest Tubes x 2-3 (pleural, mediastinal): May be hooked to LIWS or water seal
• Foley
• Pacer box and wires:May be on or off
• Telemetry
• Arterial Line
• Supplemental Oxygen
• CVP (IJ insertion)*
• Swan-Ganz (PA catheter)*
• *Likely to be seen with more complicated cases

Question 3

Sternal precautions s/p CABG

Answer 3

• No pushing or pulling
• No lifting more than 5lb (1/2 gallon of milk)
• No lifting one arm above your head (can lift both hands above head at same time)
• No reaching behind your back

Question 4

Basic principles following cardiac surgery

Answer 4

• Follow your sternal precautions at all times (8-10 wks)
• Pace yourself, plan your day to include activity & rest
• Rest for 1 hr after meals before doing exercise & strenuous activities
• Avoid excessive heat & cold

Question 5

Define sternal instability

Answer 5

• Can be described as sternal dehiscence/disruption or chronically (>6 months post-op) as sternal nonunion
• Can result in sternal clicking, excessive sternal movement, pain, & difficulty performing functional tasks

Question 6

What movement creates the greatest sternal separation

Answer 6

• Pushing up from chair during STS

Question 7

What movement produces the least amount of sternal separation

Answer 7

• Elevating both arms simultaneously overhead

Question 8

In patients with chronic sternal instability experienced the greatest amount of pain during transitions from

Answer 8

• Supine to short sitting

Question 9

Greatest skin movement during ___________ and ________________ transfers using upper extremities and least movement when

Answer 9

• STS and supine to long sitting
• Lifting containers up to 1 gallon of water (~8lbs)

Question 10

Changes in pulmonary function s/p Median Sternotomy are suggestive of _____________ or _________________ of the lungs due to sternal pain that occurred wks after median sternotomy

Answer 10

• Lung hyperinflation
• Incomplete emptying

Question 11

Force across the median sternotomy during a cough is __________ than during lifting activities including lifting 40 lb weights

Answer 11

• Greater

Question 12

Most of what is currently done in clinical practice (regarding sternal precautions/activity level) is based on anecdotal evidence and _____________

Answer 12

• Expert opinion

Question 13

Describe the sternal instability scale

Answer 13

• 0 corresponds to clinically stable sternum w/no detectable motion or separation of the sternal edges
• 3 corresponds to a completely separated sternum w/markedly increased motion or separation of the sternal edges

Question 14

Physical examination and manual palpation of the sternum along the median sternal ridge, and the allocation of a single grade that reflects the instability during dynamic upper body movements including:

Answer 14

• Shoulder flexion & abduction
• Trunk rotation & lateral flexion
• Deep inspiration
• Coughing