Wednesday, December 14, 2011

Heart Hugger Reduces Sternal Dehiscence and Infection

At Wake Forest University Baptist Medical Center, Winston-Salem, NC, approximately 
4% of all cardiac surgery-related readmissions are attributed to sternal wound 
dehiscence and/or infection. Some 800 cardiac surgeries are performed annually. Now 
they hope to cut these readmissions dramatically.
A factor contributing to sternal complications is patient noncompliance with 
precautions following open heart surgery. These precautions include the need to 
support the sternum when deep breathing and coughing, and to avoid lifting more than 
10 pounds or pushing or pulling objects. 
To improve compliance among high-risk patients, the cardiothoracic surgery team 
introduced the use of a sternal support harness. Such devices provide circumferential 
sternal support during movement and activity.
Few studies in the literature evaluate sternal support harnesses. One study, however, 
found sternal support to be effective in reducing pain during coughing and deep 
breathing exercises in the outpatient cardiac rehabilitation setting. 
An easy solution to a costly problem
The Wake Forest cardiothoracic surgery team conducted a trial to evaluate the 
effectiveness of the sternal support harness among a group of high-risk patients. 
Patients with like characteristics were randomly selected as a control group. 
High-risk characteristics are:
1. Presence of diabetes 
2 . W eight greater than 250 pounds 
3. Large chest, and/or pendulous breasts
4. Redo sternotomy 
Heart Hugger Reduces Sternal Dehiscence and Infections
An article published by corehealth.com5. Use of bilateral mammary arteries for coronary bypass grafts.
A sternal support device was placed on the selected patients immediately after 
extubation. Patients, family members, and the nursing staff were taught the 
appropriate application and use of the device to help ensure effectiveness. The Heart 
Hugger device is adjustable and easy for the patient to manage (see figure 1). It is 
manufactured by General Cardiac Technology Inc., Los Gatos, CA. 
Patients were asked about their pain level and device compliance throughout their 
hospital stay. Overall, patients reported decreased pain, increased compliance with 
sternal precautions, and increased mobility with the use of the sternal support 
harness. The patients were instructed to use the device for three to four weeks after 
discharge. Final follow-up was completed at the time of the postoperative visit with the 
Convincing results
Among 19 patients randomized to the sternal support device group, 2 were readmitted 
with sternal wound infections. The average length-of-stay was three days. In the 
control group, 4 of 19 patients were readmitted with wound infections. LOS ranged 
from three weeks to three months. 
Based on these findings, the sternal support harness was approved by the hospital’s 
Product Evaluation Committee. It will be used for all high-risk patients. Approximately 
30% to 40% of adult patients who undergo cardiac surgery at Wake Forest meet the 
criteria for being at risk for wound dehiscence. The cost of the harness is $85. It is a 
Medicare approved medical device.
Johnny Veal is director of cardiovascular services at Wake Forest University Baptist 
Medical Center. For more information, contact him via e-mail at 
Bridgett Byrd Sellars, RN, MA, is a former a clinical nurse specialist at Wake Forest. 
She is a critical care educator at Paradise Valley Hospital, National City, CA.
For more information about the sternum support harness, visit 
Reference: "The sternum support harness for the treatment of sternotomy pain and the 
prevention of sternal instability," Peg Meisler, PT, Cardiopulmonary Physical Therapy 
Journal, vol. 11, #2, February 2000, pp. 1163-68. 

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