The Fowlers Position Is A Standard Surgical Position

The Fowlers position is a standard surgical position.
It is commonly used for some ear and
nose procedures and craniotomies involving a posterior or occipital approach. The semi-Fowler
position is used for shoulder, nasal, cranial, abdominoplasty, or breast reconstruction procedures.
The position releases the tension of the abdominal muscles which will allow for improved
breathing in patients. It is also used to increase comfort during eating as well as other necessary
activities. It can improve uterine drainage in postpartum women. It consists of placing the patient
in a semi-upright sitting position (45-60 degrees). Knees may be bent or straight. There are
however several varieties of this position, low, semi and high Fowlers. High is when the patients
head is raised 80-90 degrees and semi is 30-45 degrees. (Wikipedia)
<http://en.wikipedia.org/wiki/fowler’s_position> 12-2-09.
The Fowler position was named after George Ryerson Fowler. He served as a surgeon in the
Spanish-American War in 1898. He was the founder and first president of the Brooklyn Red
Cross in 1884 and introduced first-aid instruction to the New York National Guard. He received
a chair of surgery at the New York Polyclinic Medical School. He kept this position for the rest
of his life. (whonamedit.com) http://www.whonamedit.com/doctor.cmf/2561.html 12-3-09.
As with any position used during surgery, there are risks and interventions that should be
considered and integrated. According to “Alexander’s care of the patient in surgery”, the
following table lists such risks and interventions.
Fowlers position (sitting)
Risks:
1. Pressure to scapulae, sacrum, coccyx, ishium, back of knees, and heels.
2. Air embolism if venous sinus is opened.

3. Shearing.
4. DVT in lower extremities.
5. Venous pooling shifts toward lower body.
Interventions:
1. Pressure-reducing OR mattress. Additional padding as needed.
2. Doppler probe over chest wall, insert central venous catheter, saline-soaked sponges
available.
3. Momentarily tilt torso slightly away from OR bed to allow skin to realign with skeletal
structures.
4. Sequential compression stockings.
5. Slow, smooth postural transitions to diminish cardiovascular effects.
Semi-Fowlers position (beach chair)
Risks: Risks similar to Fowler position, but generally not as severe.
1. Pressure to cheeks, eyes, ears, breasts, genitalia, patellae, and toes.
2. Falls and dislodgement of airway and monitoring cords and intravenous lines.
3. Diminished lung capacity.
4. Injury to shoulders, arms, and upper extremity nerves.
Interventions: Same interventions
1. Pressure-reducing OR mattress. Additional padding as needed. Check ears, cheeks, eyes,
and genitalia for pressure. Tape eyes closed.
2. Lock both beds. Use a minimum of 4 people for turning patient. Secure airway and all
cords and lines.

3. Chest rolls and close respiratory monitoring.
4. Arms never hang off the side of the OR bed. Arms on arm board are flexed and pronated
with upper arm <90 degrees to the OR bed. Pads placed above and below elbow to free
ulnar nerve.
A fairly common procedure that utilizes a Semi-Fowler position is the repair of the rotator
cuff. When the shoulder is dislocated, ligament damage may occur. In such cases, surgery must
be done as ligaments cannot repair themselves or resolve without surgical intervention. The
doctor will base his assessment on the range of function that the patient will acquire from
surgical repair. In situations where damage is severe, surgery should be performed as soon as
possible to avoid loss of the tissue and atrophy that may occur. Prognosis for this type of
procedure is high and the patient can usually expect an optimal result. The Semi-Fowlers
position is also sometimes referred to as the beach chair position, and is the position of choice for
the repair. The patient should be placed as close to the edge of the table as possible to provide
optimal manipulation of the arm. Arm-holding devices are available which eliminate the need
for an individual to hold the arm during the procedure. The foot on the table should be dropped
and the midsection of the table slightly flexed. The head should be turned toward the opposite
shoulder, and any undue stretch in the neck should be avoided.
There are three common techniques used for rotator cuff repair. Open repair, mini-open
repair, and all-arthroscopic repair. The open repair is performed without arthroscopy. The
surgeon will make an incision over the shoulder and detach the deltoid to provide maximum
exposure of the rotator cuff. The surgeon will remove and bone spurs that might be present as
well. The rotator cuff will then be repaired as needed. The mini-open repair is a smaller version
where the incision is much smaller (typically 3-5cm). This technique included an arthroscopy to
visualize and access any damage and tears within the joint. Use of the arthroscopy prevents the
need to detach the deltoid muscle. This technique is out-patient, and is the most common
method. It has proven to be durable over a long period of time. Finally, the all arthroscopic
technology can be used but it is very challenging and is only used by highly skilled surgeons. It
is the least invasive using multiple tiny incisions or portals. It is also out-patient. All techniques
can provide 80-95% patient satisfaction.
References
Wikipedia. 02 Dec. 2009 <http://en.wikipedia.org/wiki/fowler’s_position>

Whonamedit.com 03 Dec. 2009 http://www.whonamedit.com/doctor.cmf/2561.html Ed. Daniel
Enerson.
Rothrock, Jane C. Alexander’s Care of the Patient in Surgery. Ed. Donna R. McEwen. 13 ed.
Missouri: Mosby, 2007.

Shauna Stanford
Fowlers Position in Surgery
December 7, 2009
Aseptic Techniques for Surgical Technologist
Javier E. Espinales

The Fowlers Position Is A Standard Surgical Position

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The Fowlers position is a standard surgical position.

It is commonly used for some ear and

head is raised 80-90 degrees and semi is 30-45 degrees. (Wikipedia)

of his life. (whonamedit.com) http://www.whonamedit.com/doctor.cmf/2561.html 12-3-09.

following table lists such risks and interventions.

Fowlers position (sitting)

1. Pressure to scapulae, sacrum, coccyx, ishium, back of knees, and heels.

2. Air embolism if venous sinus is opened.

4. DVT in lower extremities.

5. Venous pooling shifts toward lower body.

1. Pressure-reducing OR mattress. Additional padding as needed.

4. Sequential compression stockings.

5. Slow, smooth postural transitions to diminish cardiovascular effects.

Semi-Fowlers position (beach chair)

Risks: Risks similar to Fowler position, but generally not as severe.

1. Pressure to cheeks, eyes, ears, breasts, genitalia, patellae, and toes.

3. Diminished lung capacity.

4. Injury to shoulders, arms, and upper extremity nerves.

Interventions: Same interventions

1. Pressure-reducing OR mattress. Additional padding as needed. Check ears, cheeks, eyes,

and genitalia for pressure. Tape eyes closed.

cords and lines.

shoulder, and any undue stretch in the neck should be avoided.

can provide 80-95% patient satisfaction.

Wikipedia. 02 Dec. 2009 <http://en.wikipedia.org/wiki/fowler’s_position>

Missouri: Mosby, 2007.

Fowlers Position in Surgery

Aseptic Techniques for Surgical Technologist

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