Supported fowler's position, Contradictions

The placement of the patient is essential for a successful surgery. Whether a patient is sleeping peacefully in the emergency room or as an in-patient, the Fowler position is most often used.

Fowler's patient placement often called a sitting position, is frequently utilised for shoulder and neurosurgical procedures. Low Fowler's Position, Semi Fowler's Position, and High/Full Fowler's Position are all variations of the Standard Fowler's Position.

Since gravity pushes the diaphragm lower in Fowler's position, it allows for more chest and lung expansion, making it useful for a variety of individuals who have breathing problems.

Learn more about the distinctions between the postures and how Fowler's position is used in typical medical operations.

WHAT IS STANDARD FOWLER’S POSITION

For shoulder surgeries and neurosurgery, the standard Fowler's position, also known as the sitting position, is frequently used. The angle of the bed ranges from 45 to 60 degrees. 

The patient's legs could be straight or just slightly bent. Surgery on the head, chest, and shoulders frequently takes place in this position.

The preferred position to treat respiratory distress syndrome is standard Fowler's position. Standard Fowler's position benefits from better chest expansion due to the bed's positioning, which enhances breathing by facilitating oxygenation. 

Increased blood and cerebral spinal fluid drainage as well as improved hemostasis are additional benefits.

WHAT IS LOW FOWLER’S POSITION 

Similar to the Supine Position, Low Fowler's is when a patient's head is included at a 15–30° angle. To relieve lower back discomfort after surgery, deliver medication, and avoid aspiration during tube feeding, assume this posture. The ideal resting posture for patients is thought to be the low Fowler's position.

WHAT IS SEMI-FOWLER’S POSITION

For shoulder operations and neurosurgery, the standard Fowler's position, commonly known as the sitting position, is often employed. The angle of the bed ranges from 45 to 60 degrees.

The patient's legs might be straight or just slightly bowed. Surgery on the head, chest, and shoulders often takes place in this posture.

The ideal posture to treat respiratory distress syndrome is standard Fowler's position.

Standard Fowler's position benefits from improved chest expansion due to the bed's posture, which enhances breathing by aiding oxygenation.

Increased blood and cerebral spinal fluid outflow as well as better hemostasis are additional benefits.

WHAT IS HIGH/FULL FOWLER’S POSITION

The patient often sat straight-backed in the High Fowler posture. Between 60 and 90 degrees are present in the upper body. The patient's legs might be bent or straight.

When the patient is defecating, eating, swallowing, getting an X-ray, or needing assistance breathing, this position is often employed.

Elderly individuals are often placed in the high Fowler's position since it has been scientifically shown to assist with digestion and alleviate respiratory issues.

Long periods of time spent resting in the High Fowler's posture may be uncomfortable and increase the risk of developing pressure sores.

CONTRADICTIONS OF FOWLER’S POSITION

The main goal of patient positioning is to maximise anatomical exposure during surgery.

Adjustments may be made to meet any intolerances of the patient in cases when the patient does not tolerate the sitting posture well.

For instance, patients who have pressure ulcers in their buttocks or lower back may not be able to tolerate sitting.

It may be necessary to take additional steps to lessen pressure and contact between the injured area and hard surfaces. These might include adding more padding, adjusting the angles, or using tilt to relieve pressure on lateral injuries.

Additionally, patients who have had prior spine surgery may have range-of-motion restrictions that rule out this position. Patients should be evaluated to determine whether they can tolerate this position and to identify any inherent patient characteristics that could increase their risk.

PATIENT POSITIONING CONSIDERATIONS FOR FOWLER’S POSITION

A conventional surgical table's built-in sections or the addition of surgical table accessories and positioning aids may be used in a variety of ways to attain Fowler's position.

Beach chair positioners and foam body positioners are typical surgical table accessories & positioning aids used while applying for Fowler's position.

In orthopaedic shoulder treatments, Beach Chair Positioners are most often utilised for High Fowler's posture (total shoulder replacement, shoulder arthroscopy, rotator cuff, etc.).

Beach chairs often include detachable left and right back portions that provide access to the patient's shoulder during surgery.

In addition, beach chairs often incorporate lateral support that is used to maintain the patient's posture while limiting lateral torso movement during demanding upper extremity operations.

When doing orthopaedic shoulder surgeries, Limb Positioners are often utilised in conjunction with Beach Chairs and High Fowler's posture.

Basic limb positioners may include elbow and arm positioners for neutral placement of the patient's non-operative arm(s) to get them out of the surgeon's way or the patient's operative arm for access to the surgical site.

With more ¹sophisticated limb positioners, the surgical team may place the patient's arms in unusual spatial configurations that facilitate shoulder surgical site access for a variety of shoulder joint surgeries.

For positions other than Fowlers, such as lateral patient placement to permit suspended arm positioning for orthopaedic shoulder surgeries, OR personnel may also use advanced limb positioners.

Similar to simple limb positioners, multi-position arm boards allow for neutral placement of the patient's operational arm for access to the surgical site or the non-operative arm(s) to clear the way for the surgeon to reach the target anatomy.

In Semi-and Fowler's High Fowler's positioning, ²neurosurgical headrests and head positioners are frequently used to gain surgical site access to the patient's skull, facial, and neck anatomy.

To reach the required Fowler's posture, the general table is often placed using native table parts (no Beach Chair is utilised). To facilitate immobilisation of the head and surgical site access, the native head section of the surgical table is frequently removed and the desired anterior or posterior positioning accessories are attached.

All of Fowler's positioning variations frequently employ gel and foam positioners. Headrest doughnuts, face masks for beach chairs, arm cradles, wedge positioners (for the legs or feet), heel and ankle cradles, and egg-crate foam sheets to protect or bolster key anatomical areas are common positioning aids that support the patient across Fowler's positions.

It is always advisable to perform pre-operative patient assessments to evaluate the patient's skin, body morphology, bony prominences, and any unique anatomical areas that call for special consideration during surgery. For more information, read the article on pressure management in the STERIS Healthcare Knowledge Center.

Read Also: What is a Flutter Valve for Breathing?

CONCLUSION

The Fowler's position, one of the most popular patient positions, offers greater surgical exposure and enhanced ventilation.

The surgical team should think about potential dangers and issues with the Fowler position, including:

• a reduction in the heart's ability to receive blood
• Vascular embolism
• a gas or air inside the skull
• an increased risk of airway loss
• elevated danger of nerve injury and facial edema

The Standard Fowler's position, Low-position, Fowler's Semi-position, Fowler's and High-position Fowler are all variations of Fowler's position.

Additional resources and citations

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  sophisticated limb positioners
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  neurosurgical headrests