The semi-Fowler position is an inclined position obtained by raising the head of the bed 25-40 cm, flexing the hips and placing a support under the knees so that they bend approximately 90º, thus allowing the fluid in the abdominal cavity to accumulate in pelvis.
It is similar to the Fowler position but with the head less elevated. In the Semi-Fowler position the patient is lying on the bed in a supine position with his upper body at 30 to 45 degrees. This position is good for the patient receiving food through a tube and is also used during labor in women.
There are different positions of Fowler. They are used to help the patient with basic body actions. They are also very important for nurses and medical professionals to better do their jobs and treat patients.
All Fowler positions were named for Dr. George Ryerson Fowler, a surgeon from New York City. The Fowler position is the standard position of the patient.
Introduction to surgical positions
Surgical procedures that require the use of anesthesia (both general and conscious sedation) make patients vulnerable to potential injuries, so each position carries some degree of risk, which is magnified in the anesthetized patient.
Consequently, medical personnel must provide full protection of the patient by providing specific care especially when there are bony prominences, joint position and dependent portions of the patient’s body.
Although Fowler positions are considered non-surgical, they are also used during very specific surgeries. The dependent portions at risk of injury are of utmost importance, so the following parts of the body should be included and taken into account:
- Eyes ears
- Penis / scrotum
- Pendulum tissue (table-related injury)
Patient positioning can affect all systems of the human body in particular:
The circulatory system:
- Alteration of the autonomic / sympathetic nervous systems
- Loss of vasomotor tone
- Depressed cardiac flow
- Effects of gravity and redistribution of circulating volume
- Compression of extremities or great vessels
- Ischemia / decreased venous return
The pulmonary system:
- Barriers to thoracic excursion
- Loss of hypoxic pulmonary vasoconstriction (HPV)
- Alteration in the ventilation / perfusion ratio (V / Q)
- Peripheral nerves
The risk of nerve damage is high; and nerve injuries are generally one of the most common causes of surgery-related lawsuits.
Benefits of the semi-Fowler position
In the semi-Fowler position, patients are placed in a sitting position with the head of the bed 30-90 degrees above the horizontal plane. The chin should be 1-2 finger widths from the chest; otherwise, this position may strain the C5 vertebra.
The advantages of this position include facilitating the drainage of blood to the brain. This position allows feeding patients who cannot do it themselves, helps with nasogastric feeding, and also makes it easier for the chest to expand and helps with postural changes.
This position allows improved breathing due to chest expansion and oxygenation, it can also be implemented during episodes of respiratory distress. This position is also used to deliver oral and gastric feeding tubes to the patient. The position can also help with chest decompression.
This position also helps control hemodynamics and makes breathing and daily activities easier, such as eating or talking, in frail patients. A cross-sectional study of hypertensive patients found that tension lowered, compared to supine tension in patients in intensive care.
However, the effects of slight postural differences in Fowler’s position on cardiovascular regulation and hemodynamics have not been investigated. The physiological influences of various positions must be understood to improve patient care in the clinical context.
In heart problems
The patient may develop a decrease in mean arterial pressure and central venous pressure, an alteration in the venous return of a reduced stroke volume and a decrease in cardiac output (by 20%).
In pulmonary issues
Increases lung capacity with greater compliance, decreases pulmonary arterial pressure with increased pulmonary vascular resistance.
In nervous problems
Affected nerves can include sciatica (lack of flexion in the knees) and cervical nerves.
Pressure points in the semi-Fowler position include the occiput, scapula, elbow, sacrum, heels.
Among the advantages of this position we also find that the patient is in better surgical exposure, contributes to blood circulation and drainage of cerebrospinal fluid , and also has a possible advantage in improving hemostasis.
Among the disadvantages of the semi-Fowler position we find postural hypotension, where there is a decrease in the return of blood to the heart (a situation that can be avoided by changing the position of the patient gradually).
It also decreases cerebral perfusion and there may be a risk of venous embolism, especially cranial.
It can increase the presence of air or gases inside the skull, it can cause ocular compression, mid-cervical tetraplegia, edema or macroglossia.
There is greater potential for airway loss, nerve injury, facial / gloss edema, Pneumocephalus, and the risk of quadriplegia is increased in patients. It should be noted that the use of nitrous oxide with a patient in this position should be avoided, as it increases the size of the bubble if a venous air embolism occurs.
When comparing the semi-fowler position with each of the lateral positions, the semi-Fowler position was found to be beneficial in improving tidal volume and oxygenation in mechanically ventilated ICU patients. These findings may be helpful in reducing side effects related to oxygen toxicity.
This type of position is also widely used by otolaryngologists, patients suffering from asthma, when the chest, ears, nose, neck, head and throat need to be examined.
It is important to know that for the comfort of the patient, pillows can always be placed under the back, in the lumbar area, on the neck and shoulders, on the upper part of the thighs and pillows that help to elevate the heels.
- Bartlett, J. (2001). Positioning and patient effects. 2-2-2017, from Jones & Bartlett Learning, LLC Website: samples.jbpub.com.
- For Miller-Keane Encyclopedia: Fowler’s position. (nd) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved February 2 2017 from medical-dictionary.thefreedictionary.com.
- For Mosby’s Medical Dictionary: Fowler’s position. (nd) Mosby’s Medical Dictionary, 8th edition. (2009). Retrieved February 2 2017 from medical-dictionary.thefreedictionary.com.
- NurseFAdmin. (2016). Fowler’s position. 2-2-2017, from www.nursefrontier.com Website: nursefrontier.com.