Proper Patient Positioning Guidelines: Fowler's Position

July 6, 2018
fowlers positioning

The sitting position is a common surgical position, also known as the Fowler's position, and was named for George Ryerson Fowler. While used during some ear and nose procedures it is primarily used for shoulder surgery. A beach-chair table attachment is often used that allows for half of the backrest to be removed for improved access to the surgical site. Although the sitting position has been used for some craniotomies and cervical laminectomies; however, this is rare because negative venous pressure in the head and neck places patients at risk for potentially fatal air embolism.

The patient is initially positioned supine with the head supported with a secure headrest. The patient’s head, neck, and torso elevated 20 degrees to 90 degrees. The feet are supported on a padded foot rest and the foot of the table is slowly lowered, flexing the hips to 45 degrees to 60 degrees and the knees to 30 degrees.1 The upper portion of the table is then raised to become the backrest until the patient’s torso reaches an upright position. The patient’s arms can be at rest on a pillow on their lap or on an adjustable padded platform like the Versa-Board in front of them but never left to hang at their sides. Pressure points are similar to the supine position; and the AliGel Head Donut can be used to support the back of the head, however, the OR table should have well-constructed pressure-reducing pads like AliMed’s Deluxe Support Surface designed to give a higher degree of pressure redistribution, because the weight of the patient’s body rests on the ischial tuberosities and sacral nerve.

References

  1. Burlingame B, Davidson J, Denholm B, et al. Guideline for positioning the patient. Guidelines for Perioperative Practice. 2017;1. DOI: 10.6015/psrp.17.01.e1.

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