The Semi-Fowler position Is a tilted 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 about 90 °, thus allowing fluid in the abdominal cavity to accumulate in the pelvis.
It is similar to Fowler's 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 who receives food through a tube and is also used during labor in women.
There are different Fowler positions. They are used to help the patient with basic bodily actions. They are also very important for nurses and medical professionals to do their job better and treat patients.
All Fowler positions were named after Dr. George Ryerson Fowler, a surgeon in New York City. Fowler's position is the patient's standard position.
Introduction to Surgical Positions
Surgical procedures requiring the use of anesthesia (both general and conscious sedation) make patients vulnerable to potential injuries so that each position carries some degree of risk, which is magnified in the anesthetized patient.
Consequently, medical personnel should provide full patient protection by providing specific care especially when there are bony prominences, joint position, and portions dependent on the patient's body.
Although Fowler positions are considered non-surgical, they are also used during very specific surgeries. Dependent portions at risk of injury are of utmost importance and the following parts of the body should be included and taken into account:
- Eyes ears
- Penis / scrotum
- Breasts
- Fingers
- Pendulum tissue (table related injury)
The positioning of the patient can affect all the systems of the human organism in particular:
The circulatory system:
- Alteration of Autonomic nervous systems
- Loss of vasomotor tone
- Depressed heart rate
- Effects of gravity and redistribution of the 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 ventilation / perfusion ratio (V / Q)
- Peripheral nerves
The risk of nerve damage is high; And nerve injuries are usually one of the most common causes of demands related to surgery.
Benefits of semi-Fowler position
In the semi-Fowler position, patients are placed in a seated 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 tighten the vertebra C5.
The advantages of this position include facilitating drainage of blood to the brain. This position allows feeding patients who can not do it by themselves, collaborates with the nasogastric feeding and also facilitates that the thorax expands and helps the postural changes.
This position allows for improved breathing due to chest expansion and oxygenation, it can also be implemented during episodes of respiratory distress. This position is also used to implement oral and gastric feeding tubes to the patient. The position can also help with decompression of the chest.
This position also helps control hemodynamics and facilitate breathing and daily activities, such as eating or talking to fragile patients. A cross-sectional study of hypertensive patients found that tension was low compared to supine tension in intensive care patients.
However, the effects of slight postural differences on Fowler's position on cardiovascular regulation and hemodynamics have not been investigated. Physiological influences of various positions should be understood to improve patient care in the clinical setting.
In heart problems
The patient may develop a decrease in mean arterial pressure and central venous pressure, altered venous return of reduced stroke volume and decreased cardiac output (by 20%).
In pulmonary issues
It increases lung capacity with higher compliance, decreases pulmonary arterial pressure with increased pulmonary vascular resistance.
In nervous problems
Affected nerves may 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.
Advantage
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 has a possible advantage in improving hemostasis.
Disadvantages
Among the disadvantages of the semi-Fowler position are postural hypotension, where there is a decrease in the return of blood to the heart (a situation that can be avoided by gradually changing the position of the patient).
Cerebral perfusion also decreases and there may be a risk of venous embolism, especially cranial.
It can increase the presence of air or gases inside the skull, can cause ocular compression, cervical tetraplegia, edema or macroglosia.
There is greater potential for airway loss, nerve damage, facial / gloss edema, Pneumocephalus, and the risk of quadriplegia increases in patients. It should be noted that the use of nitrous oxide with a patient in this position should be avoided since the size of the bubble increases if a venous air embolism occurs.
When comparing the position of semi-fowler with each of the lateral positions, the positioning of semi-Fowler was found to be beneficial to improve tidal volume and oxygenation in patients ventilated mechanically in ICU. These findings may be useful in reducing side effects related to oxygen toxicity.
This type of position is also widely used by otolaryngologists, patients suffering from asthma, when it is necessary to explore the chest, ears, nose, neck, head and throat.
It is important to know that for the comfort of the patient, pillows can be placed under the back, in the lower back, neck and shoulders, upper thighs and pillows to help raise heels.
References
- 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. (N.d.) 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. (A.n.d.) 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.