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The Fowlers Position is a Standard Surgical Position

The Fowlers Position is a Standard Surgical Position

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Published by txrose2020
fowlers surgical position for shoulder surgery
fowlers surgical position for shoulder surgery

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Published by: txrose2020 on Dec 22, 2009
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01/08/2013

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The Fowlers position is a standard surgical position. It is commonly used for some ear andnose 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 necessaryactivities. It can improve uterine drainage in postpartum women. It consists of placing the patientin a semi-upright sitting position (45-60 degrees). Knees may be bent or straight. There arehowever several varieties of this position, low, semi and high Fowlers. High is when the patientshead 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 theSpanish-American War in 1898. He was the founder and first president of the Brooklyn RedCross in 1884 and introduced first-aid instruction to the New York National Guard. He receiveda chair of surgery at the New York Polyclinic Medical School. He kept this position for the restof 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 beconsidered and integrated. According to “Alexander’s care of the patient in surgery”, thefollowing 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 spongesavailable.3.Momentarily tilt torso slightly away from OR bed to allow skin to realign with skeletalstructures.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 interventions1. 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 allcords 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 pronatedwith upper arm <90 degrees to the OR bed. Pads placed above and below elbow to freeulnar 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. Thedoctor will base his assessment on the range of function that the patient will acquire fromsurgical 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 provideoptimal manipulation of the arm. Arm-holding devices are available which eliminate the needfor an individual to hold the arm during the procedure. The foot on the table should be droppedand the midsection of the table slightly flexed. The head should be turned toward the oppositeshoulder, and any undue stretch in the neck should be avoided.There are three common techniques used for rotator cuff repair. Open repair, mini-openrepair, and all-arthroscopic repair. The open repair is performed without arthroscopy. Thesurgeon will make an incision over the shoulder and detach the deltoid to provide maximumexposure of the rotator cuff. The surgeon will remove and bone spurs that might be present aswell. The rotator cuff will then be repaired as needed. The mini-open repair is a smaller versionwhere the incision is much smaller (typically 3-5cm). This technique included an arthroscopy tovisualize and access any damage and tears within the joint. Use of the arthroscopy prevents the

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