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High Fowler Position

What Is It, Its Uses, and How It Helps Breathing

Authors:Maria Emfietzoglou, MD,Kelsey LaFayette, DNP, RN

Editors:Alyssa Haag,Emily Miao, PharmD

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is high Fowler position?

High Fowler position, also known as full Fowler position or sitting position, is a supine position in which an individual lies on their back on a bed, with the head of the bed elevated between 60-90 degrees, and the legs of the patient can be either straight or bent at the knees. A pillow can also be placed under the calves for support and comfort. This patient positioning is recommended for postoperative management, feeding, taking X-rays at the bedside, as well as during breathing treatments. 

Illustration of a patient sitting in bed with head of bed elevated to 90 degrees.

What is the difference between high Fowler, standard Fowler, and semi-Fowler positions?

The difference between a high Fowler, standard Fowler, and semi-Fowler position is the bed angle. In the standard Fowler position, the head of the bed is elevated between 45-60 degrees, and this position is commonly used for head, shoulder, and chest surgeries as well as for respiratory distress syndrome because it facilitates breathing. In the semi-Fowler position, the bed angle is between 30-45 degrees, and this positioning is recommended for an individual who has difficulty breathing, has a feeding tube, is experiencing gastroesophageal reflux disease (GERD), or is giving birth. 

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What is a high Fowler position used for?

The high Fowler position is used postoperatively as it allows for dependent drainage (i.e., drainage of a cavity into a receptacle) after abdominal or lung surgery. It is also frequently used for feeding as well as during feeding tube insertion as it reduces the risk of regurgitation or aspiration. High Fowler position is also sometimes used in order to take a bedside X-ray at an upright position. Finally, it can be used for individuals who have difficulty breathing or are receiving breathing treatments. 

How does a high Fowler position help breathing?

High Fowler position helps breathing as it promotes oxygenation. More specifically, as the patient sits in the high Fowler position, the diaphragm (i.e., a dome-shaped sheet of skeletal muscle that divides the thoracic cavity from the abdominal cavity) is pulled down due to gravity, increasing the volume of the thoracic cavity and allowing for maximum chest expansion. This position also relaxes the tension of other abdominal muscles participating in respiration to further improve breathing. 

What are the most important facts to know about the high Fowler position?

The high Fowler position is a supine position with the head of the bed elevated between 60-90 degrees. This patient positioning is recommended postoperatively after abdominal or lung surgery to allow dependent drainage, for feeding and feeding tube insertion, as well as for taking upright X-rays at the bedside. High Fowler position is also used for individuals with breathing difficulties as it pulls down the diaphragm and relaxes abdominal respiratory muscles, allowing maximum chest expansion and improvement of breathing.

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Resources for research and reference

Anatomy, Patient Positioning. (2021, November 5). In StatPearls. Retrieved March 4, from https://www.ncbi.nlm.nih.gov/books/NBK513320/

Carter, P. J. (2012). Lippincott’s textbook for nursing assistants: A humanistic approach to caregiving (3rd ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.

Frey, R., & Shearer Cooper, L. (1996). Introduction to nursing assisting: Building language skills. Delmar Publishers.

Perry, A. G., Potter, P. A., & Ostendorf, W. (2013). Clinical nursing skills and techniques. (8th ed.). Mosby.

Semi-Fowler’s position. In Nurse Plus Academy. Retrieved March 4, 2022, from https://nurse.plus/nclex-terminology/terms-abbreviations/semi-fowlers-position/

Sorrentino, S. A., & Remmert, L. N. (2017). Mosby’s textbook for nursing assistants (9th ed.). Elsevier.

What are the types of Fowler’s position? (2021, July 14). In Steris Healthcare. Retrieved March 4, 2022, from https://www.steris.com/healthcare/knowledge-center/surgical-equipment/fowlers-position-guide