AORN Ergonomic Tool 5: Tissue Retraction in the Perioperative Setting

Abstract

Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. Ergonomic Tool #5: Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.

Graceful: Galaxy II Retrospective Safety and Effectiveness Follow Up Long-term Study–An Original Article

“…The use of self-retaining retractors enables the surgeon to handle tissue and maintain complete control of the surgical site, and use exposure techniques that do not require extended manual retraction. There are guidelines with a specific algorithm for perioperative care providers to determine if and when manual retraction of tissue is safe and when self-retaining retractors should be used instead [16].…”

Workplace Safety Equals Patient Safety

“…A partnership between AORN, the Veterans Health Administration, and the National Institute for Occupational Safety and Health resulted in development of a series of ergonomic guidelines for safe patient handling in the OR environment 18‐25 . The guidelines incorporated the latest scientific knowledge in biomechanics, psychophysics, and physiology to develop safe recommended exposure limits for various patient handling and lifting tasks with high risk of causing musculoskeletal disorders, such as back and shoulder disorders.…”

“…The guidelines incorporated the latest scientific knowledge in biomechanics, psychophysics, and physiology to develop safe recommended exposure limits for various patient handling and lifting tasks with high risk of causing musculoskeletal disorders, such as back and shoulder disorders. The guidelines address recommendations for transferring a patient laterally from a stretcher to an OR bed, 19 positioning a patient on an OR bed, 20 lifting and holding the patient's limbs, 21 prolonged standing in the OR, 22 manual retraction tasks, 23 lifting supplies and equipment in the OR, 24 and pushing and pulling wheeled objects and equipment 25 From a safety engineering standpoint, the data used to derive the guidelines (ie, muscle strength capability, spinal force limits, and physiological fatigue limits) were selected with the goal of providing a safe level of exposure for nearly all OR personnel.…”