Retraction & Fatigue

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- Matthew Mcfatter
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[JorgeLopez-ixzi]

As a CSFA, ( been in the OR over 30 years) one of the biggest challenges today is that surgeons make very small incisions. You have to retract harder in order for them to get adequate exposure. This is harder for the assistant and harder on the tissue. Sometimes this stronger retraction causes more noticeable post op pain for the patient so we need to be mindful of that. Sometimes it’s a fine line. P.S. love your videos, keep them coming!

[monkeycucumber]

Some tips I share in the OR for Med students:
1. Try to use larger, postural muscles to provide most of the retraction force (eg pull with bicep over wrist extensors, or pull with back over bicep, or grip as neutral as possible, and lean back with your body so that you are pulling with your lower body)
2. Place the retractor in the most proximal portion of your hand. Hold it in your palm is best, better in the metacarpal-phalange, worse in the DIP
3. Place your body and posture in the most relaxed, neutral position as possible. Avoid leaning, bending, twisting, overreaching etc.
4. Use the minimal force possible. Use enough force to retract without tensioning the tissue, so that you only need to overcome gravity instead of the tissue tensile strength.
5. Try to position each joint in mid range of motion (eg elbow approx 90 deg, wrist neutral, etc). Muscles are weaker and have less endurance at end ROM.
6. Alternate the hand applying retraction. Just like you shift from foot to foot when standing. You can also switch grips as needed. Switch at 50% to 80% fatigue. You will recover faster than if you push through the burn.
7. Stay active and stay in shape. You can only pull with the strength and endurance that you train and maintain.

[lmdmt]

Glad you’re back man. Can you make a video on the instruments used in ortho cases and certain ppe that may be required?

[laurenelizabeth]

It's great to see such a specific subject. These videos have a whole new value for me now that I've just graduated. Start new job tomorrow! Thanks so much for the uploads and happy Father's day!

[surgicaltechcrafter]

Loosen up and move, I switch hands, switch positions I have done some big open/vascular cases for the past six years and now I am starting new in the cardiovascular center at the University of Michigan....I'm so freaking excited. Love this career. If you work at a teaching hospital it's usually the medical students holding retractors though. Thank you for your time. I wish I had the courage to do Youtube.

[rayortiz]

I am a student in Connecticut and totally enjoy your videos Shane. Keep it going Sir.

[alexdelvalle]

Love the realness of these videos. Fatigue. Definity have to warm up before surgery. I started to use a (medium tension) band for my shoulders before surgery and noticed improvement in my physical performance during the case. Be careful not to warm-up too much, made that mistake. Keep it light. Also, I use the band through the week.

[alec]

great video, i'm a PA in the OR, I use the elbow tuck technique a lot, also just adjusting my feet, stance, posture can help

[christopherhenry]

Going to start my first week soon. These videos from a experienced and knowledgeable tech have been a jump start. Keep them coming and thanks for sharing.

[MrKeno]

Love your vids. Would u please do more videos on the Surgical assistant duties and responsibilities. Thanks

[msbananas]

Just started clinics, this was very helpful! Thank you 😊

[jennmcg]

Just finished my first week of school! Love it already! These videos have been super helpful! Thanks for amazing content Shane!!

[jaysonmilliken]

Can you do a video about what happens with tissue, organs, amputations, etc, that are removed in surgery?

[DomiPordeus]

Can you make a video on how to use different types of self retaining surgical retractors?

[B-chuk]

Ugh - I don't want those anywhere near my abdominal cavity

[andreytarkov]

Thank you very much sir! Its very helpful for medical students-surgeons

[jazminibison]

In the hospital setting are there certain specialties to go into as a surgical tech such as labor&delivery, general surgery, ortho, etc? Or is it all bunched together?

[Nooorrriii]

First time ever assisting in a total shoulder… I had to hold 2 retractors from above (opposite to everyone and on two stools) not only my arms but my legs got stiff.

[Wonder_World_video]

Can u do video on perfusion assembling provesure please and more about perfusion job

[theoneandonlyronda]

Could you do a video on the difference between getting your certification in surgical tech vs an associates degree? Is there a difference in the duties or pay ?