68 PROCESS MARCH / APRIL 2026 www.myhspa.org INSTRUMENT WHISPERER Retractors are essential surgical instruments used to move tissue and organs aside to expose the surgical site. Because they directly affect visualization and tissue safety, proper identification and inspection of retractors is a critical responsibility of Sterile Processing (SP) professionals. The most commonly used retractors fall into three categories: handheld, self-retaining, and malleable. Handheld retractors Handheld retractors must be manually held in position by a surgical assistant or surgeon throughout the procedure. These retractors are used to retract tissue, muscle and organs and are available in a wide range of sizes and blade configurations. Technicians must be familiar with proper names and measurements to ensure the correct instrument is placed into each surgical set. Common handheld retractors include: • Richardson • Kelly • Volkmann • Crile • Army-Navy • Senn • Desmarres • Love • Fomon • Cottle • Single-prong • Meyerding • Cushing • Jackson • DeLee • Deaver • Richardson-Eastman Inspection guidelines The most critical inspection area of a retractor is the blade. Technicians should inspect blade edges for nicks, dents and burrs that could damage tissue. Next, the junction where the handle meets the shaft should be examined to ensure the weld is intact and secure. Richardson and Kelly retractors are commonly confused. The difference is in blade size—a Kelly retractor always has a wider and deeper blade than a Richardson retractor. Accurate identification is essential for correct tray assembly.
Some handheld retractors are plated. During inspection, technicians should check the finish for flaking by gently rubbing the instrument with gloved hands over a white piece of paper. If flakes appear on the paper, the instrument should be removed from service and replaced. Self-retaining retractors The term “self-retaining” refers to the instrument’s design, which holds a retracted position without manual assistance. Some retractors are set in place by closing ring handles secured with a ratchet mechanism, while others lock open due to pressure on the retractor blade from the incision itself. Self-retaining retractors come in various lengths and configurations, with sharp or blunt prongs. BY RICK SCHULTZ Proper Inspection of Handheld and Self- Retaining Retractors
MARCH / APRIL 2026 PROCESS 69www.myhspa.org INSTRUMENT WHISPERER Common self-retaining retractors include: • Weitlaner • Gelpi • Inge Lamina retractor/ spreader • Balfour • Beckman • Meyerding • Frazier • Adson • Gosset • Alm • Heiss • Jansen Inspection guidelines The lever and spring mechanism must be tested whenever a self-retaining retractor is received on the clean side of the Sterile Processing department (SPD). Press the lever and ensure it springs back into the locked position. If the lever sticks in the down position, the instrument is unsafe and must be sent for repair. Inspect springs for cracks and examine prongs for bending, missing tips, or burrs. Any damage requires removal from service. The Balfour retractor is a multi-component system that may include removable side blades, center blades, and wing nuts. All components must be verified against the count sheet to ensure the tray is complete. Malleable retractors (also known as ribbon retractors) Malleable retractors are made of soft metal, allowing them to be bent and shaped for specific surgical applications. Although they are often straightened during tray assembly, they must still be inspected for cracks, thinning metal, or surface damage. Common examples of finger retractors include Senn and Volkmann retractors. Senn retractors always have three prongs (sharp or blunt); Volkmann retractors may have two to six prongs. Count sheets should specify the number of prongs and whether they are sharp or blunt. Retractors are fundamental to safe and effective surgery, providing the exposure necessary for precision and control. By understanding the differences between handheld, self- retaining, and malleable retractors—and by performing consistent, detailed inspections—SP professionals play a vital role in supporting patient safety and surgical success.
Q : Our Operating Room (OR) has mixed several instrument trays into a single tray and then sent it to decontamination. How should we address this problem? A : There are surgical cases where a lot of trays are opened, which can contribute to such incidents. Taking photographs in the decontamination area, printing them, and showing them to the OR staff is an effective way to address the issue. Remember, documentation is essential; if something is not documented, others may assume it did not happen. RICK SCHULTZ, the Instrument Whisperer™, is an author, inventor, lecturer, and the retired Chief Executive Officer of Spectrum Surgical Instruments Corp. He served as contributing editor of HSPA’s Central Service Technical Manual (fifth, sixth, seventh and eighth editions). Schultz authored the textbooks Inspecting Surgical Instruments: An Illustrated Guide and The World of Surgical Instruments: The Definitive Inspection Textbook, which was released in June 2018. In October 2021, Schultz published the veterinary medicine textbook The World of Surgical Instruments for Animal Health. Schultz was named HSPA’s Educator of the Year in 2002 and the American Hospital Association Educator of the Year in 2006. In 2007, he was named by Healthcare Purchasing News as one of the 30 Most Influential People in Healthcare Sterile Processing. Schultz currently provides educational lectures to Sterile Processing professionals at HSPA’s annual conferences and conducts Operating Room personnel lectures across the country. Disclaimer: The views and opinions expressed in this column are those of the author and do not necessarily reflect the views of HSPA. The content provided in this column is also not a reflection or representation of any other company or organization with which the author may be affiliated.