Perfusionist Skills Checklist

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PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS:

Proficiency

  1. I have never done the stated task.
  2. I have performed the task/skill infrequently; I require more experience/practice to feel comfortable and proficient.
  3. I have performed the task/skill several times and feel moderately comfortable functioning independently but would require a resource person nearby.
  4. I have performed the task/skill frequently and would feel very comfortable and proficient performing it without supervision or practice.

Frequency

  1. 5 or less Annually
  2. 5 or less Quarterly
  3. 3 or less Monthly
  4. 1 - 5 times Daily/Weekly
EQUIPMENT AND TECHNIQUES *
SKILLFREQUENCY
Extracorporeal Circuit Components for Cardiopulmonary Bypass
Myocardial Preservation
Blood Conservation Techniques
Adequacy of Perfusion
Systemic Hypothermia
Organ Transplantation
Adjunctive Techniques
Heart-lung machine
Cell saver
Hemoconcentrator
Ventricular Assist Device (VAD)
Intra-Aortic Balloon Pump (IABP)
ExtraCorporeal Membrane Oxygenation (ECMO)
ExtraCorporeal Life Support (ECLS)
GENERAL SKILLS *
SKILLFREQUENCY
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Standard Precautions
Isolation Precautions
Administers blood products, parenteral fluids, and drugs under order from the physician
Monitors and calculates physiologic lab values
Provides complete pacemaker analysis
Autologous Blood Salvage
Left Heart Bypass
Minimally Invasive (Percutaneous) Bypass
Liver Perfusion
Retrograde Cerebral Perfusion
Selective Antegrade Cerebral Perfusion
CARDIOPULMONARY BYPASS *
SKILLFREQUENCY
Priming of Equipment
Initiation of cardiopulmonary bypass
Administration of Prescribed Fluids/Medications
Temperature Management
Anticoagulation
Acid-Base Management
Ultrafiltration
Flow Rates
Cardioplegia
Weaning/Resumption of Natural Circulation
Massive Air Embolus
Pump Failure
AGE SPECIFIC COMPETENCIES *
SKILLFREQUENCY
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler (1-3 years)
Preschooler (3-5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (64-79 years)
Elderly adults (80+ years)

Attestation

ATTESTATION: *