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Perfusionist Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

MM slash DD slash YYYY

AGE OF CLIENTS

Newborn/ Neonate (birth to 30 days)(Required)
Infant (31 days to 12 months)(Required)
Toddler/Preschool (13 months to 5 years)(Required)
School Age Child/adolescent (6 years to 18 years)(Required)
Young Adults Middle Adult (19 years to 64 years)(Required)
Older Adults/Elderly (65+ years)(Required)

GENERAL SKILLS

Standard Precautions(Required)
Isolation Precautions(Required)
Pediatric Respiratory/Cardiac Arrest(Required)
Adult Respiratory/Cardiac Arrest(Required)
Crash Carts(Required)
Defi brillators(Required)
Electronic Documentation(Required)
Automated Med Dispensing Systems(Required)

BASIC CONCEPTS

Cardiovascular Anatomy(Required)
Pathology and Surgical Repair(Required)
Physiology(Required)
Pharmacology(Required)
Physics(Required)
Chemistry(Required)
Mathematics(Required)
Immunology(Required)

TECHNOLOGY, EQUIPMENT & TECHNIQUES

Extracorporeal Circuit Components for Cardiopulmonary Bypass(Required)
Adequacy of Perfusion(Required)
Myocardial Preservation(Required)
Systemic Hypothermia(Required)
Blood Conservation Techniques(Required)
Catastrophe Management(Required)
Adjunctive Techniques(Required)
Patient Monitoring(Required)
Organ Transplantation(Required)

CARDIOPULMONARY BYPASS (CPB)

Set-up/Priming of Equipment(Required)
Initiation of CPB(Required)
Administration of Prescribed Fluids/Medications(Required)
Anticoagulation(Required)
Temperature Management(Required)
Acid-Base Management(Required)
Ultrafi ltration(Required)
Flow Rates(Required)
Cardioplegia(Required)
Hypothermic Circulatory Arrest(Required)
Power Failure(Required)
Power Failure(Required)
Oxygenator Failure(Required)
Massive Air Embolus(Required)
Weaning/Resumption of Natural Circulation(Required)

MECHANICAL ASSIST TECHNIQUES

Ventricular Assist Device (VAD)(Required)
Intra-Aortic Balloon Pump (IABP)(Required)
Extra Corporeal Membrane Oxygenation (ECMO)(Required)
Extra Corporeal Life Support (ECLS)(Required)

LAB ANALYSIS

Special Chemistry(Required)
Blood Chemistry(Required)
Coagulation(Required)

ADDITIONAL PRACTICES

Off Pump Surgery Conversion to CPB(Required)
Autologous Blood Salvage(Required)
Limb Perfusion(Required)
Left Heart Bypass(Required)
Minimally Invasive (Percutaneous) Bypass(Required)
Minibypass(Required)
Liver Perfusion(Required)
Platelet Gels(Required)
Retrograde Cerebral Perfusion(Required)
Selective Antegrade Cerebral Perfusion(Required)

PLEASE LIST THE EMR SYSTEMS YOU HAVE USED

OTHER SKILLS

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