Perfusionist Skills Checklist

Skills Checklist

Let’s assess your clinical skills and experience. Fill out this checklist to get one step closer to your next opportunity.

1

= No theory and/or experience
2

= Limited Experience
3

= Experienced/minimal support needed to perform
4

= Proficient

Age of Patients Cared For
Newborn/Neonate (birth to 30 days)*
- 1
- 2
- 3
- 4
Infant (1 month to 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 year to 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 years to 5 years)*
- 1
- 2
- 3
- 4
School Age Child (5 years to 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 years to 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 years to 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 years to 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64 years to 79 years)*
- 1
- 2
- 3
- 4
Elderly Adults (over 79+ years)*
- 1
- 2
- 3
- 4
General Skills
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Pediatric Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Adult Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Crash Carts*
- 1
- 2
- 3
- 4
Defibrillators*
- 1
- 2
- 3
- 4
Electronic Documentation*
- 1
- 2
- 3
- 4
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
List Types:
Basic Concepts
Cardiovascular Anatomy*
- 1
- 2
- 3
- 4
Pathology and Surgical Repair*
- 1
- 2
- 3
- 4
Physiology*
- 1
- 2
- 3
- 4
Pharmacology*
- 1
- 2
- 3
- 4
Physics*
- 1
- 2
- 3
- 4
Chemistry*
- 1
- 2
- 3
- 4
Mathematics*
- 1
- 2
- 3
- 4
Immunology*
- 1
- 2
- 3
- 4
Technology, Equipment & Techniques
Extracorporeal Circuit Components for Cardiopulmonary Bypass*
- 1
- 2
- 3
- 4
Adequacy of Perfusion*
- 1
- 2
- 3
- 4
Myocardial Preservation*
- 1
- 2
- 3
- 4
Systemic Hypothermia*
- 1
- 2
- 3
- 4
Blood Conservation Techniques*
- 1
- 2
- 3
- 4
Catastrophe Management*
- 1
- 2
- 3
- 4
Adjunctive Techniques*
- 1
- 2
- 3
- 4
Patient Monitoring*
- 1
- 2
- 3
- 4
Organ Transplantation*
- 1
- 2
- 3
- 4
Cardiopulmonary Bypass (CPB)
Set-up/Priming of Equipment*
- 1
- 2
- 3
- 4
Initiation of CPB*
- 1
- 2
- 3
- 4
Administration of Prescribed Fluids/Medications*
- 1
- 2
- 3
- 4
Anticoagulation*
- 1
- 2
- 3
- 4
Temperature Management*
- 1
- 2
- 3
- 4
Acid-Base Management*
- 1
- 2
- 3
- 4
Ultrafiltration*
- 1
- 2
- 3
- 4
Flow Rates*
- 1
- 2
- 3
- 4
Cardioplegia*
- 1
- 2
- 3
- 4
Hypothermic Circulatory Arrest*
- 1
- 2
- 3
- 4
Power Failure*
- 1
- 2
- 3
- 4
Pump Failure*
- 1
- 2
- 3
- 4
Oxygenator Failure*
- 1
- 2
- 3
- 4
Massive Air Embolus*
- 1
- 2
- 3
- 4
Weaning/Resumption of Natural Circulation*
- 1
- 2
- 3
- 4
Mechanical Assist Techniques
Ventricular Assist Device (VAD)*
- 1
- 2
- 3
- 4
Intra-Aortic Balloon Pump (IABP)*
- 1
- 2
- 3
- 4
Extra Corporeal Membrane Oxygenation (ECMO)*
- 1
- 2
- 3
- 4
Extra Corporeal Life Support (ECLS)*
- 1
- 2
- 3
- 4
Lab Analysis
Special Chemistry*
- 1
- 2
- 3
- 4
Blood Chemistry*
- 1
- 2
- 3
- 4
Coagulation*
- 1
- 2
- 3
- 4
Additional Practices
Off Pump Surgery Conversion to CPB*
- 1
- 2
- 3
- 4
Autologous Blood Salvage*
- 1
- 2
- 3
- 4
Limb Perfusion*
- 1
- 2
- 3
- 4
Left Heart Bypass*
- 1
- 2
- 3
- 4
Minimally Invasive (Percutaneous) Bypass*
- 1
- 2
- 3
- 4
Minibypass*
- 1
- 2
- 3
- 4
Liver Perfusion*
- 1
- 2
- 3
- 4
Platelet Gels*
- 1
- 2
- 3
- 4
Retrograde Cerebral Perfusion*
- 1
- 2
- 3
- 4
Selective Antegrade Cerebral Perfusion*
- 1
- 2
- 3
- 4
Please list the EMR systems you have used*
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*
*
I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*
Your Recruiter*
Name*
First Last
Email*
Phone*
TODAY'S DATE*
MM slash DD slash YYYY
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Skills Checklist

Age of Patients Cared For

General Skills

Basic Concepts

Technology, Equipment & Techniques

Cardiopulmonary Bypass (CPB)

Mechanical Assist Techniques

Lab Analysis

Additional Practices