Perfusionist Skills Checklist

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*

Untitled

Perfusionist Skills Checklist

Perfusionist

AGE OF PATIENTS CARED FOR

General Skills

Basic Concepts

Technology, Equipment & Techniques

Cardiopulmonary Bypass (CPB)

Mechanical Assist Techniques

Lab Analysis

Additional Practices

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