Administrative Registered Nurse Skills Checklist

Perfusionist Skills Checklist

Fill Out and Submit your Skills Checklist

(Perfusionist Skills Checklist)

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I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

Age of Patients Cared For

Newborn/Neonate (birth–30 days):

★★★★

Infant (1 month–1 year):

★★★★

Toddler (1–3 years):

★★★★

Preschooler (3–5 years):

★★★★

School Age Child (5–12 years):

★★★★

Adolescents (12–18 years):

★★★★

Young Adults (18–39 years):

★★★★

Middle Adults (39–64 years):

★★★★

Older Adults (64–79 years):

★★★★

Elderly Adults (over 79+ years):

★★★★

GENERAL SKILLS

Standard Precautions:

★★★★

Isolation Precautions:

★★★★

Pediatric Respiratory/Cardiac Arrest:

★★★★

Adult Respiratory/Cardiac Arrest:

★★★★

Crash Carts:

★★★★

Defibrillators:

★★★★

Electronic Documentation:

★★★★

Automated Med Dispensing Systems:

★★★★

List Types (Electronic Documentation & Med Dispensing Systems):

BASIC CONCEPTS

Cardiovascular Anatomy:

★★★★

Pathology and Surgical Repair:

★★★★

Physiology:

★★★★

Pharmacology:

★★★★

Physics:

★★★★

Chemistry:

★★★★

Mathematics:

★★★★

Immunology:

★★★★

TECHNOLOGY, EQUIPMENT & TECHNIQUES

Extracorporeal Circuit Components for Cardiopulmonary Bypass:

★★★★

Adequacy of Perfusion:

★★★★

Myocardial Preservation:

★★★★

Systemic Hypothermia:

★★★★

Blood Conservation Techniques:

★★★★

Catastrophe Management:

★★★★

Adjunctive Techniques:

★★★★

Patient Monitoring:

★★★★

Organ Transplantation:

★★★★

CARDIOPULMONARY BYPASS (CPB)

Set-up/Priming of Equipment:

★★★★

Initiation of CPB:

★★★★

Administration of Prescribed Fluids/Medications:

★★★★

Anticoagulation:

★★★★

Temperature Management:

★★★★

Acid-Base Management:

★★★★

Ultrafiltration:

★★★★

Flow Rates:

★★★★

Cardioplegia:

★★★★

Hypothermic Circulatory Arrest:

★★★★

Power Failure:

★★★★

Pump Failure:

★★★★

Oxygenator Failure:

★★★★

Massive Air Embolus:

★★★★

Weaning/Resumption of Natural Circulation:

★★★★

MECHANICAL ASSIST TECHNIQUES

Ventricular Assist Device (VAD):

★★★★

Intra-Aortic Balloon Pump (IABP):

★★★★

Extra Corporeal Membrane Oxygenation (ECMO):

★★★★

Extra Corporeal Life Support (ECLS):

★★★★

LAB ANALYSIS

Special Chemistry:

★★★★

Blood Chemistry:

★★★★

Coagulation:

★★★★

ADDITIONAL PRACTICES

Off Pump Surgery Conversion to CPB:

★★★★

Autologous Blood Salvage:

★★★★

Limb Perfusion:

★★★★

Left Heart Bypass:

★★★★

Minimally Invasive (Percutaneous) Bypass:

★★★★

Minibypass:

★★★★

Liver Perfusion:

★★★★

Platelet Gels:

★★★★

Retrograde Cerebral Perfusion:

★★★★

Selective Antegrade Cerebral Perfusion:

★★★★

EMR / DOCUMENTATION SYSTEMS USED

Please list the EMR systems you have used:

Perfusionist Skills Checklist

Fill Out and Submit your Skills Checklist

(Perfusionist Skills Checklist)

Proficiency Scale:

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