Skills Checklist - Perfusionist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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AGE OF PATIENTS CARED FOR

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Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64 years to 79 years)
Elderly Adults (over 79+ years)

GENERAL SKILLS

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Standard Precautions
Isolation Precautions
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Electronic Documentation
Automated Med Dispensing Systems

BASIC CONCEPTS

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

TECHNOLOGY, EQUIPMENT, AND TECHNIQUES

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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)

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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

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

LAB ANALYSIS

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Special Chemistry
Blood Chemistry
Coagulation

ADDITIONAL PRACTICES

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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

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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