OPERATING ROOM SKILLS CHECKLIST
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- Ashlie Bishop
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1 OPERATING ROOM SKILLS CHECKLIST Name: Registered Nurse Technician CTS When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill. CARDIOVASCULAR The scale is as follows: 1. Not performed 2. Intermitten experience 3. Very experienced. 1. Aortic Femoral Bypass graft Femoral-Popliteal Bypass Pacemaker Implantation Care of patients with pacemaker Cardiac cath lab A. Intra-Aortic Balloon Pump Septal defects Shunts Coronary Artery Bypass Graft Pediatric procedures Valve replacement Aortic aneurysm ENT 1. Adenoidectomy/Tonsillectomy Caldwell - Luc Cleft lip/palate repair Mastoidectomy Middle ear procedure Radical neck dissection Rhinoplasty/septoplasty Tracheotomy EQUIPMENT 1. Camera/video systems 1 2 3
2 2. Cell saver Cidex soak Cryo-ophthalmic unit CUSA Vac-Pac/ Bean Bag Hypo/Hyperthermia Unit Drills and saws Electrosurgical unit Fiber optic luminator Cavitron Autoclave Fracture tables Stapling devices Mesh graft/dermatome Microscopes Nitrogen tank Pneumatic tourniquet Steris unit Pulsevac Irrigation Autotransfusion Drain Ligasure machine GENERAL SURGERY 1. Abdominal peritoneal resection Breast biopsy Bowel resection Gastric procedures Hernia: open repair Colostomy/Ileostomy Appendectomy - open Appendectomy - Laparoscopic Cholecystectomy/Laparoscopic 1 2 3
3 10.Cholecystectomy/colongiogram-open Hiatal herniorraphy Hepatic resection Hickman/Groshong/Portacath insertion Rectal procedures Pancreatectomy/pancreatogram Splenectomy Thyroidectomy Colonoscopy/Sigmoidoscopy Gastroscopy/ Esophagoscopy Nissen fundoplication laparoscopic GYNECOLOGY 1. Cesarean section Dilation and Curettage (D&C) TAH/BSO Vaginal Hysterectomy Marshall-Marchetti Ovarian cystectomy AP Repair Laparoscopic procedures Hysteroscopy NEUROLOGY 1. Discectomy/laminectomy Anterior/posterior cervical fusion Cranioplasty/craniotomy tumor Craniotomy for aneruysm Shunt procedure/vp, VA/LP Halo traction application Pediatric procedures Spinal fusion Spinal fusion with instrumentation 1 2 3
4 OPTHALMOLOGY 1. Cataract extraction with IOL Corneal transplants Scleral buckle Vitrectomy Anterior procedures Exterior procedures Equipment: A. Legacy B. Millenium ORAL 1. Closed reduction facial fractures and wiring Dental procedures LeFort osteotomies Mandibular osteotomy TMJ procedures ORTHOPEDICS 1. Amputation - leg, arm Carpel tunnel release Hand surgery Hip compression nails, screws and pinning Bipolar/unipolar hip prosthesis Iliac crest bone graft Intramedullary rods Open reduction internal fixation Patellectomy Reimplantation of digits Rotator cuff repair Total joint knee/shoulder/wrist Arthroscopic procedures Pediatric procedures PLASTICS
5 1. Free Flap/Rotational Flap Radical Mastectomy Mastectomy Adominoplasty Blepharoplasty Face lift Augmentation mammoplasty Reduction mammoplasty Reconstructive mammoplasty tram flaps Skin graft THORACIC 1. Thombectomy/Embolectomy Lobectomy Thoracotomy Chest tube Bronchoscopy Mediastinoscopy Thoracoscopy TRANSPLANTS 1. Bone marrow Heart/Lung Kidney Corneal Harvesting Liver Pancreas UROLOGY 1. Implants; penile, testicular Lithotripsy Nephrectomy Orchiopexy 1 2 3
6 5. Prostatectomy TURP Vasovasostomy Cystocopy/Ureteroscopy PROFESSIONAL EXPERIENCE AND CERTIFICATIONS 1. Years of experience as: RN Tech. 2. Years of experience in: Adult Pediatric. 3. Area of most proficiency: 4. Area of least proficiency: 5. Are you willing to assist with elective abortions? Yes No 6. Are you Laser certified? Yes No The information I have given is true and accurate to the best of my knowledge. Please sign and date below. SIGNATURE: (Last 4 digits of your SSN) Reenter your last 4 digits of your SSN: DATE: eset
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Arteriovenostomy for renal dialysis 39.27, 39.42
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Name: Date: _ Years of Experience :
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GENERAL SURGERY Scrub Circ. EQUIPMENT Scrub Circ. Hernias Breast Biopsies Perineal Resection Anal Fissurectomy Mastectomy Radical Mastectomy Bowel Resection Colostomy / Ileostomy Adreanalectomy Appendectomy
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