Service. Years of Experience: Directions for completing skills checklist:
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1 Professional Nursing Service Name: Surgical Technician Checklist Date: Years of Experience: Directions for completing skills checklist: The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate your level of experience/proficiency with each area and, where applicable, the types of equipment and/or systems you are familiar with. Use the following key as a guideline: A) Theory Only/No Experience--Didactic instruction only, no hands on experience B) Limited Experience--Knows procedure/has used equipment, but has done so infrequently or not within the last six months C) Moderate Experience--Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed. D) Proficient/Competent--Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach. A. EAR, NOSE & THROAT A B C D 1. Adenoidectomy 2. Caldwell - Luc 3. Cleft lip/palate repair 4. Closed reduction nasal fracture 5. Ethmoidectomy 6. Excision of salivary gland tumor 7. Fenestration procedure 8. Frontal flap sinus procedure 9. Glossectomy 10. Laryngectomy 11. Mandibulectomy 12. Mastoidectomy 13. Maxillary advancement with hip graft 14. Maxillectomy 15. Myringoplasty 16. Myringotomy/with PE tube insertion 17. Nasal polypectomy 18. Open reduction facial fracture 19. Open reduction nasal fracture 20. Parotidectomy 21. Pharyngeal flap procedure 22. Radical neck dissection 23. Ranulectomy 24. Rhinoplasty/septoplasty
2 25. Selective osteotomy of maxilla/mandible 26. Sinus endoscopy 27. Sinusotomy 28. Stapedectomy 29. Submucous resection 30. Tonsillectomy 31. Tracheostomy 32. Tympanoplasty B. ENDOSCOPIC PROCEDURES 1. Bronchoscopy 2. Colonoscopy 3. Culdoscopy 4. Cystoscopy 5. Esophagoscopy 6. Gastroscopy 7. Hysteroscopy 8. Laparoscopic procedures a. Appendectomy b. Cholecystectomy/cholangiogram c. Colon resection d. Hernia repair e. Nissen fundoplication f. Salpingo-oophorectomy g. Tubal ligation h. Vaginal hysterectomy 9. Laryngoscopy & microlaryngoscopy 10. Mediastinoscopy 11. Pelviscopy 12. Sigmoidoscopy 13. Thoracoscopy C. GENERAL SURGERY 1. Abdominal perineal resection 2. Adrenalectomy 3. Anal fissurectomy 4. Appendectomy 5. Breast biopsy 6. Colectomy 7. Colostomy/ileostomy 8. Gastrectomy 9. Gastroplasty 10. Hemorrhoidectomy 11. Hepatic resection 12. Herniorrhaphy - femoral, inguinal, umbilical 13. Hiatal herniorrhaphy, transabdominal/transthoracic 14. Hickman/Groshong/Portacath insertion 15. Hydrocelectomy 16. Imperforate anus reconstruction 17. Lumbar sympathectomy
3 18. Omphalocele repair 19. Pancreatectomy/pancreatogram 20. Pilonidal cystectomy 21. Portal caval shunt 22. Pyloric stenosis 23. Radical mastectomy 24. Saphenous vein ligation and stripping 25. Sentinel node biopsy 26. Splenectomy 27. Tenchkhoff catheter placement 28. Thyroglossal duct cyst excision 29. Thyroidectomy 30. Tracheostomy 31. Vagotomy D. GYNECOLOGY 1. Cesarean section 2. Colpotomy 3. Dilation and curettage (D & C) 4. Hysterectomy, abdominal 5. Hysterectomy, vaginal 6. Marshall - Marchetti 7. Marsupialization, Bartholin cyst 8. Ovarian cystectomy 9. Radium insertion 10. Sacral spinus fixation 11. Shirodkar procedure 12. Suction curettage 13. Vaginal reconstruction 14. Vaginectomy/vulvectomy E. NEUROLOGY 1. A-V malformation 2. Anterior cervical fusion 3. Anterior laparoscopic spine procedures 4. Anterior lumbar interbody fusion (ALIF) 5. Burr holes for subdural hematoma 6. Carotid ligation 7. Cervical sympathectomy 8. Craniectomy for decompression fracture 9. Cranioplasty/craniotomy a. Clipping of aneurysm b. Tumor excision Using stealth equipment (stealth craniotomy) 10. Discectomy 11. Hypophysectomy 12. Insertion nerve stimulators/medication pumps 13. Laminectomy 14. Myelomeningocele repair 15. Pedicle screw insertion
4 16. Posterior lumbar interbody fusion (PLIF) 17. Shunt procedure/vp, VA/LP 18. Spine fusion - list systems you have used Types : 19. Ulnar nerve transfer 20. Ventriculography procedure/ventriculoscopy 21. Ventriculostomy F. OPHTHALMOLOGY 1. Cataract extraction with IOL 2. Corneal transplant 3. Dacryocystectomy 4. Dacryocystorhinostomy 5. Iridectomy 6. Lid and muscle procedures 7. Orbital implant 8. Phaco emulsification 9. Pterygium repair 10. Recession resection 11. Repair orbital blowout fracture 12. Scleral buckle 13. Vitrectomy G. ORAL 1. Closed reduction facial fractures/wiring 2. Excision odontoma 3. Extraction of deciduous teeth 4. Extraction of impacted molars 5. Fractured jaws, mandibular and zagomatic 6. LeFort osteotomies 7. Maxillary procedure with graft 8. Pediatric dentistry 9. Sagittal osteotomy 10. Temporomandibular joint (TMJ) with arthroplasty 11. TMJ exploration H. ORTHOPEDICS 1. Acetabular/pelvic ORIF 2. Achilles tendon repair 3. Amputation - leg, arm 4. Anterior cruciate ligament repair 5. Application of external fixators a. Extremities b. Pelvis 6. Application of halo traction 7. Arthroscopy a. Ankle b. Elbow c. Knee d. Shoulder
5 8. Arthrotomy 9. Bipolar/unipolar hips 10. Bunionectomy 11. Calcaneal reconstruction 12. Capsulorrhaphy 13. Carpal tunnel release 14. Closed reduction fracture 15. Hand surgery with implants 16. Harrington rod instrumentation and/or Dwyer procedure 17. Heel cord lengthening 18. Hip compression nails & lag screws a. Jewett b. Kuntscher rod c. Lottes d. Rush e. Schneider f. Zimmer g. Others - list Types : 19. Iliac crest bone graft 20. Insertion Austin Moor hip prosthesis 21. Intramedullary rods a. Extraction b. Femoral c. Humeral d. Insertion e. Supracondylar f. Tibial 22. Laminectomy 23. Olecranon bursa, excision of 24. Open reduction of fracture, internal fixation with compression set 25. Patellectomy 26. Putti Platt/Bankart procedure/rotator cuff repair 27. Reduction with compression sets 28. Reimplantation of digits 29. Repair hammer toes 30. Sacro-iliac (SI) joint screws 31. Sharrard procedure 32. Spica cast, application of 33. Spinal fusion 34. Tendon transplants (hand and foot) 35. Total joint replacements/revisions a. Total hip b. Total knee c. Total shoulder I. PLASTICS 1. Abdominal lipectomy 2. Blepharoplasty 3. Face lift 4. Mammoplasty a. Augmentation
6 b. Reduction c. Tramflaps with reconstructive mammoplasty 5. Mentoplasty 6. Otoplasty 7. Pedicle grafts 8. Scar revisions 9. Split thickness skin grafting 10. Tissue expanders J. THORACIC & OPEN HEART 1. Cervical rib excision 2. Chamberlain procedure 3. Closed thoracotomy 4. Correction pectus excavatum 5. Esophagectomy 6. Heller procedure 7. Mitral commissurotomy 8. Open heart procedures a. Mitral or aortic valve replacement b. Patent ductus arteriosus c. Septal defect repairs d. Tetrology of Fallot 9. Pacemaker implantation-endocardial 10. Pacemaker implantation-myocardial 11. Pericardiectomy 12. Resection coarctation aorta 13. Rib resection 14. Thoracoplasty 15. Tracheal resection 16. Transthoracic diaphragmatic herniorrhaphy K. TRANSPLANT 1. Bone 2. Bone marrow 3. Corneal 4. Harvesting 5. Heart 6. Kidney 7. Liver 8. Lung 9. Multi-organ 10. Pancreas 11. Skin L. TRAUMA 1. Burns 2. Gunshot/stab wounds a. Abdomen b. Chest
7 c. Head 3. Motor vehicle accidents (multiple injuries) 4. Traumatic amputations M. UROLOGY 1. Adult circumcision 2. Cystectomy 3. Cystoscopy/ureteroscopy 4. Hypospadias repair 5. Implants: penile, testicular 6. Lithotripsy 7. Nephrectomy 8. Nephrolithotomy 9. Orchiopexy 10. Prostatectomy a. Perineal b. Supra-pubic 11. Pyeloplasty 12. Radical node dissection 13. Scott incontinence device 14. TURP 15. Ureterolithotomy 16. Vasectomy 17. Vasovasostomy 18. Waterhouse procedure N. VASCULAR 1. A-V access graft 2. Aortic aneurysm with graft replacement 3. Endarterectomy/carotid - femoral 4. Peripheral vascular bypass procedures 5. Resection carotid aneurysm with graft 6. Thrombectomy/embolectomy 7. Vena cava filter/umbrella 8. Vena cava ligation O. EQUIPMENT 1. Argon beam coagulator 2. Bair Hugger 3. Blood/fluid warmer 4. Camera/video systems a. Camera controller b. Light source c. Printers d. VCRs 5. Cell saver 6. Cidex soak 7. Cryophthalmic unit 8. Dermatome
8 a. Brown b. Padgett c. Zimmer 9. Disposable grounding pads 10. Drills a. 3-M Maxi driver b. Codman craniotome c. Hall air driver d. Hall dental e. Hall neurotome f. Midax Rex/Anspach g. Minidriver h. Stryker drills (1) Large battery Stryker (2) Small battery Stryker i. Surgairtome j. Synthes A-O Drill 11. Electrosurgical unit 12. Emerson thoracic pump 13. Ethylene oxide sterilizer - AMSCO 14. Eye magnet 15. Fiber optic luminator - list types Types : 16. Flash autoclave - AMSCO 17. Fracture tables a. Chick table/marquet table b. Jackson table c. Rush table/skytron table 18. Hypo/hyperthermia unit 19. Intestinal stapling devices a. EEA b. GIA c. LDS d. TA 20. Kreiselman resuscitator 21. Laser a. CO2 b. Eye c. Yag d. Other Types : 22. Mesh graft 23. Microscopes, type Types : 24. Nerve stimulator 25. Nitrous oxide bank 26. Ohio suction units 27. Orthopedic arm board with drain 28. Pleurevac disposable chest drainage 29. Pneumatic tourniquet 30. Sterad machine 31. Steri-vac aeration cabinet, 3-M, portable 32. Steris unit 33. Suction unit, disposable 34. Tele-thermometer
9 35. Ultrasonic cleaner - AMSCO 36. Vac-pac positioner 37. Vacuum curettage 38. Washer sanitizer - AMSCO 39. Washer sterilizer - AMSCO AGE SPECIFIC PRACTICE A.Newborn/Neonate (birth - 30 days) D.Preschooler (3-5 years) G.Young adults (18-39 years) B.Infant (30 days - 1 year) E.School age children (5-12 years) H.Middle adults (39-64 years) C.Toddler (1-3 years) F.Adolescents (12-18 years) I.Older adults (64+) EXPERIENCE WITH AGE GROUPS A B C D E G H I Able to adapt care to incorporate normal growth and development. Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level. Can ensure a safe environment reflecting specific needs of various age groups. My experience is primarily in: (Please indicate number of years) Medical year(s) Cardiothoracic year(s) Neuro year(s) Neurological year(s) Cardiovascular year(s) Burn year(s) Trauma year(s) Coronary care year(s) PACC year(s) Other (specify) year(s) The information I have given is true and accurate to the best of my knowledge. I hereby authorize Professional Nursing Service to release Surgical Technician Skills Checklist to client facilities of PNS in relations to consideration of employment as a Traveler with those facilities. Signature Date Address Phone
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