operating checklist last first date a – able b – · pdf fileoperating. room...

OPERATING ROOM SKILLS CHECKLIST

Last First Date

Please mark thecorrespondingexperiencelevel for eachsectionA – Able to performwithoutany supervisionB – Perform infrequently(Would requiresomesupervision)C – No experience(Require Assistance / Supervision )

EXPERIENCE LEVEL A B C

A. GENERAL SURGERY1. Cholecystectomy/Cholangiogram2. Hemorrhoidectomy3. ImperforateAnus Reconstruction4. Radical Mastectomy5. Tracheostomy6. Vagotomy7. SaphenousVein Ligation andStripping8. Lumbar Sympathectomy9. Hepatic Resection10. Circumcision11. Abdominal Perineal Resection12. Adrenalectomy13. Colectomy14. Herniorrhaphy,femoral, inguinal15. Pancreatectomy/Pancreatogram16. Splenectomy17. Whipple Procedure18. Bowel Resection19. Pilonidal Cystectomy20. Hiatal Herniorraphy, transabdomina

l21. Colostomy/Ileostamy22. Anal Fissurectomy23. Appendectomy24. Gastrectomy25. Organ Procurement26. Portal Caval Shunt27. Thyroidectomy

B. ORTHOPEDIC A B C1. Amputation:arm/leg

6167 Stoney Creek Drive, Fort Wayne, IN 46825 * Phone: 260-442-8884 * Fax: 1-866-373-7744 http://www.pacemedcare.com of 8

P.O. Box 32 * Stevensville, MI 49127 * Phone: (269) 325-2850 * Fax: (269) 556-0042www.pacemedicalstaffinginc.com

2. Insertion of McIntosh Tibial PlateauProsthesis3. Insertion of SwansonFinger Prosthesis4. TendonTransplants5. Carpal Tunnel release6. Putti Platt/BankartProcedure7. Spinal Fusion8. Patellectomy9. Heel Cord Lengthening10. Bunionectomy11. Application of Halo Traction12. Capsularrhaphy13. Laminectomy14. Repair Hammer Toes15. Application of Spica Cast16. Excision of OlecrannonBursa17. Cup Arthroplasty/InsertionProsthesis18. SharranrdProcedure19. Nailing Proceduresa. A-Ob. Lottesc. Jewettd. K Wirese. Schneiderf. Kuntscher Rodg. Rush

C. NEURO A B C1. Anterior Cervical Fusion2. Laminectomy3. Ulna Nerve Transplant4. Craniectomy for DecompressionFracture5. Burrholes for SubduralHematoma6. MeningoceleRepair7. Vinke Tong Insertion8. Clipping of Intracranial Aneurysm9. Carotid Ligation10. ShuntProcedures;VP/VA/LP11. VentriculographyProcedures12. Cranioplasty13. Crutchfield Tong Insertion14. Cervical Sympathectom

y15. Hypophysectomy16. Craniotomy


D. GYN A B C1. Hyserectomy, vaginal2. Hysterectomy,abdominal3. Terminationof Pregnancy4. CaesareanSection5. Laser Surgery6. Marsupialization Bartholin Cyst7. Colpotomy8. Radium Insertion9. Vaginal Reconstruction10. Dilation andCurettage11. Vaginectomy12. Tubal Ligation13. Marchetti-Marshall14. Shirodkar Operation15. Salpingo-Oopherectomy

E. UROLOGICAL A B C1. Vasectomy2. Cystectomy3. HypospediusRepair4. Nephrectomy5. Circumcision6. Prostatectomy,perineal7. Protstectomy,suprapubic8. Kidney Transplant9. T.U.R.10. Orchietomy11. Ureterolithotomy12. Pyeoplasty

F. Thoracic/Cardiovascular A B C1. Closed Thoracotomy2. Pericardiectomy3. Tracheal Resection4. Transthoracic DiaphragmaticHerniorrhaphy5. Esophagectomy6. Thoracoplasty7. Mitral Commissurotomy8. Closure PatentDuctus Arteriosis9. Endocardial-PacemakerImplantation10. Myocaridal-PacemakerImplantation11. Correction Pectus Excavatum12. Pnemunectomy/Lobectomy13. First Rib Resection



14. Excision Cervical Rib15. Revascularization Coronary Arteries16. Heller Procedure17. Resection CoarctationAorta18. OpenHeart Procedure/CPBypassa. Septal Defect Repairsb. Heart Valve Replacement19. Aortic Femoral Bypass graft20. Femoral Popliteal Bypass21. Aortic Aneurysm w/graftreplacemen

t22. EndoscopicVein Harvesting23. Cardiac Cath Lab-Intra-Aortic Balloon Pump24. Septal Defects, ASV,VSD25. Coronary Artery Bypass Graft26. Off PumpBypass

G. Vascular A B C1. Shunts2. Vena Cava Ligation3. Embolectomy4. Angiography5. A -V access grafts6. PeripheralVascular Bypass Procedures7. Thrombectomy8. Endarterectomy;carotid/femoral9. Resection Carotid Aneurysm with Graft

H. Ear, Nose & Throat A B C1. Luc-Caldwell2. Maxillary Advancementwith Hip Graft3. Selective Osteotomyof Maxilla/Mandible4. CammendoProcedure5. Open ReductionFacial Fractures6. SubmuccusResection7. FenestrationProcedure8. Parotidectomy9. Tympanoplasty10. Laryngectomy11. Radial Neck Dissection12. Cleft Lip-Palate Repair13. Myringotomy14. Sinusotomy15. Ethymoidectomy16. OpenReductionNasal Fracture17. Tonsillectomy


P.O. Box 32 * Stevensville, MI 49127 * Phone: (269) 325-2850 * Fax: (269) 556-0042

18. Frontal Flap Sinus Procedure19. PE Tueb Insertion20. Myringoplasty21. Mastoidectomy22. Ranulectomy23. Closed ReductionNasal Fracture24. Nasal Ploypectomy25. Stapedectom

y26. Excision Salivary Gland Tumor27. OpenReductionTripod Fracture28. Tracheostomy29. Glossectomy30. PharyngealFlap Procedure

I. EYE A B C1. PterygiumRepair2. Corneal Transplant3. Ocutome4. Dacryocystorlfinostomy5. Microscope6. Enucleation7. Repair of Retinal Detachment8. Orbital Implant9. Phacoemulsifier10. Repair Orbital Blowout Fracture11. Dacryocystectomy12. CataractExtraction13. Recession Resection14. Diathermy Operation15. Iridectomy

J. ORAL A B C1. Closed reductionfactial fractures/wiring2. Extraction of ImpactedMolars3. Extraction of DeciduousTeeth4. Excision Odontoma

K. PLASTIC1. Rhinoplasty2. Mentoplasty3. Blepheroplasty4. ReductionMammoplasty5. Reconstructive6. Augmentatio

nMammoplasty


OPERATING ROOM SKILLS CHECKLIST

7. Otoplasty8. Cleft-Lip Palate Repair9. Split Thickness Skin Grafting10. Dermabrasion11. Scar Revisions12. Skin Grafting13.Liposuction

L. Endoscopic1. Gastroscopy2. Sigmoidoscopy3. Bronchoscopy4. Laryngoscopy5. Culdoscopy6. Mediastinoscopy7. Laparoscopy8. Esophagoscopy9. Cystoscopy

M. CARDIOVASCULAR RESUSCITATION1. Intubation2. Mouth to Mouth Resuscitation3. Ambu4. Cardiac Compression

N. Trauma1. Motor Vehicle Accidents2. Amputations3. Gunshot/Stab

wounds4. Burns

O. INTRAVENOUS THERAPY1. Medicut2. Jelco3. Intracath4. Regular IntravenousSet5. Scalp Vein

P. MISCELLANEOUS EQUIPMENT1. DisposableBovie Plates2. K-Pad Unit3. PneumaticTube System4. Washer Sterilizer--AMSCO5. Ultrasonic Cleanser--AMSCO


6. Washer Sanitizer--AMSCO7. Flash Autoclave--AMSCO8. Ethylene Oxide Sterilizer--AMSCO9. Defibrillator-Datascope680 Resuscitation10. AquamaticK Thermia Unit11. Kiddie PneumaticTourniquet12. PortableLight13. Vaccum Curettage14. Hemokinetitherm-BloodWarmer15. Eye Magnet16. Nitrous Oxide Bank17. Auto Suture, TA 30, Stapling Instrument18. Auto Suture, TA 55, Stapling Instrument19. Auto Suture, TA 90, Stapling Instrument20. Auto Suture, GIA, Stapling Instrument21. Pleur-e-vac Units (Disp. Chest Drainage)22. Vac-pac Positioner23. Blood Bank Refrigerator24. Emerson-Thoracic Pump25. Nerve Stimulator26. PortableCardiac Monitor, Datascope85027. Cry-Opthalmic Unit28. AOMI, Fiber Optic Luminator29. PILLING, Fiber Optic Luminator30. OrthopedicArm Board with Drain31. Bovie Electrosurgical Unit32. Dual Tract Lights (bulb changing;handles)33. Kreiselman Resuscitator34. Steri-vac-nerationCabinet, 3-M, portable35. Electrodyne-Cardiac Montior & Pacemaker36. Conductomete

r37. OperatingMicroscope38. Cell Saver39. Laser40. Defibrillator-Electrodyne41. Hall Neurotome42. Nesq Graft43. OperatingRoom Table, Castle 5 Section44. Ohio Suction Units45. Suction Unit, Disposable46. Tele-thermometer47. CompressionSet, Zimmer48. Drillsa. Smith Cranialb. Hall Air Driver



c. Hall Dentald. Chayese. JordanDayf. A-O49. Dermatomea. Cordless Davol Unitb. Brownc. Padgettd. Castroviejo Electro-Kerotome

AGE EXPERIENCEIndicate groupsin which you have expertisein providing

age-appropriate

nursingcare. YesYesYesYes No

0 – 30 Days30 Days – 1 year

1 – 5 years5 -13 years

13 – 18 years18 - 39 years39 – 64 years

64 years +

The informationthatI have given is accurateandtrueto thebestof my knowledge.PMSI to releasesameto her client healthcare facilities.

___Signature Date


The information that I have given is acquire and true to the best of my knowledge. I hereby authorize PACE Medical Staffing, Inc. to release same to her client health care facilities.

operating checklist last first date a – able b – · pdf fileoperating. room...

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