NC 04604

OSP 8/91

CLINICAL PERFUSIONIST

This is highly specialized technical work within a university hospital setting. Employees work within the
division of Cardiothoracic Surgery in procedures requiring circulatory support for patients undergoing
open heart operations and long term cardiac and pulmonary support such as extracorporeal membrane
oxygenation and ventricular assist. This extracorporeal support is provided through mechanical
assistance at which time the functions of the heart and lungs are controlled by the perfusionist. Work
requires the employees to maintain the circulation at an adequate level to meet the needs of the tissues
and provide the proper blood composition and temperature through manipulation of equipment as
instructed by the surgeon. The Employees are also responsible for reviewing the patient's history,
physical and heart catherization data, and for using an autotransfusion device (cell saver) to reclaim a
patient's blood. Employees must also be formally educated in techniques of operating the intra-aortic
balloon pump, other invasive monitoring equipment, and performing related duties as required.
Employees report to the Chief Perfusionist and/or a surgeon.

I. DIFFICULTY OF WORK:
Variety and Scope - Employees assist cardiac surgeons and anesthesiologist in the operating room
during open-heart surgery. Tasks are of moderate variety to include setting-up the perfusion equipment
before the patient comes to the OR, connecting the patient to the machine, monitoring the patient and
equipment during the surgery, and taking the patient off the machine. This process involves reviewing
the patient history; looking for situations which may affect oxygenation and medications during surgery;
and setting up the equipment according to the patient's needs including oxygenator and canula sizes,
amount of heparin, blood flow rates for adequate tissue perfusion, correct tubing size and amount of
liquids, and assuring no air is in the system. Employees maintain all of the patients temperatures and
pressures as directed when patient is on the machine, circulate blood at the appropriate flow rate; bring
body to normal temperatures when removing patient from system; use cell-saver to process remaining
blood; and, clean and maintain the equipment. They also report blood values to make the surgeon
aware of blood product needs.

Intricacy -The operation of the perfusion equipment requires independent judgement and an in-depth
understanding of the machine. Tasks are performed with considerable detail in operating and
maintaining the perfusion equipment, the intra-aortic balloon pump, and other life support devices.
Considerable detail is also demonstrated while setting up and operating electronic recording equipment
for complex computer monitors utilized in statistical data. Constant attention must be given to the
patient's temperatures, pressures and other vital signs over long periods of time. Employees anticipate
and respond to the needs of the surgeon while considering type of procedures, condition of the patient
and the anesthetic techniques.

Subject Matter Complexity - Work requires employees to have a thorough understanding of complex
perfusion equipment and techniques, and an understanding of general physiology and anatomy with an
emphasis on cardiac anatomy and physiology. Employees must be aware of the progress of the
surgery and what events in the procedure are taking place to be able to respond to the surgeon's
request. Knowledge of the patient's condition is required, with particular attention to circulatory
dynamics and cardiac function. Familiarity with the pharmacology of the various drugs used during the
procedure is also required.

Guidelines - Guidelines followed in this work are generally standard procedures. Detailed instruction is
usually provided by the surgeon or anesthesiologist in technical as specific to the procedure. When
preparing for a case, considerations are given to the procedure, the condition of the patient and the
anesthetic technique to be used. Guidelines for the operation of the perfusion equipment are usually
understood. Employees stay abreast of current perfusion technique by reading related journals and
NC 04604
OSP 8/91

textbooks and participating in a continuing education process through the American Society of
Extracorporeal Circulation Technology or the American Academy of Cardiac Perfusionist.

II. RESPONSIBILITY:
Nature of Instructions - Instructions are usually through oral communication from the surgeon and/or
anesthesiologist with whom the employees stay in close contact during surgery. While in orientation,
instructions are provided by the Chief Perfusionist. Administrative issues are also discussed with the
Chief Perfusionist.

Nature of Review - Work is reviewed daily for readiness prior to surgery and while surgery is in
progress.

Scope of Decisions - Work directly affects the patient population served in providing proper blood flow
and composition necessary to prevent adverse effects in the patient and avoiding catastrophic
accidents such as air infusion. Presenting effective information extracted during the procedure can
affect other health care professionals.

Consequence of Decisions - Work affects the patient's life directly while on cardiopulmunary bypass.
Employees actions could vary from death and disability of the patient to time delay or waste of
materials.

III. INTERPERSONAL COMMUNICATIONS:

Scope of Contacts - Employees coordinate efforts and serve as liaison with, other health care providers
while preparing for surgery and during surgery. This requires daily communication with surgeons,
surgical assistants, nurses, anesthesiologists, medical students, anesthesia and surgical residents, and
other services (blood bank, pharmacy and central supply) of the hospital. Information exchanged
regarding the operation and maintenance of equipment is usually understood.

Nature and Purpose - Employees gather and disseminate patient information with, others while
coordinating efforts prior to, during, and after surgery.

IV. OTHER WORK DEMANDS:

Nature of Working Conditions - Employees work in an operating room with constant exposure to stress,
variable concentrations of waste anesthetic gases, infectious diseases, and life-threatening patient
situations. Work necessitates long periods of exact concentration and confined sitting or standing.
Employees may also incur injury when moving equipment and discomfort during extended procedures.

Nature and Potential of Personal Hazards - Employees working in the operating room have certain
inherent hazards such as exposure to needles, scalpel blades, blood products and contaminated body
fluids, and are in a high-risk category for hepatitis, AIDS, and other blood-borne diseases. Since they
work with anesthetic agents, the potential for exposure exists with these hazardous materials.

V. JOB REOUIREMENTS:
Knowledges, Skills, and Abilities - Thorough knowledge of perfusion procedures, techniques, and
equipment; considerable knowledge of cardiopulmonary physiology, computer operation and
physiologic monitoring, equipment; general knowledge of physiology and anatomy, with emphasis on
cardiac anatomy and physiology; knowledge of hemodyanamics and aseptic technique; knowledge of
basic surgical supplies (solution, bags, IV lines, and needles). Working knowledge of membrane
oxygenators, inter-aortic balloon pump and blood conservation equipment. Good manual dexterity.

Minimum Training and Experience - Graduation from school of perfusion technology and certification or
eligible to be certified by the American Board of Cardiovascular Perfusion.