ANESTHESIA TECHNICIAN SKILLS ANESTHESIA TECHNICIAN SKILLS This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Explore RN 0 = Not Applicable 1 = No Experience 2 = Some Experience 3 = Intermittent Experience 4 = Experienced 5 = Very Experienced Personal Information Name * Name First First Last Last Email * Phone * AGE OF PATIENTS CARED FOR * Newborn/Neonate (birth to 30 days) * 0 1 2 3 4 5 Infant (1 month to 1 year) * 0 1 2 3 4 5 Toddler (1 year to 3 years) * 0 1 2 3 4 5 Preschooler (3 years to 5 years) * 0 1 2 3 4 5 School Age Child (5 years to 12 years) * 0 1 2 3 4 5 Adolescents (12 years to 18 years) * 0 1 2 3 4 5 Young Adults (18 years to 39 years) * 0 1 2 3 4 5 Middle Adults (39 years to 64 years) * 0 1 2 3 4 5 Older Adults (64 years to 79 years) * 0 1 2 3 4 5 Elderly Adults (over 79+ years) * 0 1 2 3 4 5 GENERAL SKILLS * Isolation Precautions * 0 1 2 3 4 5 Pediatric Respiratory/Cardiac Arrest * 0 1 2 3 4 5 Crash Carts * 0 1 2 3 4 5 Electronic Documentation * 0 1 2 3 4 5 IV Pumps * 0 1 2 3 4 5 Sterile and Aseptic Technique * 0 1 2 3 4 5 Obtaining Vital Signs * 0 1 2 3 4 5 Transfer of Patient * 0 1 2 3 4 5 Patient Prep * 0 1 2 3 4 5 Procedure Set-Up * 0 1 2 3 4 5 Airway Maintenance * 0 1 2 3 4 5 Level of Consciousness * 0 1 2 3 4 5 Patient Positioning * 0 1 2 3 4 5 Placement of EKG Pads * 0 1 2 3 4 5 Placement of Oximetry Probe * 0 1 2 3 4 5 BIS Monitor * 0 1 2 3 4 5 Understands the Effects of Anesthesia Drugs * 0 1 2 3 4 5 Proper Identification of Patient using 2 Identifiers * 0 1 2 3 4 5 Proper Identification/Labeling of Lab/Specimen Results * 0 1 2 3 4 5 Pre-Procedural Time-Out Process * 0 1 2 3 4 5 Demonstrate Application of all Monitoring Devices * 0 1 2 3 4 5 Understand Scope of Practice and Limitations * 0 1 2 3 4 5 Prioritize Tasks Related to Role and Function * 0 1 2 3 4 5 Delegate Responsibilities to Other Anesthesia Team Members * 0 1 2 3 4 5 Knowledge of “Do Not Use” Abbreviations * 0 1 2 3 4 5 Fire, Electrical, Laser, and Explosion Hazards in the Operating Room/Anesthesia Related Areas * 0 1 2 3 4 5 Storage, Use, and Safe Handling of Bulk/Cylinder Gases * 0 1 2 3 4 5 Use of Common Anesthetic Gases * 0 1 2 3 4 5 Cleans, Sterilizes, Disinfects, Stocks, Orders, and Maintains Anesthesia Equipment/Supplies * 0 1 2 3 4 5 Implement Safety Procedures and Guidelines for Fire Safety and Infection Control * 0 1 2 3 4 5 OXYGEN ADMINISTRATION * Ambu-Bag * 0 1 2 3 4 5 Nasal Cannula * 0 1 2 3 4 5 Non-Rebreather Mask * 0 1 2 3 4 5 Portable Oxygen * 0 1 2 3 4 5 Trach Collar * 0 1 2 3 4 5 Simple Masks * 0 1 2 3 4 5 Tracheostomy * 0 1 2 3 4 5 Venturi Masks * 0 1 2 3 4 5 Ventilator * 0 1 2 3 4 5 ASSIST WITH * Spinal Anesthesia * 0 1 2 3 4 5 Spinal Anesthesia * 0 1 2 3 4 5 General Anesthesia * 0 1 2 3 4 5 Regional Anesthesia * 0 1 2 3 4 5 SUPPLIES * Types of ET * 0 1 2 3 4 5 LMA * 0 1 2 3 4 5 Oral/Nasal Airway * 0 1 2 3 4 5 Stylets * 0 1 2 3 4 5 Exchange Catheters * 0 1 2 3 4 5 PROCEDURES/EQUIPMENT * Apply Cricoid Pressure * 0 1 2 3 4 5 Assist with Intubation * 0 1 2 3 4 5 Assist with Fiberoptic Intubations * 0 1 2 3 4 5 Provide Jaw Thrust * 0 1 2 3 4 5 Remove Stylet Suring Intubation * 0 1 2 3 4 5 Inflate ET Cuff * 0 1 2 3 4 5 Manually Ventilate While Placement Verified * 0 1 2 3 4 5 Secure Airway * 0 1 2 3 4 5 INVASIVE LINE PLACEMENT * Prepare Sterile Field and Equipment * 0 1 2 3 4 5 Prepare Arterial Line Set-Up * 0 1 2 3 4 5 Prepare Central Venous Line Set-Up * 0 1 2 3 4 5 Prepare Peripheral Vascular Lines * 0 1 2 3 4 5 Assist with IA/IV Therapy * 0 1 2 3 4 5 SPECIMEN COLLECTIONS * Arterial Line Blood Draw * 0 1 2 3 4 5 Central Line Blood Draw * 0 1 2 3 4 5 Venipuncture * 0 1 2 3 4 5 ANESTHESIA MACHINE * Test Scavenging System Function * 0 1 2 3 4 5 Calibrate Oxygen Monitor * 0 1 2 3 4 5 Check Low Oxygen Alarm * 0 1 2 3 4 5 Verify Carbon Dioxide Absorbent is Adequate * 0 1 2 3 4 5 Breathing System Pressure and Leak Testing * 0 1 2 3 4 5 Verify Gas Flows Properly * 0 1 2 3 4 5 Document Checkout Procedures * 0 1 2 3 4 5 ENSURE PROPER FUNCTIONING OF * Suction * 0 1 2 3 4 5 IV Pump* * 0 1 2 3 4 5 Hotline Fluid Warmer * 0 1 2 3 4 5 BIS Monitor * 0 1 2 3 4 5 Verify No Gas Leaks * 0 1 2 3 4 5 Flowmeters * 0 1 2 3 4 5 Rapid Infuser * 0 1 2 3 4 5 Ultrasound * 0 1 2 3 4 5 IABP * 0 1 2 3 4 5 TEE * 0 1 2 3 4 5 Bair Hugger * 0 1 2 3 4 5 Capnography * 0 1 2 3 4 5 Doppler * 0 1 2 3 4 5 Fiber-Optic/Flexible Scope * 0 1 2 3 4 5 POINT OF CARE TESTING EQUIPMENT * GEM * 0 1 2 3 4 5 ISTAT * 0 1 2 3 4 5 Glucometer * 0 1 2 3 4 5 TEG * 0 1 2 3 4 5 IV PUMPS * Alaris * 0 1 2 3 4 5 Alibaba * 0 1 2 3 4 5 Bard * 0 1 2 3 4 5 Baxter * 0 1 2 3 4 5 Braun * 0 1 2 3 4 5 CADD * 0 1 2 3 4 5 IVAD * 0 1 2 3 4 5 Zynomed * 0 1 2 3 4 5 Other * 0 1 2 3 4 5 Application Agreement * I certify that all the information provided by me is true of my knowledge The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Explore TEK. to release this Skills Checklist to staffing clients of Explore TEK.. Submit this skills evaluation with your initial application. To be updated annually. Signature Clear If you are human, leave this field blank. Submit
