OR SCRUB TECH SKILLS CHECKLIST

DESCRIPTION 1 2 3 4
NAME:       28. Splenectomy
ID #:       29. Thyroidectomy
DATE:       30. Tracheostomy
This Skills Checklist is for use by nurses with more than 31. Vagotomy
one year experience in their discipline and specialty. GYNECOLOGY:
Please be accurate with your assessment. 1. Abdominal Hysterectomy
2. A&P Repair
DIRECTIONS: Please indicate your level of experience by 3. Cesarean Section
placing a check (√) in the box. Experience level: 4. Colposcopy
1 NO EXPERIENCE 5. Colpotomy
6. Dilation & Curettage
2 MINIMAL EXPERIENCE-requires supervision/assistance 7. Laparoscopy
3 MODERATELY EXPERIENCED-requires initial review, 8. Marshall Marchetti
then performs independently 9. Radium Insertion
4 VERY EXPERIENCED- proficient 10. Sacral Spinus Fixation
11. Salpingoplasty
DESCRIPTION 1 2 3 4 12. Shirodkar Operation
GENERAL SURGERY: 13. Suction Curettage
1. Abdominal Resection 14. Tuboplasty
2. Adrenal Biopsy 15. Tubal Ligation
3. Anal Fissurectomy 16. Vaginal Hysterectomy
4. Appendectomy 17. Vaginal Reconstruction
5. Breast Biopsy ENDOSCOPIC:
6. Colectomy 1. Bronchoscopy
7. Cholecystectomy 2. Colonoscopy
8. Colon Resection 3. Cystoscopy
9. Colostomy 4. Culdoscopy
10. Femoral Herniorrhaphy 5. Esophagoscopy
11. Gastrectomy 6. Gastroscopy
12. Hemorrhoidectomy 7. Laryngoscopy
13. Hernia Repair 8. Pelviscopy
14. Hepatic Resection 9. Sigmoidoscopy
15. Hiatal Herniorrhaphy 10. Thoracoscope
16. Hydrocelectomy ENT:
17. Inguinal Herniorrhaphy 1. Adenoidectomy
18. Lap Chole 2. Caldwell_LUC Operation
19. Laparotomy 3. Closed Reduction Nasal
20. Lumbar Sympathectomy 4. Fenestration Procedure
21. Mastectomy 5. Glossectomy
22. Pancreatectomy 6. Laryngectomy
23. Pilonidal Cystectomy 7. Mandibulectomy
24. Portal Caval Shunt 8. Mastoidectomy
25. Pyloric Stenosis 9. Myringotomy
26. Radical Mastectomy
27. Saphenous Vein Ligation
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 OR SCRUB TECH SKILLS CHECKLIST
DESCRIPTION 1 2 3 4
NAME:       8. Maxillary Procedures
ID #:       9. Pediatric Dentistry
DATE:       10. Sagittal Osteotomy
11. TMJ exploration
12. TMJ w/Arthroplasty
ENT (CONT): OPTHALMOLOGY:
DESCRIPTION 1 2 3 4 1. Cataract Extraction
10. Parotidectomy 2. Corneal transplant
11. Pharyngeal Flap Procedure 3. Dacryocystectomy
12. Radical Neck Dissection 4. Iridectomy
13. Rhinoplasty/Septoplasty 5. Orbital Implant
14. Sinusotomy 6. Pterygium Repair
15. Stapendectomy 7. Recession Resection
16. Submucous Resection 8. Scleral Buckle
17. Tonsillectomy ORTHOPEDIC:
18. Tracheostomy 1. Acetabular/Pelvic ORIF
19. Tympanoplasty 2. Achilles Tendon Repair
NEURO: 3. ACL Repair
1. A-V Malfunction 4. Amputation
2. Anterior Cervical Fusion 5. Arthrotomy
3. Carotid Ligation 6. Bone Graft
4. Cervical Sympathectomy 7. Bunionectomy
5. Clipping of Aneurysm 8. Calcaneal Reconstruction
6. Cranioplasty/Craniotomy 9. Capsulorrhaphy
7. Decompressive Craniectomy 10. Carpal Tunnel Release
8. Discectomy 11. Cup Arthroplasty
9. Hypophysectomy 12. Hand Surgery
10. Laminectomy 13. Heel Cord Lengthening
11. Myelomeningocele Rep. 14. Hip Prosthesis
12. Pedicle Screw Insertion 15. Laminectomy
13. Shunt Procedure 16. Patellectomy
14. Spinal Fusion 17. Reimplantation of Digits
15. Tumor Excision 18. Repair Hammer Toes
16. Ulnar Nerve Transfer 19. Rotator Cuff Repair
17. Ventriculography 20. Sacro-Illiac Joint Screws
18. Ventriculostomy 21. Sharrard Procedure
ORAL: 22. Spinal Fusion
1. Closed Reduction Facial Fractures 23. Tendon Transplant
2. Excision Odontoma 24. Total Joint Replacement
3. Extraction of Deciduous Teeth PEDIATRIC:
4. Extraction of Impacted Molars 1. Broviac
5. Fractured Jaw 2. ECMO Cannulation
6. LeFort Osteotomies 3. Gastrosclesis
7. Mandiblectomy 4. Myelomeningocele Repair

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 OR SCRUB TECH SKILLS CHECKLIST
17. Tracheal Resection
NAME:       UROLOGY:
ID #:       1. Circumcision
DATE:       2. Cystectomy
PEDIATRIC (CONT): 3. Lithotripsy
DESCRIPTION 1 2 3 4 4. Nephrectomy
5. Omphalocele 5. Orchiopexy
6. Open Heart 6. Penile Implants
7. Pyloric Stenosis Repair 7. Prostatectomy
8. Repair of TEF 8. Pyeloplasty
PLASTICS 9. Radical Node Dissection
1. Abdominal Lipectomy 10. Scott Incontinence Device
2. Augumentation 11. TURP
3. Blepharoplasty 12. Ureterolithotomy
4. Cleft Lip 13. Vasectomy
5. Dermabrasion 14. Vasovasostomy
6. Face Lift 15. Waterhouse Procedure
7. Mammoplasty VASCULAR:
8. Mentoplasty 1. Aortic Aneurysm w/Graft
9. Otoplasty 2. A-V Access Graft
10. Pedicle Grafts 3. Carotid Aneurysm
11. Reconstructive 4. Endarterectomy Peripheral
12. Reduction 5. Thrombectomy Resection
13. Rhinoplasty 6. Vascular Bypass Resection
14. Scar Revisions 7. Vena Cava Filter
15. Skin Grafting 8. Vena Cava Ligation
16. Tissue Expanders EQUIPMENT:
THORACIC/OPEN HEART 1. Anesthesia Equipment
1. Aortic Valve Replacement 2. Arthroscopy Cameras
2. Cervical Rib Excision 3. Blood Warmer
3. Chamberlain Procedures 4. Cardiac Monitors
4. Closed Thoracotomy 5. Doppler Drills/Saws Cell Saver
5. Esophagectomy 6. Electrosurgery Unit
6. Heller Procedure 7. Endoscopy Scopes
7. Mitral Commissurotomy 8. Fluid Pumps Eye Magnet
8. Mitral Valve Replacement 9. Fracture Table
9. Open Heart 10. Intra Aortic Balloon Pump
10. Pacemaker Implant 11. Infusion Pumps
11. Patent Ductus Arteriosus 12. Microscope Pacemakers
12. Pericardiectomy 13. Midas Rex Laser
13. Rib Resection 14. Nerve Stimulators
14. Septal Defect Repairs 15. Nitrous Oxide Bank
15. Tetralogy of Fallot 16. Tourniquet Portable
16. Thoracoplasty
DESCRIPTION 1 2 3 4

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 OR SCRUB TECH SKILLS CHECKLIST
The information I have provided in this knowledge and
NAME:       skills checklist it true and accurate to the best of my
ID #:       knowledge.
DATE:      
           
Signature (Written/Electronic) Date
EQUIPMENT (CONT): ID #:      
DESCRIPTION 1 2 3 4
17. Ultrasonic Cleaners This skills checklist has been reviewed and approved by
18. Ventilators Nicole Bloxham, RN.
COMPUTERIZED CHARTING
1. Cerner            
2. Eclipsys Signature (Written/Electronic) Date
3. Epic ID #:      
4. McKesson
Please return to: Northwest Nurse Staffing Company, PA
5. Meditech
ATTN: Records Dept.
6. Other: Fax: (866) 352-4338

I HAVE CURRENT CERTIFICATIONS FOR: Email: records@nns-ic.com

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