Perioperative Skills Checklist
This profile is for use by Perioperative nurses with more than one year's experience in their discipline and specialty.
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Please indicate your level of experience
A. Theory, no practice
C. Two plus years experience
B. One - two years experience
A. EAR, NOSE & THROAT
SCRUB
CIRCULATE
1. Adenoidectomy
A
B
C
A
B
C
2. Caldwell - Luc
A
B
C
A
B
C
3. Cleft lip/palate repair
A
B
C
A
B
C
4. Closed reduction nasal fracture
A
B
C
A
B
C
5. Ethmoidectomy
A
B
C
A
B
C
6. Excision of salivary gland tumor
A
B
C
A
B
C
7. Fenestration procedure
A
B
C
A
B
C
8. Frontal flap sinus procedure
A
B
C
A
B
C
9. Glossectomy
A
B
C
A
B
C
10. Laryngectomy
A
B
C
A
B
C
11. Mandibulectomy
A
B
C
A
B
C
12. Mastoidectomy
A
B
C
A
B
C
13. Maxillary advancement with hip graft
A
B
C
A
B
C
14. Maxillectomy
A
B
C
A
B
C
15. Myringoplasty
A
B
C
A
B
C
16. Myringotomy/with PE tube insertion
A
B
C
A
B
C
17. Nasal polypectomy
A
B
C
A
B
C
18. Open reduction facial fracture
A
B
C
A
B
C
19. Open reduction nasal fracture
A
B
C
A
B
C
20. Parotidectomy
A
B
C
A
B
C
21. Pharyngeal flap procedure
A
B
C
A
B
C
22. Radical neck dissection
A
B
C
A
B
C
23. Ranulectomy
A
B
C
A
B
C
24. Rhinoplasty/septoplasty
A
B
C
A
B
C
25.Selective osteotomy of maxilla/mandible
A
B
C
A
B
C
26. Sinus endoscopy
A
B
C
A
B
C
27. Sinusotomy
A
B
C
A
B
C
28. Stapedectomy
A
B
C
A
B
C
29. Submucous resection
A
B
C
A
B
C
30. Tonsillectomy
A
B
C
A
B
C
31. Tracheostomy
A
B
C
A
B
C
32. Tympanoplasty
A
B
C
A
B
C
B. ENDOSCOPIC PROCEDURES
SCRUB
CIRCULATE
1. Bronchoscopy
A
B
C
A
B
C
2. Colonoscopy
A
B
C
A
B
C
3. Culdoscopy
A
B
C
A
B
C
4. Cystoscopy
A
B
C
A
B
C
5. Esophagoscopy
A
B
C
A
B
C
6. Gastroscopy
A
B
C
A
B
C
7. Hysteroscopy
A
B
C
A
B
C
8. Laparoscopic procedures
a. Appendectomy
A
B
C
A
B
C
b. Cholecystectomy/cholangiogram
A
B
C
A
B
C
c. Colon resection
A
B
C
A
B
C
d. Hernia repair
A
B
C
A
B
C
e. Nissen fundoplication
A
B
C
A
B
C
f. Salpingo-oophorectomy
A
B
C
A
B
C
g. Tubal ligation
A
B
C
A
B
C
h. Vaginal hysterectomy
A
B
C
A
B
C
9. Laryngoscopy & microlaryngoscopy
A
B
C
A
B
C
10. Mediastinoscopy
A
B
C
A
B
C
11. Pelviscopy
A
B
C
A
B
C
12. Sigmoidoscopy
A
B
C
A
B
C
13. Thoracoscopy
A
B
C
A
B
C
C. GENERAL SURGERY
SCRUB
CIRCULATE
1. Abdominal perineal resection
A
B
C
A
B
C
2. Adrenalectomy
A
B
C
A
B
C
3. Anal fissurectomy
A
B
C
A
B
C
4. Appendectomy
A
B
C
A
B
C
5. Breast biopsy
A
B
C
A
B
C
6. Colectomy
A
B
C
A
B
C
7. Colostomy/ileostomy
A
B
C
A
B
C
8. Gastrectomy
A
B
C
A
B
C
9. Gastroplasty
A
B
C
A
B
C
10. Hemorrhoidectomy
A
B
C
A
B
C
11. Hepatic resection
A
B
C
A
B
C
12. Herniorrhaphy - femoral, inguinal, umbilical
A
B
C
A
B
C
13. Hiatal herniorrhaphy, transabdominal/transthoracic
A
B
C
A
B
C
14. Hickman/Groshong/Portacath insertion
A
B
C
A
B
C
15. Hydrocelectomy
A
B
C
A
B
C
16. Imperforate anus reconstruction
A
B
C
A
B
C
17. Lumbar sympathectomy
A
B
C
A
B
C
18. Omphalocele repair
A
B
C
A
B
C
19. Pancreatectomy/pancreatogram
A
B
C
A
B
C
20. Pilonidal cystectomy
A
B
C
A
B
C
21. Portal caval shunt
A
B
C
A
B
C
22. Pyloric stenosis
A
B
C
A
B
C
23. Radical mastectomy
A
B
C
A
B
C
24. Saphenous vein ligation and stripping
A
B
C
A
B
C
25. Sentinel node biopsy
A
B
C
A
B
C
26. Splenectomy
A
B
C
A
B
C
27. Tenchkhoff catheter placement
A
B
C
A
B
C
28. Thyroglossal duct cyst excision
A
B
C
A
B
C
29. Thyroidectomy
A
B
C
A
B
C
30. Tracheostomy
A
B
C
A
B
C
31. Vagotomy
A
B
C
A
B
C
D. GYNECOLOGY
SCRUB
CIRCULATE
1. Cesarean section
A
B
C
A
B
C
2. Colpotomy
A
B
C
A
B
C
3. Dilation and curettage (D & C)
A
B
C
A
B
C
4. Hysterectomy, abdominal
A
B
C
A
B
C
5. Hysterectomy, vaginal
A
B
C
A
B
C
6. Marshall - Marchetti
A
B
C
A
B
C
7. Marsupialization, Bartholin cyst
A
B
C
A
B
C
8. Ovarian cystectomy
A
B
C
A
B
C
9. Radium insertion
A
B
C
A
B
C
10. Sacral spinus fixation
A
B
C
A
B
C
11. Shirodkar procedure
A
B
C
A
B
C
12. Suction curettage
A
B
C
A
B
C
13. Vaginal reconstruction
A
B
C
A
B
C
14. Vaginectomy/vulvectomy
A
B
C
A
B
C
E. NEUROLOGY
SCRUB
CIRCULATE
1. A-V malformation
A
B
C
A
B
C
2. Anterior cervical fusion
A
B
C
A
B
C
3. Anterior laparoscopic spine procedures
A
B
C
A
B
C
4. Anterior lumbar interbody fusion (ALIF)
A
B
C
A
B
C
5. Burr holes for subdural hematoma
A
B
C
A
B
C
6. Carotid ligation
A
B
C
A
B
C
7. Cervical sympathectomy
A
B
C
A
B
C
8. Craniectomy for decompression fracture
A
B
C
A
B
C
9. Cranioplasty/craniotomy
a. Clipping of aneurysm
A
B
C
A
B
C
b. Tumor excision
A
B
C
A
B
C
c. Using stealth equipment (stealth craniotomy)
A
B
C
A
B
C
10. Discectomy
A
B
C
A
B
C
11. Hypophysectomy
A
B
C
A
B
C
12. Insertion nerve stimulators/medication pumps
A
B
C
A
B
C
13. Laminectomy
A
B
C
A
B
C
14. Myelomeningocele repair
A
B
C
A
B
C
15. Pedicle screw insertion
A
B
C
A
B
C
16. Posterior lumbar interbody fusion (PLIF)
A
B
C
A
B
C
17. Shunt procedure/VP, VA/LP
A
B
C
A
B
C
18. Spine fusion - list systems you have used
19. Ulnar nerve transfer
A
B
C
