______________________
Patient ID
Check when completed. If not applicable, draw line through.
Comments:
Signature: ____________________________________
Date: ________________ Time: __________________
This pre-bypass checklist, or a reasonable equivalent, should be used before initiating cardiopulmonary bypass. This is a guideline which perfusionists are encouraged to modify to accommodate differences in circuit design and variations in institutional clinical practice. Users should refer to manufacturers' information for specific procedures and/or precautions. AmSECT disclaims any and all liability and responsibility for injury and damages resulting from following this suggested checklist. Researched and developed by the AmSECT Perfusion Quality Committee.