AmSECT Pre-Bypass Checklist

______________________
Patient ID

Check when completed. If not applicable, draw line through.

  • PATIENT
    Chart reviewed
    Procedure verified

  • STERILITY
    Components checked for package integrity/expiration date
    Heat exchanger(s) leak-tested

  • PUMP
    Speed controls operational
    Roller heads smooth and quiet
    Occlusion(s) set
    Flow meter in correct direction and calibrated
    Flow rate indicator correct for patient and/or tubing size
    Holders secure

  • ELECTRICAL
    Power cord(s) securely connected

  • GAS SUPPLY
    Gas line securely connected
    Flow meter/blender functional
    Hoses leak-free
    Gas exhaust unobstructed

  • LINES/PUMP TUBING
    Connections secure
    Tubing direction traced and correct
    No kinks noted
    One-way valve(s) in correct direction
    Debubbled/leak free
    Patency of arterial line/cannula verified

  • CARDIOPLEGIA
    Solution checked
    System debubbled/leak-free

  • SAFETY MECHANISMS
    Alarms operational and engaged
    Arterial filter/bubble trap debubbled
    Cardiotomy reservoir vented

  • MONITORING
    Temperature probes in place and calibrated
    Pump pressure monitors calibrated
    In-line and/or on-line sensors calibrated
    Oxygen analyzer calibrated

  • TEMPERATURE CONTROL
    Water source connected and functional

  • SUPPLIES
    Tubing clamps available
    Drugs available and properly labeled
    Solutions available
    Blood available
    Sampling syringes/laboratory tubes available

  • ANTICOAGULATION
    Heparin time and dose verified
    Anticoagulation tested and reported

  • BACKUP
    Hand cranks available
    Emergency lighting available
    Duplicate circuit components available

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.