Detailed job description and main responsibilities

·         Review patient notes for relevant medical history, pathology and diagnosis making appropriate clinical decisions regarding the conduct of extracorporeal support, including perfusion technique, cannulation, type of equipment, intravenous fluid, blood products and drug additions to prime, for both routine and emergency cardiac surgical procedures.

·         Assemble, prime, de-air and manage extracorporeal devices and circuitry for cardiac surgical procedures, thus maintaining “life support”, according to departmental perfusion procedures and protocols.

·         Assess, interpret and manage a wide range of highly complex and routinely conflicting clinical information on a continual basis and take appropriate autonomous action, e.g. systemic blood pressure and flow, extracorporeal circuit pressure(s), central venous pressure, anticoagulation, ECG, fluid balance and patient/blood/cardioplegia/thermocirculator water temperatures.

·         Assess, interpret and take appropriate autonomous action to provide adequate gas exchange and maintain homeostasis whilst on cardiopulmonary bypass, e.g. arterial and venous “in-line” monitoring, arterial and venous blood gases, electrolytes, acid base balance, haemoglobin and derivatives and blood glucose and lactate levels.

·         Work as an independent practitioner, taking responsibility for managing a number of techniques during a single procedure, e.g. cardiopulmonary bypass, antegrade and retrograde blood cardioplegia, autologous cell salvage, haemoconcentration, high volume haemofiltration, deep hypothermic circulatory arrest, retrograde cerebral perfusion, selective antegrade cerebral perfusion.

·         Perform a range of complex myocardial preservation techniques to protect the heart from the damaging effects of ischaemia, involving the preparation and administration of blood cardioplegia into the aortic root, coronary sinus or directly into the coronary arteries, and careful control and monitoring of cardioplegia flow, pressure, dilution, temperature and final potassium concentration.

·         Be conversant with complex procedures and specialised perfusion techniques as deemed necessary for individual patient requirements i.e. left heart bypass, vacuum assisted venous drainage, kinetic assisted venous drainage, femoro-femoral cardiopulmonary bypass.

·         Assist with the setting up, initiation and management of complex long term extracorporeal circulation techniques i.e. ECMO and/or ventricular assist devices.

·         Seek advice from senior colleagues in order to gain experience and knowledge.  Apply experience and knowledge to formulate sound clinical judgements, facilitating decision making for complex cases.

·         Integrate information from auditory, visual and perceptive senses on a constant basis and use this to manage the cardiopulmonary bypass procedure.

·         Administer drugs and fluids according to departmental protocol and as necessitated by the clinical situation i.e. priming solutions, anticoagulants, inhalational anaesthetic agents, replacement crystalloid and colloid solutions, vasoactive drugs, anti-arrhythmic drugs, phosphodiesterase inhibitors, diuretics, sodium bicarbonate, magnesium sulphate, potassium chloride and cardioplegic solutions as detailed in the Local Agreement and Clinical Perfusion Medicines Management Protocols for Patients Undergoing Cardiac Surgery.

·         Transfuse allogeneic (donor) red blood cells during CPB guided by departmental policy.

·         Act and think clearly and calmly under acute time pressures and in emergency situations, to resolve potential life threatening situations.

·         Apply specialist clinical skills and knowledge to support, advise and supervise trainee Clinical Perfusionists during routine procedures/techniques.

·         Provide CPB and cardiac support services in other clinical areas external to the operating theatre complex such as Cardiac High Dependency Unit, Intensive Care Unit, Cardiac Catheterisation Laboratory, Coronary care Unit.

·         Prepare equipment and disposable items to perform autologous cell salvage both intra- and post-operatively.  Advise on the most effective use of autologous cell salvage for high risk patients and on the relative contraindications for its use.

·         Prepare and operate the equipment necessary for the insertion of intra-aortic balloon catheters pre-, intra- or post-operatively, provide continuing management of the balloon pump for the duration of its use and troubleshooting where necessary. Oversee and provide reference and support for intra-aortic balloon catheters inserted in the cardiac catheter laboratory, and on CCU post-procedure.

·         Prepare and operate the equipment and disposables to perform carbon dioxide flooding of the operative field during valve repair/replacement surgery or any other “open” procedure.

·         Maintain sensitivity and the dignity of patients in emergency situations and in the event of a patient death during a procedure.

·         Perform daily maintenance, quality control and troubleshooting of the departmental blood-gas analyser, to ensure accuracy of all measured and derived parameters which are crucial to the safe management of the patient throughout the whole of the peri-operative period.

·         To be part of the team providing a highly skilled, reliable 24 hour on call cover for cardiac surgery and other associated areas.

Please see attached job description for full details.