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Perfusion Handover Checklist

 Efforts are currently underway in Japan to achieve reforms in work styles. Perfusionists have also been working to avoid overwork, and it is necessary to take safety measures during the handing over of cardiopulmonary bypass.

 JaSECT has prepared a perfusion handover checklist for the operation of cardiopulmonary bypass, which is usually performed by one primary operator, including breaks, and handover to the next primary operator at the end of the shift.

This checklist is not mandatory for all medical personnel who operate cardiopulmonary bypass and does not restrict the use of forms currently in use at each facility. We do not assume that the use or non-use of this checklist will be used as material in a medical lawsuit.

Produced by JaSECT:


Makoto Anno (Gunma Prefectural Cardiovascular Center)

Guideline Development Committee

Keiichi Tojo (Kitasato University Hospital)

International Exchange Committee

Koichi Kashiwa (The University of Tokyo Hospital)

Toshiko Atsumi (Hamamatsu Medical Center)

Society Activation Committee

Yasuyuki Araki (Saiseikai Kumamoto Hospital)

Education Committee

Yoshikazu Tangi (Tokyo Medical University Hachioji Medical Center)

Safety Committee

Makoto Sonoda (Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital)


Makoto Hibiya(Fujita Health University)

Societies endorsing this statement:

Yoshiki Sawa (The Japanese Association for Thoracic Surgery (JATS))

Hitoshi Saito (The Japanese Society for Cardiovascular Surgery (JSCVS))

Hirotsugu Okamoto (The Japanese Society of Cardiovascular Anesthesiologists (JSCVA))

Goro Matsumiya (The Japanese Society for Artificial Organs (JSAO))

Checklist for temporary replacement or handover of perfusionists】

Patient information(The next operator should confirm before transition)

□ □ Patient ID

□ □ Name

□ □ Age, Sex, Height, Weight, BSA

□ □ Blood type

□ □ Diagnosis, pre-existing condition

□ □ Infectious disease

□ □ Allergies

□ □ Preoperative examination item

Check of CPB record and information (Verification in the operation room)

□ □ Heart-Lung machine, oxygenator, circuits

□ □ The cardioplegia type, dosage amount, dose interval of cardioplegia

□ □ Arterial and Venous cannulas

□ □ Vent cannulas

□ □ Myocardial protection (cardioplegia) cannulas

□ □ Other cannulas

□ □ Cardiopulmonary bypass plan

□ □ Laboratory Data (blood gas analysis, electrolytes, blood coagulation ability)

□ □ The number of blood transfusion prepared and amount used (autologous blood,

red blood cells, platelet concentrate, fresh frozen plasma)

□ □ Backup devices and circuits

Handover from the primary operator

□ □ Scheduled surgery, modified surgery, current progress status, the next procedure

□ □ Status of drug usage (circulatory agonist, antibiotic, etc.)

□ □ Status of oxygenator(gas exchange capacity, pressure drop, etc.)

□ □ Time (CPB time, cross-clamp time, duration until the next cardioplegia)

□ □ Blood flow (arterial and venous)

□ □ Body Fluid Balance

□ □ Urine output

□ □ Blood flow, Vital sign

□ □ Special circulation (separated blood supply, retrograde circulation etc.)

□ □ Target temperature and status of temperature (measurement site, reaction)

□ □ Blood management(blood transfusion, blood coagulation, bleeding, residual blood etc.)

□ □ Report to the surgical team