Perfusion Education The Australian and New Zealand Process Jane Ottens B'Sc', CCP Aust Chair person

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Perfusion Education The
Australian and New Zealand
ProcessJane Ottens B.Sc., CCP (Aust)Chair
person- Australasian Board Cardiovascular
Perfusion (ABCP)Executive Member -Australasian
Society Cardiovascular Perfusion (ASCVP)Chief
Perfusionist -Ashford Hospital, South Australia
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Australia
NT
Qld
WA
SA
NSW
Vic
NI
New Zealand
SI
Tas
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Australia
NT
Qld
WA
SA
NSW
Vic
NI
New Zealand
SI
Tas
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Cardiac Units Units
Townsville
Townsville
NT
Qld
WA
Brisbane
SA
NSW
Perth
Adelaide
Newcastle
Fremantle
Canberra
Sydney
Auckland
Vic
NI
Melbourne
Hamilton
Geelong
Hobart
Wellington
SI
Dunedin
Tas
Christchurch
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Cardiac Units Units
Townsville
Townsville
NT
Qld
WA
Brisbane
SA
NSW
Perth
Adelaide
Newcastle
Fremantle
Canberra
Sydney
Auckland
Vic
NI
Melbourne
Hamilton
Geelong
Hobart
Wellington
SI
Dunedin
Tas
Christchurch
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Clinical perfusionists have been involved in the
field of cardiovascular perfusion since the very
beginning of cardiac surgery in Aust/NZ in
1960s

• Clinical Perfusionists
• Variety of qualifications/ backgrounds
• ( Allied health)
• In house training
• No Certification
• American Board Perfusion exam in USA

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Medical Perfusionists - Had their own
Society ( NAMPA) - Formed in early 80s

• Late 1970s two perfusion societies involving
  Clinical Perfusionists
• New South Wales (NSWCVP)
• Victoria (VSCVP)

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1982 Australasian Society of Cardiovascular
Perfusionists Incorporated.
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Main Objectives of the ASCVP

• To provide means of a Scientific communication
  between clinical perfusionists

- First Annual Scientific Meeting held in Sydney
1982 - one day AGM - one day workshop
(case studies) - This year holding our 19th
Annual Meeting which is a full two day meeting
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• To provide a regulatory body to up hold the
  standards of perfusion
  -executive committee

Main Objectives of the ASCVP

• To provide, with the formation of the ABCP,
  certification through a common course in
  perfusion
• 4. To obtain recognition and acceptance as
  qualified practicing clinical perfusionists via
  federal registration/license.

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Brush Turkey, North Eastern Australia
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In 1987 a referendum held for all clinical
perfusionists within the society to ascertain
their views on

• The structure of the Board and its members
• The proposed Grandfather clause for certification
• The entry requirements for the official course

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ESTABLISH A GOVERNING BODY
Tasmanian devil, Tasmania, Australia
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The First Board was formed in 1989
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RACS 2
ASCVP Inc.

ANZCA 2
Executive Committee
ASCVP 4
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.
RACS 2
ASCVP Inc.

ANZCA 2
Executive Committee
ASCVP 4
Chair person
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.
RACS 2
ASCVP Inc.

ANZCA 2
Executive Committee
ASCVP 4
Chair person
Secretary
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.
RACS 2
ASCVP Inc.

ANZCA 2
Executive Committee
ASCVP 4
Chair person
Secretary
Course Coordinator
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.
RACS 2
ASCVP Inc.

ANZCA 2
Executive Committee
ASCVP 4
Chair person
Secretary
Course Coordinator
Member
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• AIM

• Establish a Code of Ethics/Code of Practice
• Establish and support credentialing
• Support maintain perfusion education

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WHAT TO DO WITH THE PRACTICING
PERFUSIONIST?
Empress Falls, Blue Mountain National Park,
NSW,Australia
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CERTIFICATION VIA GRANDFATHER CLAUSE

• Five years minimum employment as a
  Perfusionist
• 500 cases with written clinical competency from
  hospital of employment
• In 1989 - 48 Perfusionists were certified this
  way

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CERTIFICATE OF CLINICAL PERFUSION
CCP (AUST)
Thermal Springs, Rotorua, North Island, New
Zealand
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CERTIFICATION BY EXAMINATION

• Two years minimum experience
• 200 cases with clinical competency
• Sit Examination without doing the course
• 3 hour written exam
• 1 hour Oral Exam
• This exam offered twice in consecutive years
• 23 people certified by this method

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DO THE COURSE
Great Barrier Reef, Queensland, Australia
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Cardiac Units Units
Townsville
Townsville
NT
Qld
WA
Brisbane
SA
NSW
Perth
Adelaide
Newcastle
Fremantle
Canberra
Sydney
Auckland
Vic
Melbourne
Hamilton
Geelong
Hobart
SI
Tas
Christchurch
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HOW TO IMPLEMENT AND STRUCTURE THIS PERFUSION
COURSE

• University Based (central)
• - Low volume of student numbers
• - Cost too expensive

Schools of Perfusion in each state - 1990 The
Vic. Teaching Hospitals Perfusion Course -
1 Year and three students - Precursor to the
current course - Not
viable in other states
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Correspondence Course Two year post graduate
course Combine Theoretical Practical training
in a modular method, provided at a Board
approved hospital under the guidance of a
supervisor.
The Great Barrier Reef, Queensland, Australia
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TO DEFINE THE PREREQUISITES FOR ENTRY

• Have a Bachelors Degree in Science or Applied
  Science from an Australian or New Zealand
  University.
• Employment as a trainee perfusionist in an ABCP
  accredited hospital.

Uluru,Northern Territory, Australia
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ABCP ACCREDITED HOSPITALS

• Established unit with at least 250 cases
• Available departments and staff able willing to
  teach the modules of the course
• If the hospital is only staffed by visiting
  Medical Officers (Private Hospital)
• Then it must be associated with a teaching
  hospital ( Public Hospital) with the required
  teaching infra structure and resources

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• Access to a full time Clinical or Medical
  Perfusionist
• Employment of trainee is full time

Hamersley Gorge, Pilbra National Park, Australia
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THE SUPERVISOR

• The major COG in the WHEEL
• Arrange Lectures
• Make time available for the student to study
• Have all available resources the student will
  need
• Arrange practical and theoretical tutorials
  to test the candidate
• Arrange for trips to other units to cover all
  requirements (Paediatric/ ECMO)

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Experienced Perfusionist (min 5 years)
Masked Owl, Tasmania. Australia
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Govetts Leap, Blue Mountains, NSW, Australia
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Great Barrier Reef, Queensland, Australia
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• THE MODULAR COMPONENT OF THE COURSE
• 1. Anatomy
• 2. Pathology
• 3. Physiology
• 4. Pharmacology
• 5. Physics and Chemistry
• 6. Biomedical electronics
• 7. Instrument and measurement
• 8. Introduction to Perfusion Technology
• 9. Details of perfusion techniques
• 10. Perfusion Equipment
• 11. Clinical application of bypass Techniques
• 12. Support of Operating Theatre Procedures
• 13. Occupational aspects of perfusion
• Management / Quality control

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• General Objectives
• Specific Objectives

The Three Sisters, Blue Mountains, New South Wales
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• 10 PERFUSION TECHNIQUES
• 10. Lectures
• Heart/Lung machines
• Centrifugal pumps
• Heart/ lung coolers and cell savers
• Heart lung safety equipment
• Flow meters and blenders
• Bubble Oxygenators
• Membrane oxygenators
• Pre bypass, arterial,leukocyte and gas filters
• Cardioplegia and O2 Saturation devices

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10 PERFUSION TECHNIQUES 10.
Lectures a .HEART / LUNG MACHINES 1.0 General
Knowledge 2.0 Roller pumps 3.0 Centrifugal
pumps 4.0 Pump Consoles 5.0 Pressure,Temperature
and Low Level devices 6.0 Pressure
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10 PERFUSION TECHNIQUES 10.
Lectures a .HEART / LUNG MACHINES 1.0 General
Knowledge 2.0 Roller pumps 2.1 Know the maximum
details, designs and mechanism for (T)

a.Maximum revs and swept stroke
b.Occlusion
mechanism and tubing collets
c.Rev counters and flow indicators
d.Indicators of running
hours
e.Pulsatile and non pulsatile types
f.Ventricular support

g.Manual crank mechanism
h.Effective working life of
pumps
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A written 3 hour exam at the end of each module
set by the board Marked by supervisor and Board
gt60 to pass
The Hunter, Aboriginal Rock Art, Northern
Australia
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14 Log Book 200 cases min 10 paediatric if
Adult center min 10 Adult if at
Paediatric center
Mt Cook, South Island , New Zealand
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Verification of Module Components 13 successfully
passed module examinations Completed log Book
Mud, Rotorua,North Island,New Zealand
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• FINAL EXAM over two days

• Part One
• 3hour Short answer questions (10 questions)
• Part two
• 2 hour multiple choice question
• 100 questions with only one correct answer
• Oral Exam 50 mins
• Broken into 2 x 25 min sessions
• 2 teams of Board examiners
• Topics such as equipment,cpb scenarios and
  trouble shooting

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2002 CCP (AUST) now DIPLOMA OF PERFUSION
Sun Set, Sydney Harbour, New South Wales,
Australia
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WHAT FEE TO CHARGE?

• All positions on the ABCP voluntary
• Aim was to cover costs of running the ABCP
• - Administration / Course
• - Legal costs
• As it is in house it relies on resources of
  the hospital the student employed at.

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Cost -
Application cost of AUD150 (75 Euro) - AUD400
( 200 Euro) / year for the 2 years
- AUD200 for each year extended
Salt Water Crocodile, Northern Territory,
Australia
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ON GOING COMMITMENT TO THE COURSE

• Update modules to include new technology
• Up date referencing when new text published
• Stream line modules where there is some overlap
• Condense the number of modules to 8
• Four semesters 2 modules/semester
• Future?
• - Hopefully a study day/days in conjunction with
  the Annual Scientific Meeting
• Expertise of supervisors ?

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Platypus, Australia
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Platypus, Australia
Perfusionists, New Zealand
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RECERTIFICATION
Whakarewarewa, North Island , New Zealand
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RECERTIFICATION
1997-8 ABCP survey to all Board certified
perfusionists Poor response Proposed a
recertification system which was initially
voluntary ( over a 5 year period/500cases) 1999
ASCVP members surveyed on sentiment of compulsory
recertification Small response but majority found
recertification necessary for maintaining
perfusion standards Executive Committee drafted a
proposed criteria ( based on members
wishes)
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RECERTIFICATION

• Implemented 2002 ( 3 years period)

• 150 Clinical points - Min 50 cases
  /year
• - 40 on
  pump cases (min)
• - 10 off pump/ECMO/LVAD

• 30 Non Clinical Points - Attending Meetings
  (5-10)
• - Presenting at meetings(10-15)
• - Publications (5-15)
• - Marking Exams
• - self Education /Journals (5)

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All Clinical Perfusionists with CCP/Dip.Perfusion
divided into 3 groups all to recertify within the
next 3 years and then every three years to follow
First group to recertify in January 2003
50 Clinical points 10
Non Clinical Points
Second to recertify in January 2004 100
Clinical points 20 Non clinical points
Finally to recertify in January 2005 150
Clinical points 30 Non Clinical Points
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CERTIFICATE IN CLINICAL COMPETENCY IN
PERFUSION
Franz Josef Glacier, South Island,New Zealand
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AUDITING OF RECERTIFICATION

• Candidates selected at random to be audited
• Due to Hospital Privacy Laws now enforced in
  Australia
• Perfusionist submitting their recertification
  documentation Must be able to supply proof of
  all clinical and non clinical activity when
  audited by a member of the Board.

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PERFUSION EMPLOYMENT IN AUSTRALIA NEW
ZEALAND

• Public Hospitals ( Government Funded)
• Private Hospitals
• 90 of Perfusionists have some type of
  Hospital employment
• Several purely private perfusion companies
• Only Medical Practitioners are able to
  charge a patient for service under the
  current medical rebate system (Australia)

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Not Mandatory to have a CCP/Dip Perfusion to be
employed in Australia/New Zealand

• The ABCP cannot legally enforce any hospital to
  employ perfusionists under our guidelines
• But as the guidelines and standards are in place
  it appears that the prerequisites for the
  CCP/Diploma of perfusion are acting as a
  reference, for hospitals, when employing
  trainees.

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Registration and Licensure will alter this It
will be Mandatory to have Diploma of Perfusion
or prerequisites to certify Slow process

(lobbying federal government departments)
New Zealand may have this in place first
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CROSS ACCREDITATION

• - International Forum in San Diego
• - Initiated by Mary Winkler
• - Representatives from Canada, USA, Europe
  Australasia
• Active Dialogue but no suggestion at the end of
  the day of cross accreditation by any of the
  Boards
• ABCP duty bound to preserve standards
• We will initiate a discussion with Boards only of
  equivalent standards
• e.g. prerequisites, duration and content of the
  course

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CROSS ACCREDITATION

• Earlier this year it was decided by the ABCP
• A Perfusionist employed in Aust or NZ with
  overseas credentials
• Appropriate credentials/prerequisites of
  equivalent standard
• ABCP Interview
• Enrolled in a modified course
• Sit the whole exam
  
• Perform 40 supervised perfusions.

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Australasian Society of Cardio-VascularPerfusioni
sts Incorporated

• 19th ANNUAL SCIENTIFIC MEETING
• NOVEMBER 8 10, 2002
• Stamford Grand Adelaide
• Moseley Square Glenelg
• South Australia

www.perfusion.com.au