臨床工学技士 : Japanese Scope of Practice ?

Hi,

Sorry to email you out of the blues.

I like your blog very much. It is very informative and gives me a better insight into the live and work of a Perfusionist. I hope someday I can contribute as a Perfusionist too. I am currently doing a BSc in Biological Sciences and hoping to enter the perfusion field in the near future.

I have some questions about the becoming a perfusionist. I’m quite confused regarding the jobscope of a perfusionist. I’ve been looking at sites and come across this job Rinshou Kougaku Kishi ( 臨床工学技士 in Japanese ).

It is the equivalent of a perfusionist in Japan and the Japanese address them as ME. Their jobscope are as below.”

  • Respiratory care
    inhalation therapy, mechanical ventilator
  • Cardiopulmonary services
    cardiac bypass, VAD
  • Blood purification
    blood analysis, filtration, transfusion, plasma absorption, plasmapheresis
  • Hyperbaric oxygen therapy
  • ICU and CCU
    mechanical ventilation and Auxiliary circulation system
  • Operation theatre
    mech vent, Automated External Defibrillator, Polygraph, Cardiopulmonary bypass, monitor SEP and VEP
  • Cardiac Cathether inspection lab
    Polygraph, EPS and ABL, Ablator, External pacemaker, pacemaker insertion and battery change (analysis and program operation only), IVUS, IABP, PCPS, Rotablator

(Sorry if some of the terms are not correct, I had a hard time translating it from Japanese.)

Since the perfusionist is the equivalent of the Japanese RKK, do perfusionists perform the above jobs as well?

If not, to what extent is the jobscope similar? The above jobs are so closely related to that of a perfusionist such that I am all confused now. Since I love some of the job described above, I would like to learn and perform as much as possible.

Also, I have seen some names on your blog attached with “CCP, RRT”. Does that mean that someone can actually hold a CCP and RRT at the same time? Is it possible to become both a perfusionist and respiratory therapist at the same time?

Hope you can help me with the my queries. Any help would be great since perfusion is not exactly a widely known field in my region, SE Asia (I’m lucky if anybody doesn’t think that perfusionists deal with perfume).

Thank you.

I look forward to hearing from you soon.”

Regards,
Kanra Li

Kanra,

First of all, thanks for taking the time to write. Your english is excellent. The material below should help answer many of the questions you presented above.

It is our Scope of Practice here in America- and can be found at this link:

www.amsect.org.

Regarding your question of RRT being Perfusionists- yes, many perfusionists have cross-training, degrees, and licensure in overlapping medical fields, or as is my case, Business Administration.

The material below was obtained from the official AMSECT website.

Good luck in your endeavors, and check the comments section for replies from other individuals.

Sincerely.

Frank Aprile, BBA, LP, CCP

Purpose

The purpose of this document is to define the Scope of Practice for Clinical Perfusionist Professionals and to specify their role as members of the health care team, acting in the best interest of the patient. The scope of practice is a “living” document that will evolve as techniques and technology expand.

The scope of practice defined here and the areas specifically set forth describe the breadth of professional practice offered within the profession. Levels of education, experience, skill, and proficiency with respect to the activities identified within this scope of practice vary among individual providers; a Clinical Perfusionist does not typically practice in all
areas of the field. As the American Society of Extra-Corporeal Technology Code of Ethics specifies, individuals may only practice in areas in which they are competent based on their education, training, and experience. However, Clinical Perfusionists may expand their current level of expertise. Certain situations may necessitate that the Clinical Perfusionist pursue additional education or training to expand their personal scope of practice.

The scope of practice statement does not supersede existing state licensure laws or affect the interpretation or implementation of such laws. It may serve, however, as a model for the development or modification of licensure laws.

Clinical Perfusion is a dynamic and continuously evolving profession; listing specific areas within the scope of practice does not exclude emerging areas of practice. Although not specifically identified in this document, in certain instances Clinical Perfusionists may be called on to perform services (e.g., “multiskilling” in a health care setting, collaborative service delivery in schools) for the well-being of the individual(s) they are serving. In such instances it is both ethically and legally incumbent upon professionals to determine that they have the knowledge and skills necessary to conduct such tasks.

Definition of the Profession

The Clinical Perfusionist Professional is an individual qualified by professional credentialing and academic and clinical education to provide extracorporeal patient care services. The scope of practice of the Clinical Perfusionist Professional includes those procedures, acts and processes permitted by law, for which the individual has received education and clinical experience, and in which he/she has demonstrated competency.

Scope of Practice of the Profession

1.1.0 Extracorporeal Support
1.1.1. Cardiopulmonary bypass for Adult, Pediatric, and Neonatal Patients.
1.1.2. Cardiopulmonary bypass for congenital and acquired cardiovascular disorders.
1.1.3. Extracorporeal circulatory support for renal, neurological, hepatic and vascular surgery.
1.1.4. Extracorporeal resuscitation.
1.1.5. Extracorporeal circulation for long term support of failing respiratory and/or cardiac function.

1.2. Associated Extracorporeal Support Functions
1.2.1. Myocardial protection.
1.2.2. Hemofiltration/hemodialysis.
1.2.3. Anticoagulation and hemostasis monitoring, analysis, and intervention.
1.2.4. Thermal regulation.
1.2.5. Blood gas and blood chemistry monitoring, analysis, and intervention.
1.2.6. Physiological monitoring, analysis, and intervention.
1.2.7. Administration of blood components, pharmaceuticals, and anesthetic agents

2.1. Heart Failure Therapy and Support
2.1.1. Ventricular Assist Device management
2.1.2. Intra-aortic Balloon Counterpulsation
2.1.3. Temporary Pacemaker management
2.1.4. External counterpulsation
2.1.5. Transportation of Extracorporeal Supported Patients
2.1.6. Hemofiltration (i.e. “Aquapheresis”)
2.1.7. Periodic flow augmentation therapy

3.1. Blood Management
3.1.1. Autotransfusion
3.1.2. Platelet Gel Production
3.1.3. Non-Differentiated Progenitor Cell Harvest
3.1.4. Acute Normovolemic Hemodilution
3.1.5. Phlebotomy
3.1.6. Hemostasis monitoring and analysis

4.1. Other Clinical
4.1.1. Isolated Limb/Organ perfusion
4.1.2. Isolated limb/organ delivery of chemotherapeutics, progenitor cells, gene therapy vectors, ect.
4.1.3. Organ Procurement
4.1.4. Thermogenic lavage
4.1.5. Organ Preservation
4.1.6. Dialysis
4.1.7. Surgical assistance
4.1.8. Electrophysiological analysis
4.1.9. Therapeutic Hyperthermia
4.1.10. Therapeutic Hypothermia
4.1.11. Intravascular membrane oxygenation

5.1. Non-Clinical Responsibilities
5.1.1. Documentation of duties via the official medical record
5.1.2. Education, including the establishment and management of educational programs for new and current clinical perfusionists, other healthcare providers, and consumers.
5.1.3. Administration, including managing all aspects – technical, fiscal, workflow, and human resources – of Clinical Perfusion operations.
5.1.4. Quality Control and Assurance
5.1.5. Regulatory Compliance
5.1.6. Competency/Performance Evaluation

6.1. Professional Performance
6.1.1. Obtains and maintains appropriate professional credentials .
6.1.2. Works in partnership with other health care professionals to provide the best medical care possible for all patients.
6.1.3. Adheres to the standards, policies, and procedures adopted by the profession and regulated by law.
6.1.4. Stays current with required continuing medical education (CME) in order to stay abreast of changes in the field of extracorporeal technology and to maintain professional credentials.
6.1.5. Participates in continuing education activities through professional organizations, to enhance knowledge, skills and performance.
6.1.6. Adheres to the accepted professional ethical standards as defined by the Code of Ethics .
6.1.7. Acts as a patient advocate supporting patient rights.
6.1.8. Design, coordination, and implementation of original investigation.
6.1.9. Critical evaluation of published research.

Code of Ethics

The purpose of a code of ethics is to acknowledge a profession’s acceptance of the responsibility and trust conferred upon it by society and to recognize the internal obligations inherent in that trust. The following paragraphs delineate the standards governing the conduct of members in their professional interactions with patients, colleagues, other health professionals and the general public. Realizing that no code can encompass all ethical responsibilities of the members, this enumeration of obligations in the code of ethics is not comprehensive and does not constitute a denial of the existence of other obligations, equally imperative, and not specifically mentioned herein. This code of ethics shall be binding on the members of this Society.

Members must uphold the dignity and honor of the profession, accept its disciplines and expose without hesitation illegal, unethical and incompetent conduct.

3 thoughts on “臨床工学技士 : Japanese Scope of Practice ?

  1. Wow. Thanks for the information, Frank. One more question here. Do perfusionists operate the hyperbaric chamber for oxygen therapy? Thanks.

  2. In the USA. Hyperbaric medicine is a separate specialty. It would make sense if perfusionists were to be involved, however. Long ago in USSR heart surgery was performed in large hyperbaric chambers. At 3 ATM ,there was enough oxygen dissolved in tissues to allow cardioplegia for a period of time. The problem was the side effects of the ‘dive’ on the surgical team. The team had to undergo recompression with all the inherent risks. Hyperbaric Oxygen Therapy is used for a wide variety of indications today. In cardiac surgery, if an air bubble were to be introduced and an air embolus were to result- immediate treatment would likely be curative. However, rarely do cardiac surgeons want to admit to such an occurrence, so this life, or quality of life, saving procedure is rarely utilized.

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