Below is a table of procedures indicating which procedure a surgical resident may perform, with or without supervision. In all cases the clinical situation, the experience of the specific resident and the judgment of the more senior residents and/or the responsible faculty member can modify these guidelines.
Legend
I=insert R=remove Ap=apply P=peds A=adult
Surgical residents PGY 1-4 require supervision for all procedures performed on patients < 2 yrs old, < 10 kg in weight
PGY | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Procedure | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ||
airway management, stable/unstable, trauma | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
anesthesia | ||||||||||
local | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
field block | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
peripheral nerve block | A/P | A/P | A/P | A/P | A/P | A/P | A/P | |||
ankle-brachial index | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
arterial line (I/R) | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
arthrocentesis | ||||||||||
lower extremity | A | A | A | A | A | A | A | |||
upper extremity | A | A | A | A | A | |||||
bladder (Foley) catheter (I/R) | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
bladder irrigation | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
blood gases (arterial) | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
bronchoscopy | A | A | A | A | A | A | ||||
cardiopulmonary resuscitation | ||||||||||
closed | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
open | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
cardioversion | A/P | A/P | A/P | A/P | A/P | A/P | ||||
cast/splint (Ap/R) | ||||||||||
for fracture | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
for immobilization/protection | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
central line (femoral/jugular/subclavian) | ||||||||||
insert | A/P | A/P | A/P | A/P | A/P | A/P | A/P | |||
remove | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
chest tube | ||||||||||
insert | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
remove | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
colonoscopy, with/without biopsy | A | A | A | A | ||||||
compartment pressure measurement | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
conscious sedation | A/P | A/P | A/P | A/P | A/P | A/P | ||||
cricothyroidotomy | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
cultures (urine/sputum/wound) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
cutdown | ||||||||||
venous | ||||||||||
insert | A/P | A/P | A/P | A/P | A/P | A/P | A/P | |||
remove | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
arterial | ||||||||||
insert | A/P | A/P | A/P | A/P | A/P | A/P | A/P | |||
remove | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
defibrillation | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
Doppler study | ||||||||||
venous | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
arterial | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
graft/fistula | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
drainage tube (fluid/blood/pus – not chest/mediastinal) | ||||||||||
insert | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
remove | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
drug administration | ||||||||||
intravenous | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
intra-arterial | A/P | A/P | A/P | A/P | A/P | A/P | A/P | |||
esophagogastroduodenoscopy (EGD) | A | A | A | A | ||||||
endotracheal suctioning | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
endotracheal/nasotracheal intubation | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
gastric lavage | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
incision & drainage, abscess/fluid collection/cyst | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
laceration repair | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
laryngoscopy | A/P | A/P | A/P | A/P | A/P | A/P | ||||
long intestinal tube (I/R) | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
lumbar puncture | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
mediastinal tube | ||||||||||
insert | A | A | A | A | A | A | ||||
remove | A | A | A | A | A | A | A | A | ||
nasal packing | ||||||||||
anterior | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
posterior | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
nasogastric tube (I/R) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
other resuscitation | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
other wound care – not debridement | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
(change/replace dressing; clean) | ||||||||||
pacemaker/pacer wires, transthoracic | ||||||||||
insert | A | A | A | A | A | A | ||||
remove | A | A | A | A | A | A | A | A | ||
pacemaker/pacer wires, transvenous | ||||||||||
insert | A | A | A | A | A | A | A | |||
remove | A | A | A | A | A | A | A | A | ||
paracentesis/acute PD catheter | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
percutaneoue needle aspiration/drainage/biopsy | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
for fluid collection/cyst/abscess/mass | ||||||||||
perform/interpret lab tests (spin Hct/do UA/EKG/ | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
gram stain/peripheral smear/etc) | ||||||||||
pericardiocentesis | A | A | A | A | A | A | ||||
peritoneal lavage | A | A | A/P | A/P | A/P | A/P | A/P | A/P | ||
phlebotomy (including blood cultures) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
pleurodesis | A/P | A/P | A/P | A/P | A/P | A/P | ||||
rectal tube (I/R) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
remove foreign body | A | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
sclerosis, other (eg, seroma) | A/P | A/P | A/P | A/P | A/P | A/P | ||||
sigmoidoscopy/anoscopy | ||||||||||
with biopsy | A | A | A | A | A | A | A | A | ||
without biospy | A | A | A | A | A | A | A | A | ||
sutures/staples (I/R) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
Swan Ganz catheter | ||||||||||
insert | A | A | A | A | A | A | A | |||
remove | A | A | A | A | A | A | A | A | ||
thoracentesis | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
thoracotomy, emergency | A | A/P | A/P | A/P | A/P | A/P | A/P | |||
tracheotomy | A | A | A | A | A | A | A | |||
umbilical artery catheter | ||||||||||
insert | P | P | P | P | P | P | ||||
remove | P | P | P | P | P | P | P | |||
venous line (I/R) | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P | ||
wound debridement | A/P | A/P | A/P | A/P | A/P | A/P | A/P | A/P |
Legend
I=insert R=remove Ap=apply P=peds A=adult
Surgical residents PGY 1-4 require supervision for all procedures performed on patients < 2 yrs old, < 10 kg in weight