RESIDENT PRIVILEGES
Independent operating privileges are granted to Chief and Senior Residents. They are granted on a case-by-case basis with the Attending surgeon after consultation. No patients are to be operated without prior attending notification. All Kaiser patients are assigned an Attending Surgeon. The resident who will act as surgeon must meet the patient and do an exam pertinent to the operative pathology before the operation. If this does not happen in the Pre-op Clinic, it must happen in the Ambulatory Surgery Unit on the morning of the operation. Morning rounds and breakfast must be scheduled to allow adequate time for this visit. Chief Residents/Clinical PGY-5 1. Opening and closing of abdominal wounds 2. Incision and drainage of superficial abscesses 3. Incision of peri-rectal abscesses with Seton placement, fistulotomy for fistula in-ano, hemorrhoidectomy 4. Sigmoidoscopy 5. Minor surgical excision of superficial lesions and lymph nodes 6. Appendectomy 7. Placement of Groshong catheter or Lifeport 8. Repair of inguinal, umbilical, or ventral hernias 9. Breast biopsy or simple mastectomy without axillary dissection 10. Exploratory laparotomy for diagnosis, biopsy, drainage, or lysis of adhesions 11. Small bowel resection 12. Cholecystectomy without common duct exploration (open and laparoscopic) 13. Loop or end colostomy for diversion 14. Graham patches for gastroduodenal perforations. 15. Lower extremity amputation Senior Residents/Clinical PGY-4 1. Opening and closing of abdominal wounds 2. Incision and drainage of superficial abscesses 3. Incision of peri-rectal abscesses 4. Sigmoidoscopy 5. Minor surgical excision of superficial lesions and lymph nodes 6. Appendectomy 7. Placement of Groshong catheter or Lifeport 8. Repair of first time inguinal or umbilical hernias PRIVILEGES FOR INVASIVE WARD PROCEDURES Intern/Clinical PGY-1 1. Peripheral percutaneous IV or arterial access 2. NG tube placement
3. Feeding tube placement 4. Staple/suture removal 5. Foley catheter 6. Drain removal 7. Extremity wound debridement/open wounds Junior/Clinical PGY-2 or 3 1. Central IV access TPN lines Hemodialysis access Introducer placement for Swan Ganz 2. Tube thoracostomy 3. Thoracentesis/paracentesis 4. Rigid sigmoidoscopy 5. Lumbar puncture 6. I & D Extremity access 7. Incise thrombosed external hemorrhoid 8. Cut down IV or arterial access Senior/Clinical PGY-4 1. Swan Ganz catheter placement 2. Emergent endotrachael intubation 3. Flexible sigmoidoscopy 4. Pericardiocentesis Chief/Clinical PGY-5 1. Emergent tracheostomy R II and R I LEVEL RESIDENTS All procedures including Ward Invasive Procedures are to be supervised.
APPROPRIATE DOCUMENTATION MUST APPEAR IN THE PATIENT RECORD.