Certified Surgical First Assistant

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About Duke University Hospital

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States and is the number one hospital in North Carolina, according to U.S. News and World Report for 2023-2024. Duke University Hospital is the largest of Duke Health's three hospitals and features 1048 patient beds, 65 operating rooms, as well as comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.

General Description of the Job Class

The Certified Surgical First Assistant (CSFA) will support the continuity of care for Perioperative patients. The scope of practice includes preoperative patient care management, intraoperative surgical first assisting, and postoperative patient care management. The role will help expedite surgical productivity, support the education of surgical residents, 2nd assist where needed, and first assist the Surgeons when surgical Residents are not available. The CSFA will provide patient care for all ages and provide leadership and direction to the perioperative team where needed. The CSFA in surgery collaborates with the surgeon and the health care team in performing a safe operation with optimal outcomes for the patient. The CSFA practices in collaboration with and at the surgeon's direction during the intra- operative experience.

Duties and Responsibilities of this Level

The Certified Surgical First Assistant (CSFA) possesses and demonstrates competencies related to all aspects of perioperative care, including preoperative review of patient history and physical, preoperative tests results, and postoperative transfer of care and monitoring for complications. The CSFA serves as the first assistant in designated surgical procedures under the direct supervision of the operating surgeon/physician; handles all variety of tissue appropriately to reduce the potential for injury or compromised blood supply; uses surgical instruments properly, employs principles of safe tissue handling:

• Provides exposure to the operative site
• Provides and maintains hemostasis
• Performs wound closure
• Demonstrates advanced knowledge of normal and pathological anatomy and physiology
• Safely positions patients for the surgical procedure and assists with transport to and from the operative suite
• Assists surgeon in identifying patient and staff safety hazards
• Surgical prepping and draping of patients for the surgical procedure
• Provides exposure of the operative site by the appropriate use of retractors
• Manipulates equipment and instruments to enhance the visual field
• Suctions and sponges to maintain a dry surgical field resulting in an optimal visualization of the surgical field
• Provides counter-traction of tissue utilizing various instruments
• Assists with maintaining hemostasis to reduce potential for fluid volume deficits by clamping/ligating vessels, using electrocautery to tissue, applying manual direct pressure, assisting with use of pharmaceutical agents (e.g. topical thrombin) and other means as directed by the surgeon/physician
• Ties and cuts sutures
• Skillfully sutures all varieties of tissues/tissue planes with appropriate suture materials and suturing techniques
• Assists in closure of wound or independently closes wound under the direction of the surgeon
• Assists and independently applies dressing and tape at the end of the surgical procedure using proper aseptic/sterile techniques
• Maintains current knowledge of procedures performed
• The Certified Surgical First Assistant may take a scrub role when not needed as a first assistant.

Other Considerations:

• Scope of position does not include dissection down to the area to be repaired, replaced, etc., which is done by the surgeon.
• The CSFA may share a single surgical site with the surgeon being assisted and may not independently perform a procedure on an opposite site except subcutaneous tissue and skin closure.
• Placing a screw or manipulating a tool when manipulation and positioning of hardware must be held in such a specific position that the maneuver can only be accomplished by the orthopedic surgeon. All prosthetic placements, use of tools (drills, saws, etc.) and measurement to determine prosthetic size is performed by the orthopedic surgeon.
• The CSFA may prepare a tendon for grafting with the surgeon harvesting the tendon for grafting.

Robotic Cases

• The CSFA will follow the Guideline Statement for the Surgical Assistant in Robotic Surgery from the Association of Surgical Assistant (ASA) and maintain defined competencies: https://www.surgicalassistant.org/assets/docs/Guidelines_Surgical_Roboti cs.pdf

Required Qualifications at this Level

Education

Graduates from a CSA/CFA program from:

• Commission on Accreditation of allied health Education Programs (CAAHEP).
• American Board of Surgical Assistants (ABSA)/SA-C,
• National Assistant at Surgery Certification (NASC) or CCI Institute/ CRNFA
• Associate of Science in Surgical Technology preferred.

Experience

• 3 years of experience as a Surgical Technologist.

Degrees, Licensure, and/or Certification

• Certified Surgical Technologist (CST)
• Certified Surgical First Assist (CSFA)
• BLS certification from American Heart Association required

Knowledge, Skills, and Abilities

• CSFA must have sound clinical knowledge of technology and treatment applications; must also possess skills to educate/train staff and complies with AORN education standards for the CSFA; and a demonstrated knowledge of the surgeries in which the CSFA participates. Must have sound clinical OR skills (scrubbing) and have excellent interpersonal skills and organizational capability.

Distinguishing Characteristics of this Level

• N/A

Job Code: 00004640 CERTIFIED SURGICAL FIRST ASSISTANT
Job Level: E2

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