Cardiac Echocardiography Skills Checklist
  Cardiac Echocardiography Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to FILL IN THE BLANK on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) ULTRASOUND-ECHOCARDIOGRAPHY 1 2 3 4  
Adult Echocardiography  
Pediatric Echocardiography  
Fetal Echocardiography  
Trauma Echocardiography  
Stress Echocardiography  
Treadmill Testing  
Dobutamine  
Pharmacologic Stress Echo  
Transesophageal Echocardiography (TEE)  
Intraoperative Echocardiography  
Contrast Echocardiography  
Myocardial Contrast  
Echo-Guided Procedures  
Plethysmography  
Doppler Vascular Procedures  
Pressure Measurements  
Two-Dimensional Mode  
Three-Dimensional Mode  
M-Mode  
Ped Off Probe  
Pulsed Wave Doppler  
Continuous Wave Doppler  
Color Doppler Mapping  
Portable Studies  
Invasive Procedure Guidance  
EKG/ECG  
Parasternal Long Axis View  
RVIT  
RVOT  
Parasternal Short Axis View  
4 Chamber View  
2 Chamber View  
Apical Long  
Subcostal View  
Subcostal Short Axis of RV Inflow and Outflow  
IVC  
Hepatic Veins  
Abdominal Aorta  
Suprasternal Notch  
Simpson’s Rule  
Proximal Isovelocity Surface Area  
Diastolgy with TDI  
Continuity Equation  
Rating Stars (Click) PEDIATRIC ECHO 1 2 3 4  
Two-Dimensional Mode  
Three-Dimensional Mode  
M-Mode  
Ped Off Probe  
Pulsed Wave Doppler  
Continuous Wave Doppler  
Color Doppler Mapping  
Portable Studies  
Invasive Procedure Guidance  
EKG/ECG  
Parasternal Long Axis View  
RVIT  
RVOT  
Parasternal Short Axis View  
4 Chamber View  
2 Chamber View  
Inverted Apical 4 Chamber View  
Inverterd Apical 5 Chamber View  
Subcostal Long View  
Subcostal Long with Sweep  
Subcostal Short with Sweep (Bi Caval View)  
Subcostal Aortic Arch  
Subcostal Abdominal Aorta  
Subcostal Situs View  
Suprasternal Notch View- Long  
Suprasternal Notch View- Short  
Left Atrium with Pulmonary Veins with Suprasternal Notch  
Pulmonary Artery Branches  
Ductal View  
Arch Sidedness  
Scanning Complex Anomolies  
Scanning Post-Surgical Repairs  
Simpson’s Rule  
Proximal Isovelocity Surface Area  
Diastology  
Stress Echo  
Continuity Equation  
Rating Stars (Click) EQUIPMENT 1 2 3 4  
Phillips  
Siemens  
Toshiba  
Hitachi  
General Electric  
HP  
Other  
Rating Stars (Click) AGE SPECIFIC EXPERIENCE 1 2 3 4  
Newborn/Neonate (birth to 30 days)  
Infant (1 month to 1 year)  
Toddler (1 year to 3 years)  
Preschooler (3 years to 5 years)  
School Age Child (5 years to 12 years)  
Adolescents (12 years to 18 years)  
Young Adults (18 years to 39 years)  
Middle Adults (39 to 64 years)  
Geriatric Adults (65+ years)