Cath Lab / Interventional Radiology Nursing Skills Checklist
  Cath Lab / Interventional Radiology Nursing Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided 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) WORK SETTING 1 2 3 4  
Procedural Cath Lab  
lnterventional Cath Lab  
EP Lab  
Interventional Radiology  
Pre/Post Procedural Setting  
Charge Experience  
Other Setting (List)  
Rating Stars (Click) EQUIPMENT 1 2 3 4  
Automatic Implantable Cardiac Defibrillator  
Cardioversion  
Cardioversion  
Intra Aortic Balloon Pump (IABP)  
SV02 Recording  
Ventilator Management  
Rating Stars (Click) CARDIAC CATH LAB PROCEDURES 1 2 3 4  
AICD Placement  
Aortography  
Cardiac Biopsy  
Cardiac Implant Closure Device  
Cardiac Stent Placement  
Diagnostic Cardiac Catheterization Adult  
Diagnostic Cardiac Catheterization-Pediatric/Neonatal  
Directional Coronary Atherectomy  
IABP Placement/Removal  
Internal Mammary Angiography  
Laser Assisted Procedures  
Percutaneous Transluminal Coronary Angioplasty  
Pericardiocentesis  
Permanent Pacemaker Placement  
Pulmonary Angiography  
Rotational Coronary Atherectomy  
Saphenous Vein Graft Angiography  
Transluminal Extraction Catheter  
Valvuloplasty  
Ventricular Assist Device Insertion    
Rating Stars (Click) ELECTROPHYSIOLOGY PROCEDURES 1 2 3 4  
Electrophysiology Evaluation  
Baseline Measurements  
Cardiac Ablation  
Cardiac Mapping  
Cardioversion  
Conduction Study  
Internal Cardioverter Defibrillator Implant  
Tilt Table Study  
Rating Stars (Click) IR-GASTROINTESTINAL STUDIES 1 2 3 4  
Angioplasty  
Chemoembolization  
Cholecystostomy  
Embolization  
ERCP  
Esophageal Stent Placement  
Gastrojejunostomy  
Gastrostomy Tube Placement  
Liver Ablation  
Pericentesis  
Percutaneous Hepatic Angiography  
TIPS  
Rating Stars (Click) IR-GENITOURINARY STUDIES 1 2 3 4  
Adrenal Angiography  
Angiography of Female GU System  
Angiography of Male GU System  
Cystostomy  
Embolization  
Nephrostomy  
Percutaneous Stone Extraction  
Renal Angiography  
Renal Artery Angioplasty  
Renal Artery Stent Placement  
Ureteral Stent  
Rating Stars (Click) IR-NEUROLOGIC STUDIES          
Cerebral Angiography  
Carotid Angiography  
Neurologic Angioplasty  
Neurologic Thrombolysis  
Vertebroplasty  
Rating Stars (Click) IR-PERIPHERAL VASCULAR STUDIES          
IR-PERIPHERAL VASCULAR STUDIES  
Angioplasty  
Central Venous Access/Port Placement  
Dialysis Graft Creation/Revision  
Dialysis Graft lnterventional  
Peripheral Vascular Embolization  
Stent Graft Placement  
SVC/IVC Venograph  
Thoracic Aortography  
Upper and Lower Extremity Angiography  
Rating Stars (Click) IR-PULMONARY PROCEDURES          
Chest Tube Placement  
Pulmonary Embolization  
Pulmonary Angiography  
Thoracentesis  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS          
Conscious/Procedural Sedation  
Assist w/Central Line/Venous Line Insertion  
Venous Sampling  
Topical Hemostasis (D-Stat, Chito-Seal, Syvek Patch, etc.)  
Vascular Closure Systems (Perclose, StarClose, etc.)  
External Compression Devices (C-Clamp, Sandbags,etc.)  
Physiologic Monitoring/Recording  
Sheath Removal and Monitoring  
National Patient Safety Goals/Core Measures  
Universal Protocol Procedures  
Isolation Precautions  
Infection Prevention  
Age Specific/Population-Based Care  
Fall Risk Assessment/Prevention  
Rating Stars (Click) EMR          
Cerner  
Eclipsys  
Epic  
GE  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Medication Administration using Bar Coding Technology  
  EMR Conversion
   
CERTIFICATIONS     Expiry Date :  
BLS
 
ACLS
 
PALS
 
CCRN
 
Telemetry Certificate
 
Arrhythmia Course
 
  Other: Specify
 
Rating Stars (Click) Age Specific Competencies          
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)