|
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) | ||||||