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