|
Interventional Radiology RN 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) | GENERAL | 1 | 2 | 3 | 4 | ||
 |
Admit patient to pre-procedure holding | ||||||
|
|
Complete assessments, obtain family history & risk factors | ||||||
|
|
Start peripheral IV | ||||||
|
|
Complete pre-procedure checklist | ||||||
|
|
Transport pre-procedure patient to the Lab. | ||||||
|
|
Transport post-procedure patient to in-hospital units | ||||||
| Rating Stars (Click) | PROCEDURES | 1 | 2 | 3 | 4 | ||
|
|
Cerebral Angiogram – Prepare | ||||||
|
|
Cerebral Angiogram – Assist | ||||||
|
|
Lower Extremity Angiogram – Prepare | ||||||
|
|
Lower Extremity Angiogram – Assist | ||||||
|
|
Upper Extremity Angiogram – Prepare | ||||||
|
|
Upper Extremity Angiogram – Assist | ||||||
|
|
Ultrasound Guided Biopsy – Prepare | ||||||
|
|
Ultrasound Guided Biopsy – Assist | ||||||
|
|
CT Scan Guided Biopsy – Prepare | ||||||
|
|
CT Scan Guided Biopsy – Assist | ||||||
|
|
Liver Biopsy and Embolization – Prepare | ||||||
|
|
Liver Biopsy and Embolization – Assist | ||||||
|
|
Prepare and Assist with Line Placement – Broviac | ||||||
|
|
Prepare and Assist with Line Placement – Groshong | ||||||
|
|
Prepare and Assist with Line Placement – Hickman | ||||||
|
|
Prepare and Assist with Line Placement – PICC | ||||||
|
|
Prepare and Assist with Line Placement – PortaCath | ||||||
|
|
Uterine Fibroid Embolization – Prepare | ||||||
|
|
Uterine Fibroid Embolization – Assist | ||||||
|
|
Temporary Hemodialysis Shunt Placement– Prepare | ||||||
|
|
Temporary Hemodialysis Shunt Placement– Assist | ||||||
|
|
Permanent Hemodialysis Shunt Placement– Prepare | ||||||
|
|
Permanent Hemodialysis Shunt Placement– Assist | ||||||
|
|
AV Fistula/Shunt Declotting – Prepare | ||||||
|
|
AV Fistula/Shunt Declotting – Assist | ||||||
|
|
Vertebroplasty – Prepare | ||||||
|
|
Vertebroplasty – Assist | ||||||
|
|
Lumbar Puncture – Prepare | ||||||
|
|
Lumbar Puncture – Assist | ||||||
|
|
Myelogram – Prepare | ||||||
|
|
Myelogram – Assist | ||||||
|
|
Other Procedures (please list): | ||||||
|
|
Provide care for the post-procedure patient | ||||||
| Rating Stars (Click) | CARDIOVASCULAR | 1 | 2 | 3 | 4 | ||
|
|
Assess heart sounds and peripheral pulses | ||||||
|
|
Interpret arrhythmias | ||||||
|
|
Perform CPR | ||||||
|
|
Perform defibrillation | ||||||
|
|
Participate as a team member in resuscitation | ||||||
| Rating Stars (Click) | PULMONARY | 1 | 2 | 3 | 4 | ||
|
|
Assess lung sounds | ||||||
|
|
Set up oxygen devices | ||||||
|
|
Obtain pulse oximetry reading | ||||||
|
|
Interpret ABG | ||||||
|
|
Use Ambu bag | ||||||
|
|
Assist with intubation | ||||||
|
|
Assist with chest tube insertion | ||||||
|
|
Provide care for the patient with mechanical ventilation | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
|
|
Titrate vasoactive drugs | ||||||
|
|
Calculate mcg/min and mcg/kg/min | ||||||
|
|
Use IV infusion pump to calculate drug doses | ||||||
|
|
Administer IV dopamine | ||||||
|
|
Administer IV nitroglycerine | ||||||
|
|
Administer IV dobutamine (Dobutrex) | ||||||
|
|
Administer IV lidocaine | ||||||
|
|
Administer IV diltiazem (Cardizem) | ||||||
|
|
Administer IV epinephrine | ||||||
|
|
Administer IV atropine | ||||||
|
|
Administer IV heparin | ||||||
|
|
Administer IV benzodiazepines (Valium, Versed, Ativan) | ||||||
|
|
Administer IV propofol (Diprivan) | ||||||
|
|
Administer
IV neuromuscular blocking agents (Pavulon, Norcuron) |
||||||
|
|
Administer IV narcotics (morphine, fentanyl) | ||||||
| Rating Stars (Click) | PAIN/WOUND MANAGEMENT | 1 | 2 | 3 | 4 | ||
|
|
Assess pain level/tolerance | ||||||
|
|
Care of patient with anesthesia/analgesia | ||||||
|
|
Care of patient with IV conscious sedation | ||||||
|
|
Care of patient with narcotic analgesia | ||||||
|
|
Care of patient with patient controlled analgesia (PCA pump) | ||||||
|
|
Assess surgical wound status with/without drain(s) | ||||||
|
|
Care of patient with sterile dressing changes | ||||||
|
|
Care of patient with FemoStop device | ||||||
|
|
Assessment of VasoSeal, AngioSeal, PerClose success | ||||||
| Rating Stars (Click) | AGE SPECIFIC PRACTICE CRITERIA | 1 | 2 | 3 | 4 | ||
|
|
Pediatric (1-18years) | ||||||
|
|
Adolescents (12 - 18 years) | ||||||
|
|
Adult (19 - 65 years) | ||||||
|
|
Older adults (Older than 65years) | ||||||
| Rating Stars (Click) | EXPERIENCE WITH AGE GROUPS | 1 | 2 | 3 | 4 | ||
|
|
Calculate body weight to verify correct dosing of medication | ||||||
|
|
Assess immunization status for pediatric, and adolescent | ||||||
|
|
Set
age-appropriate short-term and long-term goals in care planning |
||||||
|
|
Provide
age-appropriate education, considering possible vision and hearing impairment for Older than 65years |
||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| ACLS | |||||||
| BCLS | |||||||
| Other: Specify | |||||||