Interventional Radiology RN Skills Checklist
   LAST 4 OF SSN      
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,
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
Provide age-appropriate education, considering possible
vision and hearing impairment for Older than 65years
CERTIFICATIONS     Expiry Date :   
Other: Specify