Skill Checklists
Cath Lab Interventional Radiology
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Procedural Cath Lab
lnterventional Cath Lab
EP Lab
Interventional Radiology
Pre/Post Procedural Setting
Charge Experience
Other Setting (List)
Automatic Implantable Cardiac Defibrillator
Cardioversion
Intra Aortic Balloon Pump (IABP)
SV02 Recording
Ventilator Management
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
Electrophysiology Evaluation
Baseline Measurements
Cardiac Ablation
Cardiac Mapping
Conduction Study
Internal Cardioverter Defibrillator Implant
Tilt Table Study
Angioplasty
Chemoembolization
Cholecystostomy
Embolization
ERCP
Esophageal Stent Placement
Gastrojejunostomy
Gastrostomy Tube Placement
Liver Ablation
Pericentesis
Percutaneous Hepatic Angiography
TIPS
Adrenal Angiography
Angiography of Female GU System
Angiography of Male GU System
Cystostomy
Nephrostomy
Percutaneous Stone Extraction
Renal Angiography
Renal Artery Angioplasty
Renal Artery Stent Placement
Ureteral Stent
Cerebral Angiography
Carotid Angiography
Neurologic Angioplasty
Neurologic Thrombolysis
Vertebroplasty
IR-PERIPHERAL VASCULAR STUDIES
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
Chest Tube Placement
Pulmonary Embolization
Thoracentesis
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
Cerner
Eclipsys
Epic
GE
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Medication Administration using Bar Coding Technology
EMR Conversion
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)
BLS
5
CNRN
ACLS
CCRN
Other:
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.
