Interventional Radiology CheckList

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

GENERAL Rating Stars (Click) 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 
PROCEDURES Rating Stars (Click) 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 
CARDIOVASCULAR Rating Stars (Click) 1 2 3 4  
Assess heart sounds and peripheral pulses 
Interpret arrhythmias 
Perform CPR 
Perform defibrillation 
Participate as a team member in resuscitation 
PULMONARY Rating Stars (Click) 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 
MEDICATIONS Rating Stars (Click) 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) 
PAIN/WOUND MANAGEMENT Rating Stars (Click) 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 
AGE SPECIFIC PRACTICE CRITERIA Rating Stars (Click) 1 2 3 4  
Pediatric (1-18years) 
Adolescents (12 - 18 years) 
Adult (19 - 65 years) 
Older adults (Older than 65years)  
EXPERIENCE WITH AGE GROUPS Rating Stars (Click) 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