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.
| WORK SETTING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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) |
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| EQUIPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| CARDIAC CATH LAB PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| ELECTROPHYSIOLOGY PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IR-GASTROINTESTINAL STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IR-GENITOURINARY STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IR-NEUROLOGIC STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IR-PERIPHERAL VASCULAR STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IR-PULMONARY PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Chest Tube Placement |
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| Pulmonary Embolization |
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| Pulmonary Angiography |
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| Thoracentesis |
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| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| EMR Conversion | |||||||
| EMR Conversion |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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) |
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