Cath Lab 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.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  WORK SETTING         Rating Stars (Click) 1 2 3 4
  Procedural Cath Lab  
  lnterventional Cath Lab  
  EP Lab  
  Interventional Radiology  
  Pre/Post Procedural Setting  
  Charge Experience  
  Other Setting (List)  
  EQUIPMENT         Rating Stars (Click) 1 2 3 4
  Automatic Implantable Cardiac Defibrillator  
  Cardioversion  
  Cardioversion  
  Intra Aortic Balloon Pump (IABP)  
  SV02 Recording  
  Ventilator Management  
  CARDIAC CATH LAB PROCEDURES         Rating Stars (Click) 1 2 3 4
  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 PROCEDURES         Rating Stars (Click) 1 2 3 4
  Electrophysiology Evaluation  
  Baseline Measurements  
  Cardiac Ablation  
  Cardiac Mapping  
  Cardioversion  
  Conduction Study  
  Internal Cardioverter Defibrillator Implant  
  Tilt Table Study  
  IR-GASTROINTESTINAL STUDIES         Rating Stars (Click) 1 2 3 4
  Angioplasty  
  Chemoembolization  
  Cholecystostomy  
  Embolization  
  ERCP  
  Esophageal Stent Placement  
  Gastrojejunostomy  
  Gastrostomy Tube Placement  
  Liver Ablation  
  Pericentesis  
  Percutaneous Hepatic Angiography  
  TIPS  
  IR-GENITOURINARY STUDIES         Rating Stars (Click) 1 2 3 4
  Adrenal Angiography  
  Angiography of Female GU System  
  Angiography of Male GU System  
  Cystostomy  
  Embolization  
  Nephrostomy  
  Percutaneous Stone Extraction  
  Renal Angiography  
  Renal Artery Angioplasty  
  Renal Artery Stent Placement  
  Ureteral Stent  
  IR-NEUROLOGIC STUDIES         Rating Stars (Click) 1 2 3 4
  Cerebral Angiography  
  Carotid Angiography  
  Neurologic Angioplasty  
  Neurologic Thrombolysis  
  Vertebroplasty  
  IR-PERIPHERAL VASCULAR STUDIES         Rating Stars (Click) 1 2 3 4
  Angioplasty  
  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  
  IR-PULMONARY PROCEDURES         Rating Stars (Click) 1 2 3 4
  Chest Tube Placement  
  Pulmonary Embolization  
  Pulmonary Angiography  
  Thoracentesis  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  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.)  
  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  
  EMR         Rating Stars (Click) 1 2 3 4
  Cerner  
  Eclipsys  
  Epic  
  GE  
  McKesson  
  Meditech  
  Other Computerized System  
  Computerized Physician Order Entry  
  Medication Administration using Bar Coding Technology  
  EMR Conversion  
  EMR Conversion  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  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)