Cath Lab Tech Checklist

NAME

LAST 4 OF SSN

Date of application

E-MAIL

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.

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.

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

AGE OF PATIENTS CARED FOR *	Rating Stars (Click)	1	2	3	4
Peds
Adults
CIRCULATING ROLE (PAV) *	Rating Stars (Click)	1	2	3	4
Airway Maintenance
Arm Cases
Biopsy
Co-Ox Setup Q.C.
Run Sample
Defibrillator Setup/Use
Defibrillator Setup/Use
IABP
Power Injector Setup/Use
Left Heart Catheterization
Right Heart Catheterization
PTCA/ Stents/ Balloons
Radiation Protection
Atherectomy
Permanent Pacemaker
Temporary Pacemaker
HEMODYNAMIC MONITORING *	Rating Stars (Click)	1	2	3	4
Biopsy
Handoff Reports
Left Heart Caths
Right Heart Caths
Coronary Intervention
Hematoma Recognition & Mgt
Coronary Atherectomy
IVUS
Intra Aortic Balloon Pump
EP Study
CATH LAB/ ANGIO/ SPECIALS: EQUIPMENT *	Rating Stars (Click)	1	2	3	4
Phillips
Siemens
Toshiba
GE
Siemens Artis Zeego
Shimadzu
Cannon Alphenix
Electronic Documentation
HEMODYNAMIC MONITORING EQUIP. *	Rating Stars (Click)	1	2	3	4
GE MacLab Marquette
Mennen
Merge Cardio/ Camtronics VERICIS
McKesson
Philips Xper IM/ WITT
Siemens Sensis