Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
    		•
    AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young AdultsMiddle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    GENERAL SKILLS
    Care of Patient in Restraints
    Lifting/Transferring Devices
    Access: Radial
    Access: Brachial
    Access: Femoral
    Access: Internal Jugular
    Automated Med Dispensing Systems
    Other Automated Med Dispensing Systems:
    Electronic Documentation
    Other Electronic Documentation:
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    PRE-PROCEDURE
    Allen Test
    Doppler
    EKG lead/pad placement
    Blood Pressure Invasive and NonInvasive
    HEMODYNAMIC MONITORING
    Hemodynamic monitoring of PAP,PCW,CVP,SVR,PVR
    Hemodynamic monitoring of CO2, CO, CI
    Monitoring/Recording cases
    Waveform Assessment
    Knowledge of arterial pressure monitoring and damped waveforms
    Knowledge of ejection fraction calculation
    Knowledge of pullback and gradient recognition
    CARDIOVASCULAR
    Hematoma Recognition/Management
    Radial, brachial, femoral, pedal pulse checks
    General labwork/cardiac enzyme interpretation
    ABG Interpretation
    Coagulation Interpretation
    Cardiac Congenital Diseases
    PULMONARY
    Set up Oxygen Delivery Devices(Cannula, NRBM, Ambu)
    Assist with Intubation
    Suction equipment (oral,NP, In line)
    End-Tidal Carbon Dioxide
    Interpreting ETCO2 Wave Form
    Attaching Nasal Canula
    PROCEDURES DIAGNOSTIC AND INTERVENTIONAL
    Panning Table
    Moving Image Intensifier, Knowledge of views( RAO, LAO, cranial, caudal)
    Scrub Diagnostic Procedures
    Scrub Interventional Procedures
    Cardiac Catheterization - Adult (R/L)
    Cardiac Catheterization - Pediatric (R/L)
    Shunt Detection and Calculation
    Angioplasty/PCI/Stent
    Ventricular Assistive Devices
    Coronary Atherectomy
    Pericardiocentesis
    Transluminal Extraction Catheter
    PercuSurge Procedure
    Thrombolysis/Thrombectomy
    AngioJet
    Cardiac Biopsy
    Pericardial Tap
    Valvuloplasty
    Intra Aortic Balloon Pump (IABP) insertion and set up
    Continuous Arteriovenous Hemofiltration (CAVH)
    Cardioversion
    Brachytherapy
    FFR (radiwire)
    IVUS/Volcano
    Embolic Protection Devices
    TR Band
    Rotoblader
    Laser
    Shockwave
    IFR
    Impella
    EP: Study
    EP: A Fib Ablations
    EP: A Flutter Ablation
    EP: SVT Ablation
    EP: VT Ablation
    Closure Devices: Mynx
    Closure Devices: Starclose
    Implant: Loop Recorder
    Implant: CardioMEMS
    Tilt Table Test
    Watchman
    PFO Closure
    TEE
    Laser Lead Extractions
    Sterile Technique
    PACEMAKERS
    Permanent Pacemaker/AICD
    Temporary Epicardial/Transthoracic Pacing
    Temporary External /transvenous pacing
    Biventricular Pacemaker/AICD
    CARE OF PATIENT DURING EMERGENCY PROCEDURES
    Emergency Defibrillation/ Cardioversion
    IABP Insertion
    Anaphylaxis
    Vasovagal Response
    Pneumothorax
    Cardiogenic Shock
    Embolism
    Myocardial Infarction
    EQUIPMENT/SUPPLIES
    ACT Machine
    Hemochron
    Power Injectors
    Manual Pressure Hold
    Femostop/ C-Clamp
    VasoSeal, Angioseal, PerClose
    Medication
    Understanding and handling Angiomax
    Understanding and handling Heparin
    Understanding and handling Nitroglycerin
    Understanding and handling Contrast (Isivue)
    Communication
    Closed Loop Communication
    Clarifying Orders
    Leading Time-outs
    Problem-solving
    Critical Thinking
    Team Player