Interventional Radiology Technician Skills Checklist

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Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

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GENERAL SKILLS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Advanced directives	123
Supervisory or Charge experience	123
National Patient Safety Goals/Core Measures	123
Awareness of HCAHPS	123
Accurate Patient Identification	123
Maintain Sterile Field	123
Use proper body mechanics	123
Use of transfer/lifting Devices	123
Infection Control	123
Universal Precautions	123
Isolation Precautions	123
Minimize fall risks	123
Crash Cart	123
Defibrillator	123
Care of patient in Restraints	123
Obtain Vital Signs	123
Patient/Family education	123
Ensures HIPAA compliance	123

SKILLS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Allen Test	123
BP non-invasive/ invasive	123
Doppler	123
Lead Placement EKG	123
Hemodynamic monitoring	123
Intubation (Assist with)	123
Interpretation of coagulation status	123
Recording cases/ documentation	123
Radial, brachial, femoral, pedal pulse checks	123
Recognition and management of hematoma	123
Set up Oxygen Devices	123
Suction	123
Waveform assessment	123

DIAGNOSTIC AND INTERVENTIONAL PROCEDURES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Angioplasty/ Stent	123
Aortogram	123
AV/ Fistulas	123
Brachial Arteriogram	123
Carotid Arteriogram	123
Cerebral Angiography	123
Cerebral Coiling	123
Endografts	123
Embolic Protection Devices	123
Femoral Arteriogram	123
Gelfoam	123
Panning Table	123
Pulmonary Arteriogram	123
PVA	123
Moving Image Intensifier	123
Renal Arteriogram	123
Scrub Diagnostic Procedures	123
Scrub Interventional Procedures	123
Selective Radiographs	123
Specimen Radiographs	123
TIPPS Procedure	123
Thrombolysis	123
Thrombectomy	123
Venogram	123

EQUIPMENT/SUPPLY MANAGEMENT:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Manage and troubleshoot equipment	123
ACT Machine	123
AngioSeal	123
Femostop/ C-clamp	123
Hemochron	123
PerCLose	123
Power Injectors	123
VasoSeal	123

PACEMAKERS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Temporary Epicardial Transthoracic Pacing	123
Temporary External Transvenous Pacing	123
Permanent Pacemaker/ACID	123

CARE PROVIDED IN EMERGENCY PROCEDURES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Anaphylaxis	123
Cardiac Arrest	123
Cardiogenic Shock	123
Emergency Defibrillation/Cardioversion	123
Embolism	123
Pneumothorax	123
Vasovagal Response	123

DOCUMENTATION:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Allscripts	123
Cerner	123
Epic	123
McKesson	123
Meditech	123

CERTIFICATIONS/LICENSURE/REGISTRATIONS:

Rank each of the following sections on a scale of 1(Yes) or 2(No):
1) Yes
2) No *

BLS	12
ACLS	12
PALS	12
ARRT	12

AGE-SPECIFIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Newborn / neonate (birth-30 days)	123
Infant (31 days-1 year)	123
Toddler (ages 2-3 years)	123
Preschool (ages 4-5 years)	123
School age (ages 6-12 years)	123
Adolescent (ages 13-21 years)	123
Young adult (ages 22-39 years)	123
Adult (ages 40-64 years)	123
Older adult (ages 65-79 years)	123
Elderly (ages 80+ years)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *