Cardiac Interventional Technologist Skills Checklist

Requested by:

Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

Confirm email: *

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 *

HIPAA Regulations	123
National Patient Safety Goals	123
Awareness of HCAHPS scores	123
Electronic Medical Record	123
Accurate Patient Identification	123
Demonstrates knowledge of anatomy	123
Proper body mechanics	123
Technique to preserve respect and dignity for patients	123
Introduction of self prior to providing care	123
Therapeutic communications	123
Supervisor/Lead experience	123
Chest compressions	123
Rescue breathing	123

PATIENT CARE:

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 *

Vital signs (HR, BP, Resp, Temp)	123
Oxygen saturation (pulse ox)	123
Weight	123
Manual BP (cuff and stethoscope)	123
Auscultation (heart sounds, apical pulse)	123
Palpation for pulse	123
Carotid pulse	123
Brachial pulse	123
Radial pulse	123
Femoral pulse	123
Skin prep (shaving, alcohol prep, diaphoretic patients, etc)	123
Patient positioning for procedures/tests	123

CARDIOVASCULAR:

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 *

Coronary circulation	123
Vascular system	123
Congestive Heart Failure	123
Ischemia	123
Pulmonary hypertension	123
Systemic hypertension	123
Diseases of aorta	123

CARDIOVASCULAR ELECTROPHYSIOLOGY:

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 *

Cardiac cycle	123
Electoral conduction system	123
Refractory	123
Transmembrane potential	123
Polarization	123
Depolarization	123
Repolarization	123
Action potential	123
Phase 0 – phase 4	123

ELECTROCARDIOGRAM:

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 *

Application of leads	123
Interpretation	123
Monitoring	123
Arrhythmias	123
P, Q, R, S, and T waves	123
Baseline values	123
Voltage	123
Axis / hexaxial system	123
Intervals	123
Segments	123
Complexes	123
Normal and abnormal ST segment	123
Recognition of recording error / artifacts	123
Incorrect standardization	123
Incorrect paper speed	123
Lead reversals	123
Incorrect lead placement	123
Electrical interference	123
Somatic tremor	123
Wandering baseline	123

EKG INTERPRETATION:

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 *

Ventricular tachycardia	123
Ventricular fibrillation	123
Atrial tachycardia	123
Atrial fibrillation	123
Atrial flutter	123
Junctional escape rhythms	123
Asystole	123
PEA (pulseless electrical activity)	123
Normal sinus rhythm	123
Sinus tachycardia	123
Sinus bradycardia	123
Acute myocardial infarction patterns	123
Cardiac pacemakers	123
Wolff-parkinson-white	123
First degree heart block	123
Second degree heart block	123
Second degree heart block Type 1	123
Second degree heart block Type 2	123
Third degree heart block	123

EKG, HOLTER, STRESS TESTING INSTRUMENTATION, & CARDIAC EQUIPMENT:

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 *

EKG calibration methods	123
Single channel	123
Three channel	123
Stress test techniques and contraindications	123
Protocols	123
Bruce	123
Modified Bruce	123
Naught on	123
Prep techniques	123
Test interpretation	123
Calculation	123
Double product	123
Bicycle procedure	123
Ergometers	123
Arms	123
Legs	123
Treadmill	123
Preparation techniques	123
Lead placement	123
Interpretation	123
Recognition of artifact	123
Temporary Pacemakers	123
Permanent Pacemakers	123
Defibrillators	123
Event Monitor	123
Holter Monitor	123
Image archiving and optimization	123

ECHOCARDIOGRAPHY:

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 *

Cardiac doppler	123
Pedof transducers	123
Portable studies	123
Stress testing	123
Transesophageal Echocardiography (TEE)	123
2-D and M Mode	123
Pulsed doppler	123
Treadmill exercise testing	123
Carotid	123
Transcerebral doppler	123
Portal system/ shunt evaluation	123
Abdominal vasculature	123

ELECTRONIC 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
Care360	123
Cerner	123
CPSI	123
eClinicalWorks	123
Eclipsys	123
EPIC	123
MACLAB	123
McKesson/Paragan	123
Meditech	123
PACS	123
Quadramed	123
Soarian	123

CARDIAC MEDICATIONS:

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 *

Antihypertensives	123
Nitrates	123
Calcium channel blockers	123
Beta-blockers	123
Cardiac glycosides	123
Antiarrhythmics	123
Emergency medications	123
Epinephrine	123
Atropine	123
Verapamil	123
Lidocaine	123
Oxygen	123
Isuprel	123

INFECTION CONTROL:

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 *

Hand hygiene	123
Precautions associated with PPE (transmission, contact, airborne, droplet)	123
Universal Precautions	123
Negative-pressure room	123
Prevention and protocols for HAIs (CAUTI, CLABSI, VAP)	123
Prevention and protocols for MRSA, C.DIFF, Sepsis, etc.	123

IR PROCEDURES - PREPARE:

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 *

Cerebral Angiogram	123
Lower Extremity Angiogram	123
Upper Extremity Angiogram	123
Ultrasound Guided Biopsy	123
CT Scan Guided Biopsy	123
Liver Biopsy & Embolization	123
Line Placement - Broviac	123
Line Placement - Groshong	123
Line Placement - Hickman	123
Line Placement - PICC	123
Line Placement - PortaCath	123
Uterine Fibroid Embolization	123
Temp Hemodialysis Shunt Placement	123
Perm Hemodialysis Shunt Placement	123
AV Fistula/Shunt Declotting	123
Vertebroplasty	123
Lumbar Puncture	123
Myelogram	123

IR PROCEDURES - ASSIST:

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 *

Cerebral Angiogram	123
Lower Extremity Angiogram	123
Upper Extremity Angiogram	123
Ultrasound Guided Biopsy	123
CT Scan Guided Biopsy	123
Liver Biopsy & Embolization	123
Line Placement - Broviac	123
Line Placement - Groshong	123
Line Placement - Hickman	123
Line Placement - PICC	123
Line Placement - PortaCath	123
Uterine Fibroid Embolization	123
Temp Hemodialysis Shunt Placement	123
Perm Hemodialysis Shunt Placement	123
AV Fistula/Shunt Declotting	123
Vertebroplasty	123
Lumbar Puncture	123
Myelogram	123

WORK SETTING 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 *

Acute care hospital	123
Outpatient clinic	123
Long term care	123
Rehabilitation center	123
Home health/private duty	123
Hospice	123

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 *

Infant (birth to 1 year)	123
Toddler (1-3 years)	123
Preschooler (4-5 years)	123
Childhood (6-12 years)	123
Adolescent (13-17 years)	123
Young Adult (18-30 years)	123
Adults (31-64 years)	123
Older Adults (65-79 years)	123
Elderly (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. *