Interventional Radiology Technologist Skills Checklist

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EXPERIENCES WITH AGES

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Newborn/Neonate (birth to 30 days)	1234
Infant (31 days to 12 months)	1234
Toddler/Preschool (13 months to 5 years)	1234
School Age Child/Adolescent (6 years to 18 years)	1234
Young Adults/Middle Adult (19 years to 64 years)	1234
Older Adults/Elderly (65+ years)	1234

GENERAL SKILLS

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Care of Patients in Restraints	1234
Lifting/Transferring Devices	1234
Knowledge of "Do Not Use Abbreviations"	1234
Charge/Supervisor Experience	1234
Knowledge of current Joint Commission National Patient Safety Goals	1234
Knowledge/familiarity with HCAHPS scores	1234

AUTOMATED MED DISPENSING SYSTEMS

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Accudose	1234
Metro	1234
Omnicell	1234
Promanager Rx	1234
Pyxis	1234

ELECTRONIC DOCUMENTATION

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Allscripts	1234
Care360	1234
Cerner	1234
eClinicalWorks	1234
EPIC	1234
MACLAB	1234
McKesson	1234
Meditech	1234
PACS	1234
Soarian	1234

IV PUMPS

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Alaris	1234
Alibaba	1234
Bard	1234
Baxter	1234
Braun	1234
CADD	1234
IVAC	1234
Zynomed	1234

PRE-PROCEDURE

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Allen Test	1234
Doppler	1234
EKG lead/pad placement	1234
Blood Pressure Invasive and Noninvasive	1234

HEMODYNAMIC MONITORING

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Monitoring/Recording cases	1234
Waveform Assessment	1234
Coagulation Interpretation	1234

CARDIOVASCULAR

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Hematoma Recognition/Management	1234
Radial, brachial, femoral, pedal pulse checks	1234

PULMONARY

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Set up Oxygen Delivery Devices (Cannula, NRBM, Ambu)	1234
Assist with Intubation	1234
Suction equipment (oral, NP, In line)	1234

PROCEDURES DIAGNOSTIC AND INTERVENTIONAL

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Panning Table	1234
Moving Image Intensifier, Knowledge of views (RAO, LAO, cranial, caudal)	1234
Scrub Diagnostic Procedures	1234
Scrub Interventional Procedures	1234
Specimen Radiographs	1234
Selective Radiographs	1234
TIPPS Procedure	1234
Angioplasty/Stent	1234
Thrombolysis/Thrombectomy	1234
Embolic Protection Devices	1234
Cerebral Coiling	1234
PVA	1234
Gelfoam	1234
Cerebral Angiography	1234
Carotid Arteriogram	1234
Brachial Arteriogram	1234
Aortogram	1234
Femoral Arteriogram	1234
Renal Arteriogram	1234
Pulmonary Arteriogram	1234
Venogram	1234
Endografts	1234
AV Fistulas	1234

PACEMAKERS

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Permanent Pacemaker/AICD	1234
Temporary Epicardial/Transthoracic Pacing	1234
Temporary External/transvenous pacing	1234

CARE OF PATIENT DURING EMERGENCY PROCEDURES

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

Emergency Defibrillation/Cardioversion	1234
Anaphylaxis	1234
Vasovagal Response	1234
Pneumothorax	1234
Cardiogenic Shock	1234
Embolism	1234
Cardiac/Respiratory arrest	1234

EQUIPMENT/SUPPLIES

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

*

ACT Machine	1234
Hemochron	1234
Power Injectors	1234
Manual Pressure Hold	1234
Femostop/C-Clamp	1234
VasoSeal, Angioseal, PerClose	1234

Attestation

ATTESTATION: *

I certify that the information provided 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. *