Cath Lab Skills Checklist Form

This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with Pace Medical Staffing, Inc.

PROFICIENCY SCALE

1. No Experience
2. Need Training
3. Able to perform with supervision
4. Able to perform independently

Assessment of:

Abnormal heart sounds / murmurs

1

2

3

4

Auscultation (rate, rhythm, volume)

1

2

3

4

Blood pressure / non-invasive

1

2

3

4

Doppler

1

2

3

4

Pulses / circulation checks

1

2

3

4

Lab results of cardiac enzymes & isoenzymes

1

2

3

4

Lab results of coagulation studies

1

2

3

4

EKG Interpretation

1

2

3

4

Lab results of coagulation studies

1

2

3

4

EKG Interpretation

1

2

3

4

Equipment and Procedures:

Arterial line insertion

1

2

3

4

Central line insertion

1

2

3

4

Open chest emergency

1

2

3

4

PA catheter I Swan Ganz insertion

1

2

3

4

Pericardocentesis

1

2

3

4

Transesophageal echocardiogram

1

2

3

4

Auto internal cardioverter defibrillator

1

2

3

4

Controlled caridioversion

1

2

3

4

CAVH-D

1

2

3

4

Emergency defibrillation

1

2

3

4

IABP (intra-aortic balloon pump)

1

2

3

4

Monitoring / telemetry:

Basic 12 lead EKD interpretation

1

2

3

4

Arrhythmia interpretation

1

2

3

4

Lead placement: 5 electrode tele

1

2

3

4

Lead placement: I, Ill, V-leads

1

2

3

4

Lead placement: Lead II and MCL

1

2

3

4

Set up and rerun 12 lead EKG

1

2

3

4

Rhythm strip assessment

1

2

3

4

Hemodynamic Monitoring:

A-line / radial

1

2

3

4

Cardiac index

1

2

3

4

Cardiac output

1

2

3

4

CVP monitoring

1

2

3

4

Femoral artery sheath removal

1

2

3

4

MAP

1

2

3

4

PA / Swan-Ganz

1

2

3

4

PCW pressure

1

2

3

4

PVR

1

2

3

4

SVO2

1

2

3

4

SVR

1

2

3

4

Pacemaker:

Permanent

1

2

3

4

Temporary epicardial / transthoracic

1

2

3

4

Temporary external pacing

1

2

3

4

Temporary transvenous

1

2

3

4

Temporary external pacing

1

2

3

4

Ventricular assist device (RVAD / LVAD)

1

2

3

4

Pain management:

Pain level assessment

1

2

3

4

Epidural anesthesia / analgesia

1

2

3

4

Narcotic analgesia

1

2

3

4

Patient controlled analgesia (PCA) pump

1

2

3

4

Oncology diseases

1

2

3

4

Drug addiction / withdrawals

1

2

3

4

Care of patients with:

Abdominal aortic aneurysm repair

1

2

3

4

Abdominal aortic bypass

1

2

3

4

Acute Ml

1

2

3

4

Aneurysm

1

2

3

4

Angina

1

2

3

4

Cardiac arrest

1

2

3

4

Cardiac tamponade

1

2

3

4

Cardiomypathy

1

2

3

4

Carotid endarteretomy

1

2

3

4

Congestive heart failure (CHF)

1

2

3

4

EP study & ablation

1

2

3

4

Femoral-popliteal bypass

1

2

3

4

Heart transplant

1

2

3

4

Immediate post open-heart surgery

1

2

3

4

Infective endocarditis

1

2

3

4

Myocardial contusion

1

2

3

4

Pericarditis

1

2

3

4

Post acute MI (24 - 48 hours)

1

2

3

4

Post AICD insertion

1

2

3

4

Post arthrectomy (DCA)

1

2

3

4

Post CABG (24 hours)

1

2

3

4

Post intracoronary stent replacement

1

2

3

4

Post percutaneous balloon valvuoplasty

1

2

3

4

Post rotoblade

1

2

3

4

Post valve repair / replacement

1

2

3

4

Pre/post angioplasty

1

2

3

4

Pre/post cardiac cath

1

2

3

4

Administration of:

Amiodarone (Cordarone)

1

2

3

4

Atropine

1

2

3

4

Bicarbonate

1

2

3

4

Bretylium (Bretylol)

1

2

3

4

Cardizem (Diltiasem hydrochloride)

1

2

3

4

Digoxin (Lanoxin)

1

2

3

4

Dobutamine (Dobutrex)

1

2

3

4

Dopamine (Intropin)

1

2

3

4

Epinephnne (Adrenalin)

1

2

3

4

Esmolol (Brevibloc)

1

2

3

4

Heparin

1

2

3

4

Inocor Amrinone

1

2

3

4

Lidocaine (Xylocaine)

1

2

3

4

Metoprolol (Lopressor)

1

2

3

4

Nipride (Nitroprusside)

1

2

3

4

Nitroglycerine (Tndit)

1

2

3

4

Oral anticoagulants

1

2

3

4

Oral & IVP antihypertensives

1

2

3

4

Oral & topical nitrates

1

2

3

4

Procainamide (Pronestyl)

1

2

3

4

Reteplase recominant (Retavase)

1

2

3

4

Strepokinase

1

2

3

4

TPA (Alteplase)

1

2

3

4

Verapamil (Galan, Isoptin, Verelan)

1

2

3

4

Versed

1

2

3

4

Able to ensure a safe and caring environment for the specific age groups indicated below; able to communicate and instruct patients from various age groups: able to evaluate age-appropriate behavior and skills.

Newborn (birth-30 days)

1

2

3

4

Infant (30 days-I yrs)

1

2

3

4

Toddler (1-3 yrs)

1

2

3

4

Preschooler (3-5 yrs)

1

2

3

4

School Age (5-12 yrs)

1

2

3

4

Adolescents (12-18 yrs)

1

2

3

4

Young Adults (18-39 yrs)

1

2

3

4

Middle Adults (39-64 yrs)

1

2

3

4

Older Adults (64 yrs +)

1

2

3

4

The information represented above is true and correct to the best of my knowledge. I also authorize Pace Medical Staffing, Inc. to share the above skills checklist with its hospital clients.

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