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CARDIAC CATH LAB
TECHNICIAN SKILLS CHECKLIST
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NAME
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LAST 4 OF SSN
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DATE
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I hereby certify that
ALL information I have provided to IMCS Group on this skills checklist and
all other documentation, is true and accurate. I understand and acknowledge
that any misrepresentation or omission may result in disqualification from
employment and/or immediate termination.
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Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
below to describe your experience/expertise in each area listed below.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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CIRCULATING ROLE (PAV)
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1
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2
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3
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4
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Air Way Maintenance
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Arm Cases
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Biopsy
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Co-Ox Setup Q.C., Run
SamplE
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DCA’s
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Defibrillator Setup/Use
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IABP
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Left hearT
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RA Pressure Waveform
Recognition
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PA Pressure Waveform
Recognition
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LVEDP
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Ejection Fraction
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Power Injector Setup/Use
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PTCA’s
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Psycho/Social
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Patient/Family
Teaching
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Patient/Fam Teach Pre/Post
Proced
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Rating Stars
(Click)
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CIRCULATING ROLE
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1
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2
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3
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4
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Left Heart
Catheterization
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Right Heart Catheterization
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Left & Right Heart
Catheterization
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PTCA
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Stent Implantation
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Ventricular Pacers
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Push Drugs ordered by MD
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Radiation Protection
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Directional Coronary
Atherectomy
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Permanent Pacemaker
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Temporary Pacemaker
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Setting Threshold of
Pacemakers
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Rotoblator
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Sphygmomanometer Monitoring
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Stents
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Transducer
Setup/Calibration
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Run Co-Ox Machine
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Run Angio Jet Machine
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IVUS
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Rating Stars
(Click)
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RECORDING POSITION
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1
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2
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3
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4
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Biopsy
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Call in Reports
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DCA’s
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PTCA’s
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Left Heart Caths
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Right Heart Caths
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Stents
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Hematoma Recognition &
Mgt
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Rotational Coronary
Atherectomy
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IVUS
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Intra Aortic Balloon Pump
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Directional Coronary
Atherectomy
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EP Study
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Ablation
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Cardioversion
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Rotoblator
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Rating Stars
(Click)
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SCRUB POSITION (PSC)
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1
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2
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3
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4
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Left Heart Catheterization
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Right Heart Catheterization
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Left & Right Heart
Catheterization
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PTCA
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Stent Implantation
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Rotational Coronary
Atherectomy
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IVUS
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Intra Aortic Balloon Pump
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Biopsy
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Closure Device (Per close,
Angio Seal)
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DCA’s
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Temporary Pacemakers
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Angio Jet
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Arm Cases
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Exchange Sheaths
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Directional Coronary
Atherectomy
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Rating Stars
(Click)
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EQUIPMENT - CATH LAB/
ANGIO/ SPECIALS
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1
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2
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3
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4
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GE Advantx LC Mobile
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GE LUA Mobile
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GE LUA/C MobileGE LUA/EDEC
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Philips Integris H3000
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Philips Integris Mobile
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Philips Integris V3000
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Philips MD-3
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Philips Poly A Combo Mobile
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Philips Poly A Mobile
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Philips Poly C Mobile
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Philips Poly C2
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Philips Poly C-2 Mobile
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Philips Poly C-2 Modular
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Siemens ACOM M/B
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Siemens Angioskop D
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Siemens Angioskop D-2
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Siemens Angiostar
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Siemens Axiom Artis BC
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Siemens Axiom Artis FC
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Siemens Cathcor
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Siemens Coroskop C
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Siemens Hicor 1.0/2.0
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Siemens Hicor 1.0/2.0
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Siemens Infinity SC 8000
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Siemens Infinity SC 9000XL
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Siemens PolyStar
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Siemens Powermobil
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Toshiba Angiorex Modular
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Toshiba Infinix VC-
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Toshiba KXO-200A
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Toshiba KXO-80-CD Mobile
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Toshiba Super G
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Other:
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Rating Stars
(Click)
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RADIOLOGY/ FLUOROSCOPY
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1
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2
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3
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4
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GE Prestige
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GE Prestilix 1690
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GE RFX
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GE SFX-II
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Litho Gall Bladder
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Litho Kidney
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Philips Diagnost 92
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Picker Clinix R/F
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Picker Vector 100
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Siemens Pantoskop 5 ML
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Siemens Sireskop 30
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Siemens Sireskop 4
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Siemens Sireskop SX
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Toshiba EPS- Plus
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Toshiba KXO- 850
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Toshiba Tosrad
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Toshiba Ultimax
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Atak R/F Ablation IABP
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Daylight System
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Digatech
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GE Advantx
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GE Advantx 80 LFX
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Rating Stars
(Click)
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HEMODYNAMIC MONITORING
EQUIP
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1
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2
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3
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4
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Hewlett Packard
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Lifecare
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Marquette
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Mennen
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Nihon Koder
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Philips
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Siemens
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Spacelab
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Witt
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Other:
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Rating Stars
(Click)
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EMR
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1
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2
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST
PARTUM
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CRITICAL UNIT
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LABOR
& DELIVERY
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PACU
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NEWBORN
NURSERY
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NEUROLOGY
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LEVEL
II NICU
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TELEMETRY
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LEVEL
III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING ROOM
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RRT
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EMERGENCY ROOM
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CRT
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TRAUMA CENTER LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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Age Specific Competencies
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1
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2
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3
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4
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Newborn/Neonatal (birth –
30 days)
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Infant (30 days-1 year)
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Toddler (1-3 years)
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Preschool (3-5 years)
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School Age Children (5-12
years)
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Adolescent (12-17 years)
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Young Adults (18-44 years)
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Middle Adults (45-64 years)
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Older Adults (>65 years)
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