CYNET_SYSTEMS_MAIN_LOGO.gif   CARDIAC CATH LAB TECHNICIAN SKILLS CHECKLIST
   NAME    
   LAST 4 OF SSN      
   DATE    
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.  
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.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) CIRCULATING ROLE (PAV) 1 2 3 4  
Air Way Maintenance  
Arm Cases  
Biopsy  
Co-Ox Setup Q.C., Run SamplE  
DCA’s  
Defibrillator Setup/Use  
IABP  
Left hearT  
RA Pressure Waveform Recognition  
PA Pressure Waveform Recognition  
LVEDP  
Ejection Fraction  
Power Injector Setup/Use  
PTCA’s   
Psycho/Social   
Patient/Family Teaching   
Patient/Fam Teach Pre/Post Proced  
Rating Stars (Click) CIRCULATING ROLE 1 2 3 4  
Left Heart Catheterization   
Right Heart Catheterization  
Left & Right Heart Catheterization  
PTCA  
Stent Implantation  
Ventricular Pacers  
Push Drugs ordered by MD  
Radiation Protection  
Directional Coronary Atherectomy  
Permanent Pacemaker  
Temporary Pacemaker  
Setting Threshold of Pacemakers  
Rotoblator  
Sphygmomanometer Monitoring  
Stents  
Transducer Setup/Calibration  
Run Co-Ox Machine  
Run Angio Jet Machine  
IVUS  
Rating Stars (Click) RECORDING POSITION 1 2 3 4  
Biopsy  
Call in Reports  
DCA’s  
PTCA’s  
Left Heart Caths  
Right Heart Caths  
Stents  
Hematoma Recognition & Mgt  
Rotational Coronary Atherectomy  
IVUS  
Intra Aortic Balloon Pump  
Directional Coronary Atherectomy  
EP Study  
Ablation  
Cardioversion   
Rotoblator  
Rating Stars (Click) SCRUB POSITION (PSC) 1 2 3 4  
Left Heart Catheterization  
Right Heart Catheterization  
Left & Right Heart Catheterization  
PTCA  
Stent Implantation  
Rotational Coronary Atherectomy  
IVUS  
Intra Aortic Balloon Pump  
Biopsy  
Closure Device (Per close, Angio Seal)  
DCA’s  
Temporary Pacemakers  
Angio Jet  
Arm Cases  
Exchange Sheaths  
Directional Coronary Atherectomy  
Rating Stars (Click) EQUIPMENT - CATH LAB/ ANGIO/ SPECIALS  1 2 3 4  
GE Advantx LC Mobile   
GE LUA Mobile  
GE LUA/C MobileGE LUA/EDEC  
Philips Integris H3000  
Philips Integris Mobile  
Philips Integris V3000  
Philips MD-3  
Philips Poly A Combo Mobile  
Philips Poly A Mobile  
Philips Poly C Mobile  
Philips Poly C2  
Philips Poly C-2 Mobile  
Philips Poly C-2 Modular  
Siemens ACOM M/B  
Siemens Angioskop D  
Siemens Angioskop D-2  
Siemens Angiostar  
Siemens Axiom Artis BC  
Siemens Axiom Artis FC  
Siemens Cathcor  
Siemens Coroskop C  
Siemens Hicor 1.0/2.0  
Siemens Hicor 1.0/2.0  
Siemens Infinity SC 8000  
Siemens Infinity SC 9000XL  
Siemens PolyStar  
Siemens Powermobil  
Toshiba Angiorex Modular  
Toshiba Infinix VC-  
Toshiba KXO-200A  
Toshiba KXO-80-CD Mobile  
Toshiba Super G  
Other:   
Rating Stars (Click) RADIOLOGY/ FLUOROSCOPY 1 2 3 4  
GE Prestige  
GE Prestilix 1690  
GE RFX  
GE SFX-II  
Litho Gall Bladder  
Litho Kidney   
Philips Diagnost 92  
Picker Clinix R/F  
Picker Vector 100  
Siemens Pantoskop 5 ML  
Siemens Sireskop 30  
Siemens Sireskop 4  
Siemens Sireskop SX  
Toshiba EPS- Plus  
Toshiba KXO- 850  
Toshiba Tosrad  
Toshiba Ultimax  
Atak R/F Ablation IABP  
Daylight System  
Digatech  
GE Advantx  
GE Advantx 80 LFX  
Rating Stars (Click) HEMODYNAMIC MONITORING EQUIP 1 2 3 4  
Hewlett Packard  
Lifecare  
Marquette  
Mennen  
Nihon Koder  
Philips  
Siemens  
Spacelab  
Witt  
Other:  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click)  Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)