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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  
0
Air Way Maintenance  
0
Arm Cases  
0
Biopsy  
0
Co-Ox Setup Q.C., Run SamplE  
0
DCA’s  
0
Defibrillator Setup/Use  
0
IABP  
0
Left hearT  
0
RA Pressure Waveform Recognition  
0
PA Pressure Waveform Recognition  
0
LVEDP  
0
Ejection Fraction  
0
Power Injector Setup/Use  
0
PTCA’s   
0
Psycho/Social   
0
Patient/Family Teaching   
0
Patient/Fam Teach Pre/Post Proced  
Rating Stars (Click) CIRCULATING ROLE 1 2 3 4  
0
Left Heart Catheterization   
0
Right Heart Catheterization  
0
Left & Right Heart Catheterization  
0
PTCA  
0
Stent Implantation  
0
Ventricular Pacers  
0
Push Drugs ordered by MD  
0
Radiation Protection  
0
Directional Coronary Atherectomy  
0
Permanent Pacemaker  
0
Temporary Pacemaker  
0
Setting Threshold of Pacemakers  
0
Rotoblator  
0
Sphygmomanometer Monitoring  
0
Stents  
0
Transducer Setup/Calibration  
0
Run Co-Ox Machine  
0
Run Angio Jet Machine  
0
IVUS  
Rating Stars (Click) RECORDING POSITION 1 2 3 4  
0
Biopsy  
0
Call in Reports  
0
DCA’s  
0
PTCA’s  
0
Left Heart Caths  
0
Right Heart Caths  
0
Stents  
0
Hematoma Recognition & Mgt  
0
Rotational Coronary Atherectomy  
0
IVUS  
0
Intra Aortic Balloon Pump  
0
Directional Coronary Atherectomy  
0
EP Study  
0
Ablation  
0
Cardioversion   
0
Rotoblator  
Rating Stars (Click) SCRUB POSITION (PSC) 1 2 3 4  
0
Left Heart Catheterization  
0
Right Heart Catheterization  
0
Left & Right Heart Catheterization  
0
PTCA  
0
Stent Implantation  
0
Rotational Coronary Atherectomy  
0
IVUS  
0
Intra Aortic Balloon Pump  
0
Biopsy  
0
Closure Device (Per close, Angio Seal)  
0
DCA’s  
0
Temporary Pacemakers  
0
Angio Jet  
0
Arm Cases  
0
Exchange Sheaths  
0
Directional Coronary Atherectomy  
Rating Stars (Click) EQUIPMENT - CATH LAB/ ANGIO/ SPECIALS  1 2 3 4  
0
GE Advantx LC Mobile   
0
GE LUA Mobile  
0
GE LUA/C MobileGE LUA/EDEC  
0
Philips Integris H3000  
0
Philips Integris Mobile  
0
Philips Integris V3000  
0
Philips MD-3  
0
Philips Poly A Combo Mobile  
0
Philips Poly A Mobile  
0
Philips Poly C Mobile  
0
Philips Poly C2  
0
Philips Poly C-2 Mobile  
0
Philips Poly C-2 Modular  
0
Siemens ACOM M/B  
0
Siemens Angioskop D  
0
Siemens Angioskop D-2  
0
Siemens Angiostar  
0
Siemens Axiom Artis BC  
0
Siemens Axiom Artis FC  
0
Siemens Cathcor  
0
Siemens Coroskop C  
0
Siemens Hicor 1.0/2.0  
0
Siemens Hicor 1.0/2.0  
0
Siemens Infinity SC 8000  
0
Siemens Infinity SC 9000XL  
0
Siemens PolyStar  
0
Siemens Powermobil  
0
Toshiba Angiorex Modular  
0
Toshiba Infinix VC-  
0
Toshiba KXO-200A  
0
Toshiba KXO-80-CD Mobile  
0
Toshiba Super G  
0
Other:   
Rating Stars (Click) RADIOLOGY/ FLUOROSCOPY 1 2 3 4  
0
GE Prestige  
0
GE Prestilix 1690  
0
GE RFX  
0
GE SFX-II  
0
Litho Gall Bladder  
0
Litho Kidney   
0
Philips Diagnost 92  
0
Picker Clinix R/F  
0
Picker Vector 100  
0
Siemens Pantoskop 5 ML  
0
Siemens Sireskop 30  
0
Siemens Sireskop 4  
0
Siemens Sireskop SX  
0
Toshiba EPS- Plus  
0
Toshiba KXO- 850  
0
Toshiba Tosrad  
0
Toshiba Ultimax  
0
Atak R/F Ablation IABP  
0
Daylight System  
0
Digatech  
0
GE Advantx  
0
GE Advantx 80 LFX  
Rating Stars (Click) HEMODYNAMIC MONITORING EQUIP 1 2 3 4  
0
Hewlett Packard  
0
Lifecare  
0
Marquette  
0
Mennen  
0
Nihon Koder  
0
Philips  
0
Siemens  
0
Spacelab  
0
Witt  
0
Other:  
Rating Stars (Click) EMR 1 2 3 4  
0
Epic  
0
Cerner  
0
Eclipsys  
0
McKesson  
0
Meditech  
0
Other Computerized System  
0
Computerized Physician Order Entry  
0
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  
0
Newborn/Neonatal (birth – 30 days)  
0
Infant (30 days-1 year)  
0
Toddler (1-3 years)  
0
Preschool (3-5 years)  
0
School Age Children (5-12 years)  
0
Adolescent (12-17 years)  
0
Young Adults (18-44 years)  
0
Middle Adults (45-64 years)  
0
Older Adults (>65 years)