CYNET_SYSTEMS_MAIN_LOGO.gif   CARDIAC CATH TECHNOLOGIST/SPECIAL PROCEDURES 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) CCATH 1 2 3 4  
Cardiac catherization - adult R/L  
Cardiac catherization - pediatric/neonatal R/L  
Aortography  
Internal mammary angiography  
Pulmonary angiography  
Saphenous vein graft angiography  
Ventricular assist device  
Shunt detections & calculation  
Permanent pacemaker placement  
Temporary pacemaker placement  
Automatic implantable cardiac defibrillator  
Angioplasty  
Arrhythmia ablation  
Debulking  
Stent placement  
Assist with A-line insertion  
Assist with PA-line insertion  
Assist with open chest emergency  
FemStop device  
Vasoseal  
Angioseal  
Perclose  
Rating Stars (Click) HEMODYNAMIC MONITORING 1 2 3 4  
PAP  
PCW  
CVP  
SVR  
PVR  
CO  
CI  
SVO2 recording  
Rating Stars (Click) SPECIAL PROCEDURES 1 2 3 4  
Specimen radiographs  
Selective angiography  
Rating Stars (Click) Cerebral Embolization 1 2 3 4  
Coiling  
Gelfoam  
PVA  
Cerebral angiography  
Carotid arteriogram  
Brachial arteriogram  
Pulmonary arteriogram  
Arch arteriogram  
Renal arteriogram  
Femoral arteriogram  
Abdominal arteriogram  
Mesenteric arteriogram  
Venogram  
Angioplasty  
Nephrostomy  
Embolizations  
A/V fistulas  
IVC filter (Inferior Vena Cava)  
TIPPS procedure  
Ablations  
Endografts  
Pressure monitoring  
Rating Stars (Click) Equipment 1 2 3 4  
Cardioversion  
Defibrillator  
Intra aortic balloon pump  
Lead placement  
Rating Stars (Click) Computerized Charting 1 2 3 4  
Cerner  
EPIC  
Mckesson  
Meditech  
Rating Stars (Click) National Patient Safety Goals 1 2 3 4  
Accurate patient identification  
Effective communication  
Infection control  
Universal precautions  
Patients in isolation  
Minimize risk for falls  
Rating Stars (Click) General Skills 1 2 3 4  
Patient/family teaching  
Patients in restraints  
Lifting/transfer devices  
Cardiac arrest/CPR  
Use of rapid response teams  
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)