CYNET_SYSTEMS_MAIN_LOGO.gif   ECHO VASCULAR 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) Technique 1 2 3 4  
Use of contrast agents  
IV insertion  
IV maintenance  
Setup errors  
Technical artifact  
Other (list):  
Rating Stars (Click) Echocardiography 1 2 3 4  
M-Mode  
Color flow  
Real time  
Stress echo  
Pediatric echocardiogram  
Adult echocardiogram  
Doppler  
Dobutamine stress echocardiogram  
TEE (transesophageal esopography)  
Other (list)  
Rating Stars (Click) Vascular Procedures 1 2 3 4  
M-Mode  
Color flow  
Real time  
Duplex  
Flow studies  
Photoplethysmography  
Strain gauge and Pneumoplethysmography  
Arterial peripheral upper extremity  
Arterial peripheral lower extremity  
Arterial peripheralstress/ pressure testing  
Carotid artery  
Vertebral artery  
Subclavian artery  
Venous peripheral upper extremity  
Venous peripheral lower extremity  
Other (list):  
Rating Stars (Click) Certifications 1 2 3 4  
RCS (Registered cardiac sonographer)  
RVS (Registered vascularspecialist)  
RDCS (Registered diagnostic cardiac sonographer  
RVT (Registered vascular technician)  
Rating Stars (Click) General 1 2 3 4  
Quality control of equipment  
Recognition of malfunctions  
Transducerselection  
Image annotation  
Patient variables  
Criteria for diagnostic quality  
Universal precautions  
Disinfection and cleaning  
Other (list):  
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 APPROPRIATE CARE 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)