CYNET_SYSTEMS_MAIN_LOGO.gif   ULTRASONOGRAPHY ECHOCARDIOGRAPHY VASCULAR TECH 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) General Ultrasound:  1 2 3 4  
Aorta  
Appendix  
Billiary tract  
Gall bladder  
Liver  
Lung biopsy  
Pancreas  
Paracentesis  
Renal/cyst aspiration  
Pelvic male  
Spleen  
Rating Stars (Click) Pelvic Transabdominal-Female 1 2 3 4  
Adnexa  
Endometrial canal  
Ovaries  
Transvaginal   
Uterus  
Rating Stars (Click) Small Part/Specials:  1 2 3 4  
Biopsies  
Breast/cyst aspiration  
Prostate/transrectal probe  
Superficial masses  
Testicular/scrotum  
Thyroid  
Rating Stars (Click) Obstetrics & Gynecology: 1st Trimester 1 2 3 4  
Adnexa  
Amniotic fluid (Abnormal)  
Amniotic fluid (Normal)  
Crown rump length 6-14 weeks  
Fetal demise  
Left Ventricular Outflow Tract (LVOT)  
Right Ventricular Outflow Tract (RVOT)  
Multiple pregnancy  
Spine if visualized   
Lower uterine segment   
Nuchal translucency  
Placenta previa   
Rating Stars (Click) 2nd Trimester:  1 2 3 4  
Cervical shortening  
Insert into placenta & abdomen  
3-Vessel cord/ratio/insertion  
4-Chamber heart (Abnormal)  
4-Chamber heart (Normal)  
ABD/HC ratio  
Abdominal circumference   
Bladder  
Cephalic index  
Cerebral ventricles  
Cerebellum  
Cisterna magnum  
Cystema magnum   
Diaphragm  
Feet   
Femur length   
Gender  
Hands  
Head circumference   
Intraorbital measurements   
Interorbital measurements  
Kidneys  
Nose & lips   
Nuchal fold   
Placenta location   
Stomach  
Rating Stars (Click) 3rd Trimester:  1 2 3 4  
Amniocentesis (If Applicable)  
High risk  
Neonatal heads   
Transvaginal procedures  
Cyst aspiration  
Biopsy puncture  
Liver/spleen   
Aorta  
Legs/arterial  
Legs/venous  
Renal arteries   
OPG eye  
Segmental pressures  
Transcranial  
Popliteal   
Rating Stars (Click) Echocardiography: 1 2 3 4  
2-dimensional   
M-mode  
PW doppler  
CW doppler  
Color doppler  
Parasternal long axis view   
Parasternal short axis view  
Pedoff probe in apical   
Pedoff probe in suprasternal   
Pedoff probe in parasternal right  
Right Ventricular Inflow Tract (RVIT)  
Right Ventricular Outflow Tract (RVOT)  
4-chamber view  
2-chamber view  
Subcostal view  
Suprasternal View  
Cardiac anatomy  
Assessment of endocardium  
Simpson’s rule  
PISA  
Diastolic dysfunction evaluation  
Continuity equation  
Rating Stars (Click) Special procedures:  1 2 3 4  
Bubble study  
Transesophageal echocardiogram  
Contrast study  
Treadmill stress echo  
Rating Stars (Click) Other Cardiology Testing: 1 2 3 4  
Holter monitors  
EKG  
General ultrasound  
Doppler studies  
Carotid  
Venous (arm/leg)  
Arterial (arm/leg)  
Renal  
Abdomen/pelvis  
Gall bladder  
Testicular  
OB/GYN examinations  
1st trimester  
Transvaginal  
Ultrasound assisted procedures  
Biopsy  
Aspiration  
Drainage  
Hysterosonography  
Amniocentesis  
Saline Infused Sonohysterography (SIS)  
Rating Stars (Click) Duplex Scans: 1 2 3 4  
Abdominal aorta  
Arterial grafts  
Dialysis grafts  
Extracranial arteries  
Lower extremity arteries  
Lower extremity veins  
Mesenteric arteries  
Penile imagina   
Renal arteries/kidneys  
Upper extremity arteries  
Upper extremity veins  
Rating Stars (Click) Diagnostic Abilities:  1 2 3 4  
Abdominal aorta/arteries  
Bypass grafts-artificial  
Bypass grafts-insitu  
Common carotid-extracranial  
Common carotid-intracranial  
Dialysis grafts  
Extremity arteries-upper  
Extremity arteries-lower  
Extremity veins-upper  
Extremity veins-lower  
Mapping-arterial  
Mapping-vein  
OPG eye  
Penile exams  
Renal exams  
Stents  
Rating Stars (Click) Indirect Tests:  1 2 3 4  
Continuous wave doppler: lower extremity  
Continuous wave doppler: upper extremity  
Continuous wave doppler: transcranial  
Palmer arch  
Penise  
Plethysmography  
Pulse volume recording  
Segmental pressures-arterial/non-imaging  
Rating Stars (Click) Equipment 1 2 3 4  
GE  
HP   
Philips  
Siemens  
Picker  
Other  
Rating Stars (Click) Computer Systems  1 2 3 4  
AGFA   
Fuji  
GE  
Siemens  
Rating Stars (Click) General Skills 1 2 3 4  
Patients in restraints  
Lifting/transfer devices  
Cardiac arrest/CPR  
Use of rapid response teams  
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 fall  
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)  
Please list any Additional Skills:  
1  
2  
3  
4  
  Additional training:  
1  
2  
3  
4  
  Additional equipment:  
1  
2  
3  
4