Skills Checklist – Cath Lab

Skills Checklist – Cath Lab

• Name
  
  First
  
  Last
• Phone
• Email
  
• Procedure/Skills*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Obtain & Interpret 12 Lead EKG
  Defibrillation/Cardioversion
  Interpretation of Arrhythmias

• Perform Physiologic Monitoring*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Record LHC/RHC
  Record Aortic/Mitral Valve Cases
  Record EP/Ablation Cases
  Record Perm. Pacemaker Insertions

• Circulate For*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  LHC/RHC
  PCI (Interventional)
  EP/Ablatins
  Permanent Pacemaker Insertions
  IABP Insertions
  Place Leads & Pads for Cardiac Mapping

• Scrub For*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  LHC/RHC
  PCI (Interventional)
  EP/Ablatins
  Permanent Pacemaker Insertions
  IABP Insertions
  Knowledge of/practice Radiation Safety
  Check and Mark Distal Pulses
  Perform Allen Test

• Medical Administration*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Antiarrthymics
  Antibiotics
  Atropine
  Anticoagulants
  Beta Blockers
  Conscious Sedation
  Sedation Reversal Agents
  Emergency Medications

• Pulmonary*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Airway Management
  Ventilator Management
  O2 Therapy & Delivery Systems
  Pulse Oximetry
  ABG Interpretation

• Post-Procedure – Monitoring & Documentation Of:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  – Vital Signs
  – EKG
  – Level of Consciousness
  – Insertion Site
  – Distal Pulses
  Use of Aldrete Sedation Recovery Scale
  Maintain A/V Sheaths in Place

• Post-Procedure – Set-Up & Maintain:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  – Arterial Sheaths to Pressure & Monitor
  – Swan Ganz via Venous Sheath to Monitor
  Obtain & Monitor ACT
  Removal of AV Sheaths
  Manual Pressure Hold

• Post-Procedure*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Clamp Hold
  Radial Hermoband

• Post-Procecure – Vascular Closure Device*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  – Application
  – Monitoring
  Sterile Pressure Dressing Application
  Maintain IABP
  Maintain Temporary Pacemaker
  Crash Cart Use
  Suction
  O2 Administration
  Emergency Meds
  Education of Patients/Family

• Equipment*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Hemachron
  Medication Dispensing Systems
  ABG Analysis Machines
  ACT Machine
  PTCA Balloons
  Stents
  Athrectomy
  Laser
  Power Injectors
  Doppler
  Computer Charting Systems

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 days – 1 year)
  Toddler (1 – 3 years)
  Preschooler (3 – 5 years)
  School Age (5 – 12 years)
  Adolescents (12 – 18 years)
  Young Adults (18 – 39 years)
  Middle Adults (39-64 years)
  Older Adults (64+ years)

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
• Signature
• Date
  
  Date Format: MM slash DD slash YYYY