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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Admit patient to pre-procedure holding
Complete assessments, obtain family history & risk factors
Complete pre-procedure checklist
Transport pre-procedure patient to the Lab.
Transport post-procedure patient to in-hospital units
Cerebral Angiogram – Prepare
Cerebral Angiogram – Assist
Lower Extremity Angiogram – Prepare
Lower Extremity Angiogram – Assist
Upper Extremity Angiogram – Prepare
Upper Extremity Angiogram – Assist
Ultrasound Guided Biopsy – Prepare
Ultrasound Guided Biopsy – Assist
CT Scan Guided Biopsy – Prepare
CT Scan Guided Biopsy – Assist
Liver Biopsy and Embolization – Prepare
Liver Biopsy and Embolization – Assist
Prepare and Assist with Line Placement – Broviac
Prepare and Assist with Line Placement – Groshong
Prepare and Assist with Line Placement – Hickman
Prepare and Assist with Line Placement – PICC
Prepare and Assist with Line Placement – PortaCath
Uterine Fibroid Embolization – Prepare
Uterine Fibroid Embolization – Assist
Temporary Hemodialysis Shunt Placement– Prepare
Temporary Hemodialysis Shunt Placement– Assist
Permanent Hemodialysis Shunt Placement– Prepare
Permanent Hemodialysis Shunt Placement– Assist
AV Fistula/Shunt Declotting – Prepare
AV Fistula/Shunt Declotting – Assist
Lumbar Puncture – Prepare
Other Procedures (please list):
Provide care for the post-procedure patient
Assess heart sounds and peripheral pulses
Participate as a team member in resuscitation
Obtain pulse oximetry reading
Assist with chest tube insertion
Provide care for the patient with mechanical ventilation
Calculate mcg/min and mcg/kg/min
Use IV infusion pump to calculate drug doses
Administer IV nitroglycerine
Administer IV dobutamine (Dobutrex)
Administer IV diltiazem (Cardizem)
Administer IV epinephrine
Administer IV benzodiazepines (Valium, Versed, Ativan)
Administer IV propofol (Diprivan)
Administer IV neuromuscular blocking agents (Pavulon, Norcuron)
Administer IV narcotics (morphine, fentanyl)
Assess pain level/tolerance
Care of patient with anesthesia/analgesia
Care of patient with IV conscious sedation
Care of patient with narcotic analgesia
Care of patient with patient controlled analgesia (PCA pump)
Assess surgical wound status with/without drain(s)
Care of patient with sterile dressing changes
Care of patient with FemoStop device
Assessment of VasoSeal, AngioSeal, PerClose success
AGE SPECIFIC PRACTICE CRITERIA
Adolescents (12 - 18 years)
Older adults (Older than 65years)
EXPERIENCE WITH AGE GROUPS
Calculate body weight to verify correct dosing of medication
Assess immunization status for pediatric, and adolescent
Set age-appropriate short-term and long-term goals in care planning
Provide age-appropriate education, considering possible vision and hearing impairment for Older than 65years