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Skills Assessment - Cardiac Cath Lab
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
General: Experience:
Admit patient to pre-procedure holding 0   1   2   3  
Complete assessments, obtain family history & risk factors 0   1   2   3  
Start peripheral IV 0   1   2   3  
Complete pre-procedure checklist 0   1   2   3  
Transport pre-procedure patient to the Lab 0   1   2   3  
Procedures - prepare 0   1   2   3  
Procedures - scrub 0   1   2   3  
Procedures - circulate 0   1   2   3  
Care of post-procedure patient 0   1   2   3  
Transport post-procedure patient to in-hospital units 0   1   2   3  
 
Cardiovascular:
Assess heart sounds and peripheral pulses 0   1   2   3  
Interpret arrhythmias 0   1   2   3  
Assist with arterial line insertion 0   1   2   3  
Provide care to the patient with an arterial line 0   1   2   3  
Draw blood samples from arterial line 0   1   2   3  
Interpret arterial line waveform/pressures 0   1   2   3  
Remove arterial line 0   1   2   3  
Assist with S/G insertion 0   1   2   3  
Provide care to the patient with S/G 0   1   2   3  
Provide care to the patient with SvO2 S/G catheter 0   1   2   3  
Interpret PA waveforms/pressures 0   1   2   3  
Remove S/G catheter 0   1   2   3  
Assist with central line insertion 0   1   2   3  
Draw blood samples from central line 0   1   2   3  
Remove central line 0   1   2   3  
Set up and run 12 Lead ECG 0   1   2   3  
Provide care for the post-procedure patient 0   1   2   3  
Provide care for the patient with an IABP 0   1   2   3  
Provide care for the patient in shock 0   1   2   3  
Perform CPR 0   1   2   3  
Perform defibrillation 0   1   2   3  
Participate as a team member in resuscitation 0   1   2   3  
 
Pulmonary:
Assess lung sounds 0   1   2   3  
Set up oxygen devices 0   1   2   3  
Obtain pulse oximetry reading 0   1   2   3  
Interpret ABG 0   1   2   3  
Use Ambu bag 0   1   2   3  
Assist with intubation 0   1   2   3  
Assist with chest tube insertion 0   1   2   3  
Provide care for the patient with mechanical ventilation 0   1   2   3  
 
Neurological:
Identify sudden change in level of consciousness 0   1   2   3  
Assess sensory, motor, speech 0   1   2   3  
Assess reflexes (Babinski, gag) 0   1   2   3  
 
Medications:
Titrate vasoactive drugs 0   1   2   3  
Calculate mcg/min and mcg/kg/min 0   1   2   3  
Use IV infusion pump to calculate drug doses 0   1   2   3  
Adminster IV epinephrine 0   1   2   3  
Administer IV dopamine 0   1   2   3  
Administer IV nitroglycerine 0   1   2   3  
Administer IV dobutamine (Dobutrex) 0   1   2   3  
Administer IV milrinone (Primacor) 0   1   2   3  
Administer IV metoprolol (Lopressor) 0   1   2   3  
Administer IV lidocaine 0   1   2   3  
Administer IV amiodarone (Cordarone) 0   1   2   3  
Administer IV adenosine 0   1   2   3  
Administer IV diltiazem (Cardizem) 0   1   2   3  
Administer IV esmolol (Brevibloc) 0   1   2   3  
Administer IV verapamil 0   1   2   3  
Administer IV ibutilide 0   1   2   3  
Administer IV atropine 0   1   2   3  
Administer IV thrombolytics
(TPA, streptokinase)
0   1   2   3  
Administer IV heparin 0   1   2   3  
Administer IV GP llb/llla inhibitors (ReoPro, Aggrastat, Integrilin) 0   1   2   3  
Administer IV benzodiazepines (Valium, Versed, Ativan) 0   1   2   3  
Administer IV propofol (Diprivan) 0   1   2   3  
Administer IV neuromuscular blocking agents
(Pavulon, Norcuron)
0   1   2   3  
Administer IV narcotics
(morphine, fentanyl)
0   1   2   3  
Administer IV antibiotics (vancomycin, gentamycin, Ancef) 0   1   2   3  
Administer IV Lasix 0   1   2   3  
 
Pain/Wound Management:
Assess pain level/tolerance 0   1   2   3  
Care of patient with anesthesia/analgesia 0   1   2   3  
Care of patient with IV conscious sedation 0   1   2   3  
Care of patient with narcotic analgesia 0   1   2   3  
Care of patient with patient controlled analgesia (PCA pump) 0   1   2   3  
Care of patient with sterile dressing changes 0   1   2   3  
Care of patient with FemoStop device 0   1   2   3  
Assessment of VasoSeal, AngioSeal, Per Close success 0   1   2   3  
 
Age-Specific Practice Criteria:
Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Pediatric (1 - 12 years)  
Adolescents (12 - 18 years)  
Adult (19 - 65 years)  
Older Adult (older than 65 years)  
 
Experience With Age Groups:
Calculate body weight to verify correct dosing of medication 0   1   2   3  
Assess immunization status for pediatric, and adolescent 0   1   2   3  
Set age-appropriate short-term and long-term goals in care planning 0   1   2   3  
Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years 0   1   2   3  
 
Certification:
ACLS Completion Date
BCLS Completion Date
Other (specify)
Completion Date
 
 
 
 


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