Interventional Radiology Skills Checklist This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with ADEX Medical Staffing, LLC. Proficency Scale: 1 = No Experience - Theory only 2 = Limited Experience - Infrequent 3 = Moderate Experience - Able to perform independently 4 = Proficient - Able to perform proficiently and instruct Scale: 1 = Never Observed 2 = Less than 6 times a year 3 = 1 or 2 Times a Month 4 = Daily or Weekly Personal Information Name: Email: City: Country: United States State/Region: Send to: None Specified General 1 2 3 4 1 2 3 4 Transport post-procedure patient to in-hospital units Transport pre-procedure patient to the Lab. Complete pre-procedure checklist
Start peripheral IV Complete assessments, obtain family history & risk factors Admit patient to pre-procedure holding Procedures 1 2 3 4 1 2 3 4 Provide care for the post-procedure patient Myelogram - Assist Myelogram - Prepare Lumbar Puncture - Assist Lumbar Puncture - Prepare Vertebroplasty - Assist Vertebroplasty - Prepare AV Fistula/Shunt Declotting - Assist AV Fistula/Shunt Declotting - Prepare Permanent Hemodialysis Shunt Placement - Assist Permanent Hemodialysis Shunt Placement - Prepare Temporary Hemodialysis Shunt Placement - Assist Temporary Hemodialysis Shunt Placement - Prepare Uterine Fibroid Embolization - Assist Uterine Fibroid Embolization - Prepare Prepare and Assist with Line Placement - PortaCath Prepare and Assist with Line Placement - PICC Prepare and Assist with Line Placement - Hickman Prepare and Assist with Line Placement - Groshong Prepare and Assist with Line Placement - Broviac Liver Biopsy and Embolization - Assist Liver Biopsy and Embolization - Prepare CT Scan Guided Biopsy - Assist CT Scan Guided Biopsy - Prepare
Ultrasound Guided Biopsy - Assist Ultrasound Guided Biopsy - Prepare Upper Extremity Angiogram - Assist Upper Extremity Angiogram - Prepare Lower Extremity Angiogram - Assist Lower Extremity Angiogram - Prepare Cerebral Angiogram - Assist Cerebral Angiogram - Prepare Cardiovascular 1 2 3 4 1 2 3 4 Participate as a team member in resuscitation Perform defibrillation Perform CPR Interpret arrhythmias Assess heart sounds and peripheral pulses Pulmonary 1 2 3 4 1 2 3 4 Provide care for the patient with mechanical ventilation Assist with chest tube insertion Assist with intubation Use Ambu bag Interpret ABG Obtain pulse oximetry reading Set up oxygen devices Assess lung sounds Neurological 1 2 3 4 1 2 3 4 Assess reflexes (Babinski, gag) Assess sensory, motor, speech
Identify sudden change in level of consciousness Medications 1 2 3 4 1 2 3 4 Administer IV narcotics (morphine, fentanyl) Administer IV neuromuscular blocking agents (Pavulon, Norcuron) Administer IV propofol (Diprivan) Administer IV benzodiazepines (Valium, Versed, Ativan) Administer IV heparin Administer IV atropine Administer IV epinephrine Administer IV diltiazem (Cardizem) Administer IV lidocaine Administer IV dobutamine (Dobutrex) Administer IV nitroglycerine Administer IV dopamine Use IV infusion pump to calculate drug doses Calculate mcg/min and mcg/kg/min Titrate vasoactive drugs Pain Management 1 2 3 4 1 2 3 4 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 Skills 1 2 3 4 1 2 3 4 School Age (5-12 years) Older Adults (64+ years) Preschooler (3-5 years) Middle Adults (39-64 years) Toddler (1-3 years) Young Adults (18-39 years) Infant (30 days - 1 year) Adolescents (12-18 years) Signature The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients. Initials: Copyright 2009 ADEX Medical Staffing, LLC Form Reviewed by ADEX Clinician - 11/16/2010