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Cath Lab Interventional Radiology

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Work Setting

Procedural Cath Lab *

Interventional Cath Lab *

EP Lab *

Interventional Radiology *

Pre/Post Procedural Setting *

Charge Experience *

Other Setting (List) *

Equipment

Automatic Implantable Cardiac Defibrillator *

Cardioversion *

Intra Aortic Balloon Pump (IABP) *

SV02 Recording *

Ventilator Management *

Cardiac Cath Lab Procedures

AICD Placement *

Aortography *

Cardiac Biopsy *

Cardiac Implant Closure Device *

Cardiac Stent Placement *

Diagnostic Cardiac Catheterization Adult *

Diagnostic Cardiac Catheterization - Pediatric/Neonatal *

Directional Coronary Atherectomy *

IABP Placement/Removal *

Internal Mammary Angiography *

Laser Assisted Procedures *

Percutaneous Transluminal Coronary Angioplasty *

Pericardiocentesis *

Permanent Pacemaker Placement *

Pulmonary Angiography *

Rotational Coronary Atherectomy *

Saphenous Vein Graft Angiography *

Transluminal Extraction Catheter *

Valvuloplasty *

Ventricular Assist Device Insertion *

Electrophysiology Procedures

Electrophysiology Evaluation *

Baseline Measurements *

Cardiac Ablation *

Cardiac Mapping *

Cardioversion *

Conduction Study *

Internal Cardioverter Defibrillator Implant *

Tilt Table Study *

IR-Gastrointestinal Studies

Angioplasty *

Chemoembolization *

Cholecystostomy *

Embolization *

ERCP *

Esophageal Stent Placement *

Gastrojejunostomy *

Liver Ablation *

Pericentesis *

Percutaneous Hepatic Angiography *

TIPS *

IR-Genitourinary Studies

Adrenal Angiography *

Angiography of Female GU System *

Angiography of Male GU System *

Cystostomy *

Embolization *

Nephrostomy *

Percutaneous Stone Extraction *

Renal Angiography *

Renal Artery Angioplasty *

Renal Artery Stent Placement *

Ureteral Stent *

IR-Neurologic Studies

Cerebral Angiography *

Carotid Angiography *

Neurologic Angioplasty *

Neurologic Thrombolysis *

Vertebroplasty *

IR-Peripheral Vascular Studies

IR-PERIPHERAL VASCULAR STUDIES *

Angioplasty *

Central Venous Access/Port Placement *

Dialysis Graft Creation/Revision *

Dialysis Graft Interventional *

Peripheral Vascular Embolization *

Stent Graft Placement *

SVC/IVC Venography *

Thoracic Aortography *

Upper and Lower Extremity Angiography *

IR-Pulmonary Procedures

Chest Tube Placement *

Pulmonary Embolization *

Pulmonary Angiography *

Thoracentesis *

Professional Knowledge and Skills

Conscious/Procedural Sedation *

Assist w/Central Line/Venous Line Insertion *

Venous Sampling *

Topical Hemostasis (D-Stat, Chito-Seal, Syvek Patch, etc.) *

External Compression Devices (C-Clamp, Sandbags, etc.) *

Physiologic Monitoring/Recording *

Sheath Removal and Monitoring *

National Patient Safety Goals/Core Measures *

Universal Protocol Procedures *

Isolation Precautions *

Infection Prevention *

Age Specific/Population-Based Care *

Fall Risk Assessment/Prevention *

EMR

Cerner *

Eclipsys *

Epic *

GE *

McKesson *

Meditech *

Other Computerized System *

Computerized Physician Order Entry *

Medication Administration using Bar Coding Technology *

EMR Conversion *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

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