Cath Lab RN

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Name*

First Last

Phone*

Email*

General Skills:

Proficiency Rating

Frequency Rating

Universal Precautions *

Universal Precautions proficiency*

Universal Precautions frequency*

Care of Patient in Isolation *

Care of Patient in Isolation proficiency*

Care of Patient in Isolation frequency*

Care of Patient with Bleeding Precautions *

Care of Patient with Bleeding Precautions proficiency*

Care of Patient with Bleeding Precautions frequency*

Care of Patient with Neutropenic Precautions *

Care of Patient with Neutropenic Precautions proficiency*

Care of Patient with Neutropenic Precautions frequency*

Care of Patient in Restraints *

Care of Patient in Restraints proficiency*

Care of Patient in Restraints frequency*

Cardiac Monitoring - Basic *

Cardiac Monitoring - Basicproficiency*

Cardiac Monitoring - Basic frequency*

Cardiac Monitoring - Advanced *

Cardiac Monitoring - Advanced proficiency*

Cardiac Monitoring - Advanced frequency*

Interpretation of Arrhythmias *

Interpretation of Arrhythmias proficiency*

Interpretation of Arrhythmias frequency*

Emergency Medications (ACLS) *

Emergency Medications (ACLS) proficiency*

Emergency Medications (ACLS) frequency*

Pediatric Cardiac / Respiratory Arrest *

Pediatric Cardiac / Respiratory Arrest proficiency*

Pediatric Cardiac / Respiratory Arrest frequency*

Adult Cardiac / Respiratory Arrest *

Adult Cardiac / Respiratory Arrest proficiency*

Adult Cardiac / Respiratory Arrest frequency*

End of Life Care *

End of Life Care proficiency*

End of Life Care frequency*

Crash Carts *

Crash Carts proficiency*

Crash Carts frequency*

Defibrillators *

Defibrillators proficiency*

Defibrillators frequency*

Electronic Documentation *

Electronic Documentation proficiency*

Electronic Documentation frequency*

List Types:

Automated Med Dispensing Systems *

Automated Med Dispensing Systems proficiency*

Automated Med Dispensing Systems frequency*

List Types:

Assessment:

Proficiency Rating

Frequency Rating

Abnormal Heart Sounds *

Abnormal Heart Sounds proficiency*

Abnormal Heart Sounds frequency*

Murmurs *

Murmurs proficiency*

Murmurs frequency*

Peripheral Pulse / Circulation Checks *

Peripheral Pulse / Circulation Checks proficiency*

Peripheral Pulse / Circulation Checks frequency*

Use of Doppler *

Use of Doppler proficiency*

Use of Doppler frequency*

Blood Pressure - Invasive *

Blood Pressure - Invasive proficiency*

Blood Pressure - Invasive frequency*

Blood Pressure – Non-Invasive *

Blood Pressure – Non-Invasive proficiency*

Blood Pressure – Non-Invasive frequency*

Evaluate Chest Pain *

Evaluate Chest Pain proficiency*

Evaluate Chest Pain frequency*

Monitoring / Telemetry:

Proficiency Rating

Frequency Rating

Basic 12 Lead EKG Interpretation *

Basic 12 Lead EKG Interpretation proficiency*

Basic 12 Lead EKG Interpretation frequency*

Arrhythmia Interpretation *

Arrhythmia Interpretation proficiency*

Arrhythmia Interpretation frequency*

Lead Placement: 5 Electrodes *

Lead Placement: 5 Electrodes proficiency*

Lead Placement: 5 Electrodes frequency*

Lead Placement: I, II, V-leads *

Lead Placement: I, II, V-leads proficiency*

Lead Placement: I, II, V-leads frequency*

Lead Placement: Lead II and MCL *

Lead Placement: Lead II and MCL proficiency*

Lead Placement: Lead II and MCL frequency*

Set up and Perform 12 Lead EKG *

Set up and Perform 12 Lead EKG proficiency*

Set up and Perform 12 Lead EKG frequency*

Rhythm Strip Interpretation *

Rhythm Strip Interpretation proficiency*

Rhythm Strip Interpretation frequency*

Hemodynamic Monitoring

Proficiency Rating

Frequency Rating

Biopsy *

Biopsy proficiency*

Biopsy frequency*

Handoff Reports *

Handoff Reports proficiency*

Handoff Reports frequency*

Left Heart Caths *

Left Heart Caths proficiency*

Left Heart Caths frequency*

Right Heart Caths *

Right Heart Caths proficiency*

Right Heart Caths frequency*

Coronary Intervention *

Coronary Intervention proficiency*

Coronary Intervention frequency*

Hematoma Recognition & Mgt *

Hematoma Recognition & Mgt proficiency*

Hematoma Recognition & Mgt frequency*

Coronary Atherectomy *

Coronary Atherectomy proficiency*

Coronary Atherectomy frequency*

IVUS *

IVUS proficiency*

IVUS frequency*

Intra Aortic Balloon Pump *

Intra Aortic Balloon Pump proficiency*

Intra Aortic Balloon Pump frequency*

EP Study *

EP Study proficiency*

EP Study frequency*

Ablation *

Ablation proficiency*

Ablation frequency*

Rotablator *

Rotablator proficiency*

Rotablator frequency*

FFR *

FFR proficiency*

FFR frequency*

Interpretation of Lab Results

Proficiency Rating

Frequency Rating

Cardiac Enzymes *

Cardiac Enzymes proficiency*

Cardiac Enzymes frequency*

GFR Bun Creatinine *

GFR Bun Creatinine proficiency*

GFR Bun Creatinine frequency*

Coagulation Studies *

Coagulation Studies proficiency*

Coagulation Studies frequency*

Chemistries *

Chemistries proficiency*

Chemistries frequency*

Other *

Other proficiency*

Other frequency*

List Types:

IV Therapy

Proficiency Rating

Frequency Rating

ASSIST WITH CARE AND MAINTENANCE OF:

Central Line *

Central Line proficiency*

Central Line frequency*

Arterial Line *

Arterial Line proficiency*

Arterial Line frequency*

Swan-Ganz Catheter *

Swan-Ganz Catheter proficiency*

Swan-Ganz Catheter frequency*

Pulmonary

Proficiency Rating

Frequency Rating

Assess Lung Sounds *

Assess Lung Sounds proficiency*

Assess Lung Sounds frequency*

Pulse Oximetry *

Pulse Oximetry proficiency*

Pulse Oximetry frequency*

Set up Oxygen Delivery Devices *

Set up Oxygen Delivery Devices proficiency*

Set up Oxygen Delivery Devices frequency*

Obtain and Interpret ABGs *

Obtain and Interpret ABGs proficiency*

Obtain and Interpret ABGs frequency*

Obtain and Interpret Mixed Venous Gases *

Obtain and Interpret Mixed Venous Gases proficiency*

Obtain and Interpret Mixed Venous Gases frequency*

Assist with Intubation *

Assist with Intubation proficiency*

Assist with Intubation frequency*

Neurological

Proficiency Rating

Frequency Rating

Neuro Assessment *

Neuro Assessment proficiency*

Neuro Assessment frequency*

Assess Sensory, Motor, Speech Function *

Assess Sensory, Motor, Speech Function proficiency*

Assess Sensory, Motor, Speech Function frequency*

Glasgow Coma Scale *

Glasgow Coma Scale proficiency*

Glasgow Coma Scale frequency*

Medication

Proficiency Rating

Frequency Rating

Contrast Media *

Contrast Media proficiency*

Contrast Media frequency*

Sedation Meds *

Sedation Meds proficiency*

Sedation Meds frequency*

Reversal Meds *

Reversal Meds proficiency*

Reversal Meds frequency*

Anticoagulation *

Anticoagulation proficiency*

Anticoagulation frequency*

Thrombolytics *

Thrombolytics proficiency*

Thrombolytics frequency*

Lopressor (Metoprolol) *

Lopressor (Metoprolol) proficiency*

Lopressor (Metoprolol) frequency*

Dilatiazem HCL (Cardizem) *

Dilatiazem HCL (Cardizem) proficiency*

Dilatiazem HCL (Cardizem) frequency*

Verapamil (Calan) *

Verapamil (Calan) proficiency*

Verapamil (Calan) frequency*

Nitrostat (Nitroglycerin) *

Nitrostat (Nitroglycerin) proficiency*

Nitrostat (Nitroglycerin) frequency*

Adenocard (Adenosine) *

Adenocard (Adenosine) proficiency*

Adenocard (Adenosine) frequency*

Amiodarone (Cardarone) *

Amiodarone (Cardarone) proficiency*

Amiodarone (Cardarone) frequency*

Corvert (Ibutilide) *

Corvert (Ibutilide) proficiency*

Corvert (Ibutilide) frequency*

Lidocaine *

Lidocaine proficiency*

Lidocaine frequency*

Pronestyl *

Pronestyl proficiency*

Pronestyl frequency*

Atropine *

Atropine proficiency*

Atropine frequency*

Sodium Nitroprusside (Nipride) *

Sodium Nitroprusside (Nipride) proficiency*

Sodium Nitroprusside (Nipride) frequency*

Inocor (Amrinone) *

Inocor (Amrinone) proficiency*

Inocor (Amrinone) frequency*

Milrinone (Primacor) *

Milrinone (Primacor) proficiency*

Milrinone (Primacor) frequency*

Adrenalin (Epinephrine) *

Adrenalin (Epinephrine) proficiency*

Adrenalin (Epinephrine) frequency*

Dobutrex (Dobutamine) *

Dobutrex (Dobutamine) proficiency*

Dobutrex (Dobutamine) frequency*

Dopamine Hydrochloride *

Dopamine Hydrochloride proficiency*

Dopamine Hydrochloride frequency*

Sodium Bicarbonate *

Sodium Bicarbonate proficiency*

Sodium Bicarbonate frequency*

Furosemide (Lasix) *

Furosemide (Lasix) proficiency*

Furosemide (Lasix) frequency*

Insulin *

Insulin proficiency*

Insulin frequency*

IV Antibiotics *

IV Antibiotics proficiency*

IV Antibiotics frequency*

Site Management / Sheaths:

Proficiency Rating

Frequency Rating

ASSIST WITH REMOVAL OF:

Femoral Arterial Sheath *

Femoral Arterial Sheath proficiency*

Femoral Arterial Sheath frequency*

Femoral Venous Sheath *

Femoral Venous Sheath proficiency*

Femoral Venous Sheath frequency*

Brachial Arterial Sheath *

Brachial Arterial Sheath proficiency*

Brachial Arterial Sheath frequency*

Radial Arterial Sheath *

Radial Arterial Sheath proficiency*

Radial Arterial Sheath frequency*

Manual Pressure Hold *

Manual Pressure Hold proficiency*

Manual Pressure Hold frequency*

Hematoma Recognition/Mgmt *

Hematoma Recognition/Mgmt proficiency*

Hematoma Recognition/Mgmt frequency*

Closure Devices *

Closure Devices proficiency*

Closure Devices frequency*

Patient Care

Proficiency Rating

Frequency Rating

Application of Sterile Pressure Dressing *

Application of Sterile Pressure Dressing proficiency*

Application of Sterile Pressure Dressing frequency*

Allen Test *

Allen Test proficiency*

Allen Test frequency*

Radiation Safety *

Radiation Safety proficiency*

Radiation Safety frequency*

Maintain Sheaths in Place *

Maintain Sheaths in Place proficiency*

Maintain Sheaths in Place frequency*

Skin Prep and Clipping *

Skin Prep and Clipping proficiency*

Skin Prep and Clipping frequency*

Aseptic Technique *

Aseptic Technique proficiency*

Aseptic Technique frequency*

Knowledge of Pediatric Cardiac Anomalies *

Knowledge of Pediatric Cardiac Anomalies proficiency*

Knowledge of Pediatric Cardiac Anomalies frequency*

Identify Sudden Change in LOC *

Identify Sudden Change in LOC proficiency*

Identify Sudden Change in LOC frequency*

Post Procedure/Recovery *

Post Procedure/Recovery proficiency*

Post Procedure/Recovery frequency*

Cath Lab Procedures / Scrub

Proficiency Rating

Frequency Rating

Cardiac Catheterization – Adult (L) *

Cardiac Catheterization – Adult (L) proficiency*

Cardiac Catheterization – Adult (L) frequency*

Cardiac Catheterization – Adult (R) *

Cardiac Catheterization – Adult (R) proficiency*

Cardiac Catheterization – Adult (R) frequency*

Cardiac Catheterization – Peds (L) *

Cardiac Catheterization – Peds (L) proficiency*

Cardiac Catheterization – Peds (L) frequency*

Cardiac Catheterization – Peds (R) *

Cardiac Catheterization – Peds (R) proficiency*

Cardiac Catheterization – Peds (R) frequency*

Cardiac Catheterization – Peds (R) *

Cardiac Catheterization – Peds (R) proficiency*

Cardiac Catheterization – Peds (R) frequency*

Temporary Epicardial/Transthoratic Pacing *

Temporary Epicardial/Transthoratic Pacing proficiency*

Temporary Epicardial/Transthoratic Pacing frequency*

Temporary External Pacing *

Temporary External Pacing proficiency*

Temporary External Pacing frequency*

Temporary Transvenous Pacing *

Temporary Transvenous Pacing proficiency*

Temporary Transvenous Pacing frequency*

Peripheral *

Peripheral proficiency*

Peripheral frequency*

Cardiac Cath Lab Procedures *

Cardiac Cath Lab Procedures proficiency*

Cardiac Cath Lab Procedures frequency*

Emergency Procedures:

Proficiency Rating

Frequency Rating

Emergency Cardioversion *

Emergency Cardioversion proficiency*

Emergency Cardioversion frequency*

Anaphylaxis (Contras Media) *

Anaphylaxis (Contras Media) proficiency*

Anaphylaxis (Contras Media) frequency*

Vasovagal Response *

Vasovagal Response proficiency*

Vasovagal Response frequency*

Sepsis/Septic Shock *

Sepsis/Septic Shock proficiency*

Sepsis/Septic Shock frequency*

Cardiac Tamponade *

Cardiac Tamponade proficiency*

Cardiac Tamponade frequency*

Cardiogenic Shock *

Cardiogenic Shock proficiency*

Cardiogenic Shock frequency*

Embolism *

Embolism proficiency*

Embolism frequency*

Myocardial Infarction *

Myocardial Infarction proficiency*

Myocardial Infarction frequency*

TIA *

TIA proficiency*

TIA frequency*

Aortic Dissection *

Aortic Dissection proficiency*

Aortic Dissection frequency*

Cardiac / Respiratory *

Cardiac / Respiratory proficiency*

Cardiac / Respiratory frequency*

Emergency Defibrillation *

Emergency Defibrillation proficiency*

Emergency Defibrillation frequency*

CATH LAB PROCEDURES / CIRCULATE:

Cardiac Cath – Adult (L) *

Cardiac Cath – Adult (L) proficiency*

Cardiac Cath – Adult (L) frequency*

Cardiac Cath – Adult (R) *

Cardiac Cath – Adult (R) proficiency*

Cardiac Cath – Adult (R) frequency*

Cardiac Cath – Peds (L) *

Cardiac Cath – Peds (L) proficiency*

Cardiac Cath – Peds (L) frequency*

Cardiac Cath – Peds (R) *

Cardiac Cath – Peds (R) proficiency*

Cardiac Cath – Peds (R) frequency*

Permanent Pacemaker *

Permanent Pacemaker proficiency*

Permanent Pacemaker frequency*

Temporary Pacing *

Temporary Pacing proficiency*

Temporary Pacing frequency*

AICD Pacemakers / Biventricular Pacer *

AICD Pacemakers / Biventricular Pacer proficiency*

AICD Pacemakers / Biventricular Pacer frequency*

Angioplasty/PCI *

Angioplasty/PCI proficiency*

Angioplasty/PCI frequency*

Arrhythmia Ablation *

Arrhythmia Ablation proficiency*

Arrhythmia Ablation frequency*

Thromolysis *

Thromolysis proficiency*

Thromolysis frequency*

AngioJet *

AngioJet proficiency*

AngioJet frequency*

Rotational Coronary Atherectomy *

Rotational Coronary Atherectomy proficiency*

Rotational Coronary Atherectomy frequency*

Cardiac Biopsy *

Cardiac Biopsy proficiency*

Cardiac Biopsy frequency*

Pericardiocentesis *

Pericardiocentesis proficiency*

Pericardiocentesis frequency*

Chest Tube Placement *

Chest Tube Placement proficiency*

Chest Tube Placement frequency*

Valvuplasty *

Valvuplasty proficiency*

Valvuplasty frequency*

IABP *

IABP proficiency*

IABP frequency*

TEE *

TEE proficiency*

TEE frequency*

CAVH *

CAVH proficiency*

CAVH frequency*

Controlled Cardioversion *

Controlled Cardioversion proficiency*

Controlled Cardioversion frequency*

Closure of ASD *

Closure of ASD proficiency*

Closure of ASD frequency*

Closure of VSD *

Closure of VSD proficiency*

Closure of VSD frequency*

Closure of Patent Foramen Ovale *

Closure of Patent Foramen Ovale proficiency*

Closure of Patent Foramen Ovale frequency*

Tilt Table Testing *

Tilt Table Testing proficiency*

Tilt Table Testing frequency*

Brachytherapy *

Brachytherapy proficiency*

Brachytherapy frequency*

Intravascular Ultrasound *

Intravascular Ultrasound proficiency*

Intravascular Ultrasound frequency*

Patient Care

Proficiency Rating

Frequency Rating

List Hemodynamic Systems you have worked with:

List Any Additional Equipment:

List Any Additional Skills:

Age

Proficiency Rating

Frequency Rating

Age-Appropriate Care:

Ability to adapt care to incorporate normal growth and development, adapt method and terminology of client instructions as it relates to the age and comprehension level of the client, and to ensure a safe environment - reflecting specific needs of the client and various age groups.

Adults *

Adults proficiency*

Adults frequency*

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I certify that I have provided true and accurate information about my skills and experience to the best of my ability

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Date*

Skills/Competences

Proficiency

Frequency

CATH LAB RN

Age-Appropriate Care:

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