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Proﬁciency Scale:

1 – No Experience

2 – Need Training

3 – Able to perform with supervision

4 – Able to perform independently

GENERAL

Admit patient to pre-procedure holding

Complete assessments, obtain family history & risk factors

Start peripheral IV

Complete pre-procedure checklist

Transport pre-procedure patient to the Lab

Transport post-procedure patient to in-hospital units

PROCEDURES

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 – Prepare

Temporary Hemodialysis Shunt – Assist

Permanent Hemodialysis Shunt – Prepare

Permanent Hemodialysis Shunt – Assist

AV Fistula/Shunt Declotting – Prepare

AV Fistula/Shunt Declotting – Assist

Vertebroplasty – Prepare

Vertebroplasty – Assist

Lumbar Puncture – Prepare

Lumbar Puncture – Assist

Myelogram – Prepare

Myelogram – Assist

Other Procedures

Provide care for the post-procedure patient

CARDIOVASCULAR

Assess heart sounds and peripheral pulses

Interpret arrhythmias

Perform CPR

Perform defibrillation

Participate as a team member in resuscitation

PULMONARY

Assess lung sounds

Set up oxygen devices

Obtain pulse oximetry reading

Interpret ABG

Use Ambu bag

Assist with intubation

Assist with chest tube insertion

Provide care for the patient with mechanical ventilation

MEDICATIONS

Titrate vasoactive drugs

Calculate mcg/min and mcg/kg/min

Use IV infusion pump to calculate drug doses

Administer IV dopamine

Administer IV nitroglycerine

Administer IV dobutamine (Dobutrex)

Administer IV lidocaine

Administer IV diltiazem (Cardizem)

Administer IV epinephrine

Administer IV atropine

Administer IV heparin

Administer IV benzodiazepines (Valium, Versed, Ativan)

Administer IV propofol (Diprivan)

Administer IV neuromuscular blocking agents (Pavulon, Norcuron)

Administer IV narcotics (morphine, fentanyl)

PAIN/WOUND MANAGEMENT

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

Pediatric (1-18 years)

Adolescents (12-18 years)

Adult (19-65 years)

Older adults (Older than 65 years)

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 65 years

Certifications	Expiration Date:
ACLS
BCLS
Other: Specify

Please list any additional areas of expertise below:

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