Interventional Radiology

Age

Newborn (0-30days)*

1
2
3
4

Infant (30 days-1year)*

1
2
3
4

Toddler (1-3 years)*

1
2
3
4

Preschooler (3-5 years)*

1
2
3
4

School Age (5-12 years)*

1
2
3
4

Adolescents (12-18 years)*

1
2
3
4

Young Adult (18-39 years)*

1
2
3
4

Middle Adult (39-34 years)*

1
2
3
4

Older Adult (64+ years)*

1
2
3
4

General Skills

Standard Precautions*

1
2
3
4

Isolation Precautions*

1
2
3
4

Sterile Field*

1
2
3
4

Care of Patient in Restraints*

1
2
3
4

Cardiac Monitoring - Basic*

1
2
3
4

Interpretation of Arrhythmias (Basic)*

1
2
3
4

Emergency Medications*

1
2
3
4

Adult Cardiac/Respiratory Arrest*

1
2
3
4

Pediatric Cardiac/Respiratory Arrest*

1
2
3
4

End of Life Care*

1
2
3
4

Crash Carts*

1
2
3
4

Defibrillators*

1
2
3
4

Automated Medication Dispensing Systems*

1
2
3
4

Adult Ventilator Management*

1
2
3
4

Automated Med Dispensing Systems*

1
2
3
4

Care Planning and Discharge*

1
2
3
4

Patient/Family Education*

1
2
3
4

Electronic Documentation*

1
2
3
4

Patient Head to Toe Examination*

1
2
3
4

Pulse Oximetry*

1
2
3
4

Use of Portable Monitors*

1
2
3
4

Airway Management*

1
2
3
4

Care of the Patient Under Neutropenic or Bleeding Precautions*

1
2
3
4

End of life care*

1
2
3
4

Circulating – Assist with Insertion/Removal/Repair of:

Hickman CVL*

1
2
3
4

Broviac CVL*

1
2
3
4

Subclavin CVL*

1
2
3
4

Jugular CVL*

1
2
3
4

Groshong CVL*

1
2
3
4

PICC*

1
2
3
4

Implantable Ports/Infusaport/Mediport*

1
2
3
4

Femoral Line*

1
2
3
4

Hemodialysis Catheter*

1
2
3
4

Declotting Central Venous Lines*

1
2
3
4

Scrub - Assist with Insertion/Removal/Repair of:

Hickman CVL*

1
2
3
4

Broviac CVL*

1
2
3
4

Subclavin CVL*

1
2
3
4

Jugular CVL*

1
2
3
4

Groshong CVL*

1
2
3
4

PICC*

1
2
3
4

Implantable Ports/Infusaport/Mediport*

1
2
3
4

Femoral Line*

1
2
3
4

Hemodialysis Catheter*

1
2
3
4

Declotting*

1
2
3
4

TIPPS*

1
2
3
4

Angiography*

1
2
3
4

Cerebral Angiogram*

1
2
3
4

Spinal Angiogram*

1
2
3
4

Ultrasound or CT Guided Biopsy*

1
2
3
4

Uterine Fibroid Embolization*

1
2
3
4

Vertebroplasty*

1
2
3
4

Myelogram*

1
2
3
4

Lumbar Puncture*

1
2
3
4

Scrub the Following Procedures

EKOS*

1
2
3
4

Nephrostomy Tubes*

1
2
3
4

G Tube*

1
2
3
4

PEG Tube*

1
2
3
4

Y90 Peripherals*

1
2
3
4

Renals*

1
2
3
4

Coiling*

1
2
3
4

Neuro Intervention*

1
2
3
4

Neuro Angiography*

1
2
3
4

Carotid Intervention*

1
2
3
4

Pedal Access*

1
2
3
4

Laser*

1
2
3
4

Snare*

1
2
3
4

Thrombectomy/Thrombolysis*

1
2
3
4

Nephroureteral Stents*

1
2
3
4

Epistaxis Embolization*

1
2
3
4

Angiography*

1
2
3
4

Spinal Angiogram*

1
2
3
4

Ultrasound or CT Guided Biopsy*

1
2
3
4

Uterine Fibroid Embolization*

1
2
3
4

Vertebroplasty/kyphoplasty*

1
2
3
4

Myelogram*

1
2
3
4

Lumbar Punture*

1
2
3
4

Electronic Documentation Systems (List Types):

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Magnet Medical to release this Skills Checklist to staffing clients of Magnet Medical. Submit this skills evaluation with your initial application. To be updated annually.

Name*

First Last

Email*

Signature

Date*

skills checklist

Age

General Skills

Circulating – Assist with Insertion/Removal/Repair of:

Scrub - Assist with Insertion/Removal/Repair of:

Scrub the Following Procedures

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