Interventional Radiology Rn Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

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

Pulmonary

Medications

Pain/wound Management

Age Specific Practice Criteria

Experience With Age Groups

Certifications

	Expiration Date
ACLS
BCLS
Other: Specify

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.