Interventional Radiology Skills Checklist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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AGE

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Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64+)

GENERAL SKILLS

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Standard Precautions
Isolation Precautions
Sterile Field
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Adult Ventilator Management
Care of Patient in Restraints
Pain Management
Automated Med Dispensing Systems
Care Planning & Discharge Planning
Patient/Family Education
Electronic Documentation
Patient Head to Toe Examination
Pulse Oximetry
Use of Portable Monitors
Cardiac Monitoring
EKG Interpretation (Basic)
Airway Management
Oxygen Delivery Devices
Care of the Patient Under Neutropenic or Bleeding Precautions
End of Life Care

CIRCULATE- ASSIST WITH INSERTION/REMOVAL/REPAIR OF:

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Hickman CVL
Broviac CVL
Subclavian CVL
Jugular CVL
Groshong CVL
PICC
Implantable Ports/Infusaport/Mediport
Femoral Line
Hemodialysis Catheter
Declotting Central Venous Lines

SCRUB-ASSIST WITH INSERTION/REMOVAL/REPAIR OF:

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Hickman CVL
Broviac CVL
Subclavian CVL
Jugular CVL
Groshong CVL
PICC
Implantable Ports/Infusaport/Mediport
Hemodialysis Catheter
Declotting
TIPPS
Angiography
Cerebral Angiogram
Spinal Angiogram
Ultrasound or CT Guided Biopsy
Uterine Fibroid Embolization
Vertebroplasty
Myelogram
Lumbar Puncture

SCRUB THE FOLLOWING PROCEDURES

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EKOS
Nephrostomy Tubes
G-tube
PEG Tube
Y90 Peripherals
Renals
Coiling
Neuro Intervention
Neuro Angiography
Carotid Intervention
Carotid Angio
Pedal Access
Laser
Snare
Thrombectomy/ Thrombolysis
Nephroureteral Stents
Epistaxis Embolization
Angiography
Spinal Angiogram
Ultrasound or CT Guided Biopsy
Uterine Fibroid Embolization
Vertebroplasty/ Kyphoplasty
Myelogram
Lumbar Puncture

Position Category

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Total Years of Experience

First Name

Last Name

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize MetaSense, Inc. (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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