INTERVENTIONAL RADIOLOGY SKILLS EVAULATION
INTERVENTIONAL RADIOLOGY SKILLS EVAULATION
Personal Information
Name
First
Last
Title / Specialty
*
Email
*
Phone
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(###)
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###
####
General
Admit patient to pre-procedure holding
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Complete assessments
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Start peripheral IV
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Complete pre-procedure checklist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Transport pos-procedure patient to lab
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Transport post-procedure patient to unit
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Age Specific Criteria
Pediactric
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Adolescents
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Adult
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Older Adult
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Procedures
Cerebral Angiogram - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Cerebral Angiogram - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lower Extremity Angiogram - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lower Extremity Angiogram - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Upper Extremity Angiogram - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Upper Extremity Angiogram - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Ultrasound Guided Biopsy - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Ultrasound Guided Biopsy - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
CT Scan Guided Biopsy - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
CT Scan Guided Biopsy - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Liver biopsy and Embolization - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Liver biopsy and Embolization - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Prepare / Assist w/Line Placement - Broviac
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Prepare / Assist w/Line Placement - Groshong
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Prepare / Assist w/Line Placement - Hickman
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Prepare / Assist w/Line Placement - PICC
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Prepare / Assist w/Line Placement - PortaCath
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Uterine Fibroid Embolization - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Uterine Fibroid Embolization - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Temp Hemodialysis Shunt Placement - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Temp Hemodialysis Shunt Placement - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Perm Hemodialysis Shunt Placement - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Perm Hemodialysis Shunt Placement - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
AV Fistula / Shunt Declotting - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
AV Fistula / Shunt Declotting - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Vertebroplasty - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Vertebroplasty - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lumbar Puncture - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lumbar Puncture - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Myelogram - Prepare
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Myelogram - Assist
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Provide care for the post-procedure patient
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Cardiovascular
Assess heart sounds / peripheral pulses
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Interpret arrhythmias
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
CPR
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Perform defibrillation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Participate as a team member in resuscitation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Neurological
Identify sudden change in consciousness
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assess sensory, motor speech
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assess reflexes (Babinski, gag)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Pulmonary
Assess lung sounds
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Set up oxygen devices
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Obtain pulse oximetry reading
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Interpret ABG
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Use Ambu bag
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assist with intubation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assist with chest tube insertion
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Provide care for patient w/mechanical vent
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Pain / Wound Managment
Assess pain level / tolerance
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with anesthesia / analgesia
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with IV conscious sedation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with narcotic analgesia
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with PCA pump
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assess wound status with or w/o drains
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with sterile dressing changes
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care of patient with FemoStop device
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Assessment of VasoSeal, AngioSeal, PerClose
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Medications
Titrate vasoactive drugs
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Calculate mcg / min and mcg / kg / min
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Use IV infusion pump to calculate drug doses
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Dopamine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Nitroglycerine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Dobutamine (Dobutrex)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lidocaine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Diltiazem (Cardizem)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Epinephrine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Atropine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Heparin
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Benzodiazepines (Valium, Versed, Ativan)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Propofol (Diprivan)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Neuromuscular blocking agents (Pavulon & Norcuron)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Narcotics (Morphine, Fentanyl)
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Additional Information
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