Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastPlease enter your full legal name as it appears on your Social Security Card.PhoneEmail * No experience: requires education, training and supervision Intermittent experience: may need support or supervise Proficient: consistent experience, independent Expert level: can teach/supervise others. Work settingDiagnostic Cardiac Cath lab1234Electrophysiology (EP) Lab1234Interventional Cardiac Cath lab1234Interventional Radiology1234Special Procedures1234Cardiac Cath Lab ProceduresAICD placement1234Aortography1234ASD Closures1234Brachytherapy1234Cardiac Biopsy1234Cardiac Implant Closure Device1234Cardiac Stent Placement1234Cardio MEMS1234Circulating1234Coronary Atherectomy1234Diagnostic Catheterizations Adult1234Diagnostic Catheterizations Pediatric/Neonatal1234ECMO1234Hemodynamic Monitoring1234Hemodynamic Monitoring1234IABP Placement/Removal1234Impella insertion1234Internal Mammary Angiography1234Laser Assisted Procedures1234Left heart catheterization1234Mitraclips1234Orbital athrectomy1234Optical Coherence Tomography (OCT)1234Pacemaker/Defibrillator lead extraction/removal1234Patent Foramen Ovale Transcather (PFO) Repair1234Percutaneous Coronary Interventions (PCI)1234Percutaneous Transluminal Coronary Angioplasty 1234Permanent Pacemaker Insertion (PPI)1234Pulmonary Artery (PA) line insertion1234Right heart catheterization1234Rotablader Athrectomy1234Saphenous Vein Graft Angiography1234Scrubbing1234Temporary Pacemaker1234Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR)1234Transesophageal Echocardiography (TEE)1234Transluminal Extraction Catheter1234Valvuloplasty1234Ventricular Assist Device Insertion1234Watchman1234Equipment/Operation/MaintenanceAutomatic Implantable Cardiac Defibrillator1234Operation of physiologic and radiographic equipment1234Troubleshoots/document equipment malfunction1234Electrophysiology StudiesArrhythmia Induction1234Baseline Measurements1234Cardiac Ablation1234Cardiac Mapping1234Cardioversion1234Conduction Studies1234Electrophysiology Evaluation1234Insertion/Programming of AICDs1234Left Atrial Appendage (LAA) Closure1234Pacemaker Insertion1234Tilt Table Study1234Equipment/Operation/MaintenanceAutomatic Implantable Cardiac Defibrillator1234Maintains equipment1234Maintains inventory1234Operation of physiologic and radiographic equipment1234Stocks supplies1234Troubleshoots/document equipment malfunction1234Interventional Radiology Abdominal and PelvicAdrenal angiography1234Angioplasty1234Aortography1234Chemoembolization1234Chest tube placement1234Embolization1234Endograft placement1234ERCP1234Esophageal Stent Placement1234Gastrostomy Tube placement1234Inferior Vena Cava (IVC) filter placement1234Inferior Vena Cava (IVC) filter removal1234Inferior vena cavogram1234Liver Biopsy1234Mesenteric Angiogram1234Paracentesis1234Pelvic angiography1234Percutaneous Hepatic Angiography1234Pulmonary arteriography1234Radiofrequency Ablation (RFA) of the liver1234Radio embolization1234Renal angiography1234Selective visceral angiography1234Stent placement1234Superior vena cavogram1234Thoracentesis1234Genitourinary Studies/ProceduresAdrenal Angiography1234Angiography of Genitourinary System1234Catheter/drain exchange1234Cholecystostomy1234Cystoscopy1234Embolization1234Gastrostomy1234Internal/external biliary drainage1234Nephrostomy1234Percutaneous Stone Extraction1234Percutaneous transhepatic cholangiogram1234Renal Angiography1234Renal Artery Stent Placement1234Ureteral Stent Placement1234Uterine Arterial Embolization1234Neurological Studies/ProceduresAngioplasty1234Carotid Angiography1234Cerebral Angiography1234Discogram1234Embolization1234Spinal Arteriography1234Stent Placement1234Thrombolysis/Thrombectomy1234Thrombolysis/Thrombectomy1234Vertebroplasty1234Vascular Studies/ProceduresAbdominal Aortography1234TIPS (Trans-jugular Intrahepatic portosystemic Shunt)1234Venous sampling1234Angioplasty1234Atherectomy1234Carotid Stenting1234Central Venous Access/Port Placement1234Dialysis Graft Creation/Revision1234Dialysis Graft interventions (fistulograms/declots)1234Endovascular Interventions1234Thoracic Aortography1234Upper and Lower Extremity Angiography1234Venous AccessCentral Venous Access (non-Tunneled/PICC lines)1234Central Venous Access (Tunneled Port)1234PICC Lines- Care and Maintenance1234Central Venous Lines- Care and Maintenance1234Blood Draw from PICC/CVL1234Access management of implanted ports1234IV infusion pumps1234Equipment and DevicesComputed tomography1234Crash Carts1234Defibrillators1234Fluoroscopy1234GE Innova IGS1234Magnetic resonance imaging1234Portable Monitors1234Restraints1234Siemens1234Ultrasound1234Procedural ResponsibilitiesAccuate monitoring1234Age/gender specific care1234Daily QC checks1234Equipment set up1234External Compression Devices (C-Clamp, Sandbags)1234Hemodynamic and computer set up1234Maintain logs, records, quality assurance1234Maintains equipment/supplies1234Monitoring and recording hemodynamic monitoring1234Operates x-ray Equipment1234Perform EKG lead Placement1234Prep Access Site1234Radiation Precautions1234Recognition of intra-cardiac electrocardiogram and measure intervals1234Recognition of life-threatening arrhythmias1234Room circulator1234Scrub- maintain sterile field1234Stocking rooms1234Topical Hemostasis (D-Stat, Chito-Seal, Syvek Patch)1234Transporting patients1234Vascular Closure Systems (Perclose, StarClose)1234Working knowledge of formula to calculate gradients, shunts, and cardiac outputs1234Professional Knowledge and SkillsIsolation Precautions1234National Patient Safety Goals/Core Measures1234Pain Assessment and Management1234Pressure Ulcer Assessment/Prevention1234Restraint Use1234Use of Rapid Response team1234Infection Control1234Cleaning of equipment1234Donning and removing PPE1234Isolation precautions1234Proper waste disposal1234Sharps disposal1234Standard precautions1234Sterile Technique1234Age specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234COMPUTERIZED CHARTINGCerner1234EPIC1234McKesson1234Meditech1234Allscripts1234Submit
