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Cath Lab Tech
Cath Lab Tech
Name
First
Last
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale:
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Age of Patient Cared For
No Experience
Limited Experience
Experienced
Highly Skilled
Peds
Adults
Circulating Role (PAV)
No Experience
Limited Experience
Experienced
Highly Skilled
Airway Maintenance
Arm Cases
Biopsy
Co-Ox Setup Q.C., Run Sample
Defibrillator Setup/Use
IABP
Power Injector Setup/Use
Left Heart Catheterization
Right Heart Catheterization
PTCA/ Stents/ Balloons
Radiation Protection
Atherectomy
Permanent Pacemaker
Temporary Pacemaker
Setting Threshold of Pacemakers
Rotablator
Sphygmomanometer Monitoring
Transducer Setup/Calibration
Run Angiojet Machine
IVUS
Hemodynamic Monitoring
No Experience
Limited Experience
Experienced
Highly Skilled
Biopsy
Handoff Reports
Left Heart Caths
Right Heart Caths
Hematoma Recognition & Mgt
Coronary Intervention
Coronary Atherectomy
IVUS
Intra Aortic Balloon Pump
EP Study
Ablation
Rotablator
FFR
Scrub Position
No Experience
Limited Experience
Experienced
Highly Skilled
Left Heart Catheterization
Right Heart Catheterization
Coronary Intervention
Stent Implantation
Rotational Coronary Atherectomy
IVUS
Intra Aortic Balloon Pump
Biopsy
Closure Device
Temporary Pacemakers
Angiojet
Radial
Brachial
Peripherals
IVUS
FFR
Impella
PPM
ICD
BiV
Loop Recorder
Structural Heart
Manifold
ACIST/Medrad
Hybrid OR
Atherectomy
Simultaneously Scrub & Pan Xray Table
Cath Lab/Angio/Specials - Equipment
No Experience
Limited Experience
Experienced
Highly Skilled
Phillips
Siemens
Toshiba
GE
Siemens Artis Zeego
Shimadzu
Cannon Alphenix
Electronic Documentation
Hemodynamic Monitoring Equipment
No Experience
Limited Experience
Experienced
Highly Skilled
GE MacLab Marquette
Mennen
Merge Cardio/ Camtronics VERICIS
McKesson
Philips Xper IM/ WITT
Siemens Sensis
Signature
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