Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Age of Patients Cared For
Newborn (birth - 30 days)
Infant (30 days - 1 year)
Preschooler (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39 - 64 years)
Preparation of Examination Room
Identification of Patient
Patient Assessment & Education Regarding Procedure
Image Optimization (Ex: Transducer Selection, Focal Zone, FOV)
Documentation of Procedure and Patient Data
Correlation of Adjunct Imaging Studies to Breast Sonogram
Biliary Tract/ Gallbladder / CBD
Superficial Structures Studies
Fetal Biophysical Profile
Interventional Procedures
Venipuncture / IV Placement
Pediatric Respiratory / Cardiac Arrest
Adult Respiratory / Cardiac Arrest
Pharmacological Stress Echo
Imaging with Contrast Agents
Parasternal Long Axis View
Right Ventricular Inflow Tract (RVIT)
Right Ventricular Outflow Tract (RVOT)
Diastolic Dysfunction Evaluation
Proximal Isovelocity Surface Area
Aortic Arch Abnormalities / Vascular Ring
Coronary Artery Anomalies
Hypoplastic Heart Syndrome
Pulmonary Venous Return Anomalies
Transposition of the Great Vessels
Tricuspid and Pulmonary Atresia
Univentricular Heart Anomalies
Pediatric Post-Surgical Scans
Arterial/Venous - Superior Mesenteric
Arterial/Venous - Inferior Mesenteric
Arterial / Venous - Hepatic
Arterial / Venous - Common Iliac
Arterial / Venous - Internal Iliac
Arterial / Venous - External Iliac
Arterial / Venous - Renal
Arterial / Venous - Splenic
Venous - Inferior Vena Cava
Posterior Tibial or Anterior Tibial or Peroneal
Segmental Pressure-Upper Extremities
ABI or Segmental Pressure-Lower Ext
PVR (Pulse Volume Recording)
Post Intervention Procedures
Post Catheterization Complications
Dialysis Access Grafts/ Fistulae