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1.877.891.4286
1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Infusion RN – Skills Checklist
This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age of Patients Cared For
Newborn/Neonate (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age Child (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (79+ years)
*
0
1
2
3
4
5
General Skills
Care of Patient in Restraints
*
0
1
2
3
4
5
Automated Med Dispensing Systems
*
0
1
2
3
4
5
Automated Med Dispensing Systems - List Types
*
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Access/Management of Implanted Ports
*
0
1
2
3
4
5
Access/Management of Central Lines
*
0
1
2
3
4
5
Titration of Drips
*
0
1
2
3
4
5
Administration of Blood/Blood Products
*
0
1
2
3
4
5
Knowledge of Current IV Therapy Guidelines
*
0
1
2
3
4
5
Knowledge of Anatomy
*
0
1
2
3
4
5
Moderate Conscious Sedation
*
0
1
2
3
4
5
Sedation Reversal Agents
*
0
1
2
3
4
5
Insertion Of
Peripheral IV – Adult
*
0
1
2
3
4
5
Peripheral IV – Child
*
0
1
2
3
4
5
Peripheral IV – Neonate
*
0
1
2
3
4
5
Vein Selection – Peripheral IVs
*
0
1
2
3
4
5
Interosseous Needles
*
0
1
2
3
4
5
Midline/Picc Lines
Midline Catheter Insertion – Adult
*
0
1
2
3
4
5
Midline Catheter Insertion – Child
*
0
1
2
3
4
5
Indications for Midline/PICC Placement
*
0
1
2
3
4
5
Contraindications for Midline/PICC Placement
*
0
1
2
3
4
5
Vein Selection
*
0
1
2
3
4
5
Measuring Technique
*
0
1
2
3
4
5
Catheter and Introducer Device Selection
*
0
1
2
3
4
5
Correct Tip Placement
*
0
1
2
3
4
5
Insertion Technique – Basic (Vein)
*
0
1
2
3
4
5
Insertion Technique – Seldinger
*
0
1
2
3
4
5
Insertion Technique – Ultrasound
*
0
1
2
3
4
5
Assist with Insertion in Interventional Radiology
*
0
1
2
3
4
5
Insertion Site Preparation
*
0
1
2
3
4
5
Maintaining Sterile Field
*
0
1
2
3
4
5
Securing Insertion Site Post Placement
*
0
1
2
3
4
5
X-Ray Assessment for Tip Location
*
0
1
2
3
4
5
Repositioning After X-Ray
*
0
1
2
3
4
5
Care and Maintenance
Peripheral IV
*
0
1
2
3
4
5
Scalp IV
*
0
1
2
3
4
5
Heparin/Saline Lock
*
0
1
2
3
4
5
Groshong PICC
*
0
1
2
3
4
5
Groshong CVL
*
0
1
2
3
4
5
Hickman/Broviac
*
0
1
2
3
4
5
Port-a-Cath
*
0
1
2
3
4
5
Vascath
*
0
1
2
3
4
5
Multilumen Catheters
*
0
1
2
3
4
5
Subclavian Line
*
0
1
2
3
4
5
IJ Line
*
0
1
2
3
4
5
Femoral Line
*
0
1
2
3
4
5
Power PICC
*
0
1
2
3
4
5
Power Port
*
0
1
2
3
4
5
Dressing Changes
*
0
1
2
3
4
5
Cap Changes
*
0
1
2
3
4
5
Flushing Lines (Frequency/Solution)
*
0
1
2
3
4
5
Medication Administration
Chemotherapy
*
0
1
2
3
4
5
Heparin
*
0
1
2
3
4
5
Streptokinase
*
0
1
2
3
4
5
TPA (Alteplase)
*
0
1
2
3
4
5
Lidocaine
*
0
1
2
3
4
5
TPN/Lipids
*
0
1
2
3
4
5
Ativan
*
0
1
2
3
4
5
Valium
*
0
1
2
3
4
5
Versed
*
0
1
2
3
4
5
Fentanyl
*
0
1
2
3
4
5
Equipment
IV Pumps
*
0
1
2
3
4
5
IV Pumps - List Types
*
Needleless Systems
*
0
1
2
3
4
5
Blood Warmer
*
0
1
2
3
4
5
PCA Pumps
*
0
1
2
3
4
5
Pressure Lines
*
0
1
2
3
4
5
Troubleshooting/Complications
Repair PICC
*
0
1
2
3
4
5
Repair Midline
*
0
1
2
3
4
5
Air Embolism
*
0
1
2
3
4
5
Bleeding
*
0
1
2
3
4
5
Brachial Plexus Injury
*
0
1
2
3
4
5
Cardiac Arrhythmia
*
0
1
2
3
4
5
Cardiac Tamponade
*
0
1
2
3
4
5
Catheter Erosion
*
0
1
2
3
4
5
Catheter Embolism
*
0
1
2
3
4
5
Catheter Occlusion
*
0
1
2
3
4
5
Catheter-Related Sepsis
*
0
1
2
3
4
5
Endocarditis
*
0
1
2
3
4
5
Exit Site Infection
*
0
1
2
3
4
5
Exit Site Necrosis
*
0
1
2
3
4
5
Extravasation
*
0
1
2
3
4
5
Hematoma
*
0
1
2
3
4
5
Laceration of Vessels or Viscus
*
0
1
2
3
4
5
Myocardial Erosion
*
0
1
2
3
4
5
Perforation of Vessels or Viscus
*
0
1
2
3
4
5
Phlebitis
*
0
1
2
3
4
5
Catheter Tip Malposition or Retraction
*
0
1
2
3
4
5
Thromboembolism
*
0
1
2
3
4
5
Venous Thrombosis
*
0
1
2
3
4
5
Ventricular Thrombosis
*
0
1
2
3
4
5
Vessel Erosion
*
0
1
2
3
4
5
Declotting Peripheral Site
*
0
1
2
3
4
5
Complications from Sedation
*
0
1
2
3
4
5
Discontinuing IV Therapy
Peripheral IVs
*
0
1
2
3
4
5
PICC/Midline
*
0
1
2
3
4
5
Central Lines
*
0
1
2
3
4
5
Other Skills
Please List:
*
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*