ICU SKILLS CHECKLIST

ICU Skills Checklist 

  • MM slash DD slash YYYY

  • NEUROLOGICAL

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Cranial Nerves
    Glasgow Coma Scale
    Level of conciousness
    Pathological reflexes
    Reflex or communication deficits
    Visual or communication deficits
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Assist with lumber puncture
    Halo traction / cervical tongs
    Intercranial pressure monitoring
    Nerve stimulators
    Rotating bed
    Seizure precautions
    Stryker frame
    Use of hyper/hypothermia blanket
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Aneurysm precautions
    Basal skull fracture
    Closed head injury
    Coma
    CVA
    DT's
    Encephalitis
    Externalized VP shunts
    Increased ICP
    Meningitis
    Metatastic tumor / cranial tumor
    Multiple sclerosis
    Post craniotomy
    Spinal cord injury
    Ventriculostomy
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Barbiturate induced coma
    Decadron (Dexamethasone)
    Dilantin (Phenytoin)
    Epidural administration
    Phenobarbital
    Valium (Diazepam)

  • ENDORINE/METABOLIC

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Blood glucose
    Thyroid studies
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Blood glucose measuring device (type________)
    Blood glucose monitoring
    Performing finger stick
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Diabetes mellitus
    Disorders of adrenal gland (Addison’s)
    Disorders of the pituitary glad (DI)
    Drug overdose
    Hyperthyroidism (Graves disease)
    Hypothyroidism
    Insulin shock
    Thyroidectomy
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Insulin pump

  • PULMONARY

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Adventitious breath sounds
    Rate and work of breathing
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Arterial blood gases
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Air leak troubleshooting:
    - Medicinal chest tube removal
    - Pleural chest tube removal
    Airway management devices/suctioning:
    - Endotacheal tube/suctioning
    - Extubation
    - Nasal airway suctioning
    - Oximetry
    - Sputum specimen collection
    - Tracheostomy/suctioning
    Assist with:
    - Bronchoscope
    - Chest tube insertion
    - Emergency Trachoestomy
    - Thoracentesis
    Establishing an airway:
    - Assist with intubation
    - Laryngospasm
    - Tension Pneumothorax
    - Tension Pneumothorax
    - Use of Pleurevac or Thoraclex drainage
    - Use of wather seal drainage
    O2 therapy & medication delivery systems:
    - Ambu bag & mask
    - ET Tube
    - Face mask
    - Nasal Cannula
    - Portable O2 tank
    - Trach collar
    Ventilator Management:
    - External CPAP
    - High frequency jet ventilation
    - IMV
    - PEEP
    - Pressure Support
    - Weaning modes & T-Piece weaning
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Acute pneumonia
    ARDS
    Chest trauma
    COPD
    Fresh Tracheostomy
    Lobectomy
    Lung Transplant
    Pneumonectomy
    Pulmonary edema/hypertension
    Pulmonary embolism
    Status asthmaticus
    Thoracotomy
    Tuberculosis
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Alupent (Metaproterenol sulfate)
    Aminophylline (Theophylline)
    Aminophylline (Theophylline)
    Bronkosol (Isoetharine Hydrachloride)
    Corticisteroids
    Venolin (Albuterol)

  • CARDIOVASCULAR

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Abnormal heart sounds/murmurs
    Auscultation (rate, rhythm, volume)
    Blood pressure/non-invasive
    Doppler
    Pulses/circulation checks
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Cardiac enzymes & isoenzymes
    Coagulation studies
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Assist with:
    - Arterial line insertion
    - Central line insertion
    - Open chest emergency
    - PA catheter/Swan Ganz Insertion
    - Pericardocentesis
    - Transesophageal echocardiogram
    - Automatic internal cardioverter
    - Cardioversion
    - CAVH-D
    Hemodynamic monitoring:
    - Cardiac index
    - Cardiac output
    - CVP monitoring
    - Femoral artery sheath removal
    - MAP
    - PA/Swan-Ganz
    - PCW pressure
    - PVR
    - Radial a-line
    - SV02
    - SVR
    - Intra aortic baloon pump
    Monitoring:
    - 12 lead EKG interpreatation
    - Arthymia interpretation
    - Lead placement
    - Rhythm strip assessment
    - Set up and rerun 12 lead EKD
    - Pacemaker
    - External
    - Temporary
    - Permanent
    - Transthoracic (epicardial)
    - Ventricular assit device (RVAD/LVAD)
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Abdominal aortic aneurysm repair
    Acute MI
    Cardiac arrest
    Cardiac tamponade
    Congestiv heart failure
    EP study & abalation
    Heart transplant
    Infective endocarditis
    Immediate open heart surgery
    Infective endocarditis
    Myocardial contusion
    Pericarditis
    Post AICD insertion
    Post artherectomy DCA
    Post commssuortomy valve
    Post Percutaneous balloon valvuloplasty
    Post rotoblade
    Pre/post angeoplasty
    Pre/post cardiac cath
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Amiodarone (Cordarone)
    Atropline
    Bicarbonate
    Bretylium (Bretylol)
    Digoxin (lanoxin)
    Diltiazaem (Cardizem)
    Dobutamine (Dobutrex)
    Dopamine (Intropin)
    Epinephrine (Adrenalin)
    Esmolol (Brevibloc)
    Inocor (Amirone)
    Lidoncane (Xylocane)
    Nipride (Nirtoprusside)
    Procainamide (Pronestyl)
    Reteplase recombinant (Retavase)
    Strepokinase
    TPA (Alteplase)
    Verapamil (Calan, Isoptin, Verelan)

  • PAIN MANAGEMENT

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Assessment of pain level tolerance
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Epidural anesthesia/analgesia
    IV conscious sedation
    Patient controlled analgesia

  • RENAL/GENITOURINARY

  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Arterio venous fistula/shunt
    Fluid balance
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    BUN & creatinine
    Electrolytes
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Bladder irrigations
    Insertion & care of straight Foley catheter:
    3-way Foley
    - Female
    - Male
    Supra-pubic
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Acute renal failure
    CAVH Dialysis
    Hemodialysis
    Nephrectomy
    Peritoneal dialysis
    Renalrejection syndrome
    TURP
    Urinary diversion (ileal conduit nephrostomy)
    Urinary tract infection
  • 1 = No Experience2 = Little Experience3 = Moderate Experience4 = Extensive Experienced
    Alupent (Metaproterenol sulfate)
    Aminophylline (Theophylline)
    Bronkosol (Isoetharine Hydrachloride)
    Corticisteroids
    Corticisteroids

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