Pediatric Skills Checklist Name* First Last Date* Date Format: MM slash DD slash YYYY Please use the following key: 1 = Done Frequently; well skilled 2 = Occasionally Done; moderately skilled 3 = Rarely Done; skill limited 4 = Observed only; never doneBlood / Blood Product Administration / Precautions*1234Calculation of Rates*1234Mcg / min*1234Mcg / kg / min*1234Mg / min*1234Hang IV Piggyback*1234Heparin Lock*1234Hyperalimentation*1234Peripheral / Central Line*1234Knowledge of Solution*1234Insertion of Central Line*1234Use of Broviac / Hickman / Groshong Catheters*1234Lab Assessment*1234Implanted Venous Access Ports*1234Dressing Changes*1234Insertion of Peripheral Line*1234Dressing Change*1234D / C Line*1234Universal Precautions*1234Isolation Procedures*1234Airborne Isolations*1234Wound / Blood Isolations*1234Specimen Collection*1234Arterial Line Blood Draw*1234Blood Culture*1234Capillary Blood Draw*1234Central Line Blood Draw*1234PICC Line Blood Draw*1234Sputum*1234Stool*1234Urine Culture*1234Urinalysis*1234Venipuncture*1234Wound Culture*1234Normal Anatomy of the Heart*1234Left Side*1234Right Side*1234Resuscitation*1234Team Member*1234Perform Defibrillation*1234Perform / Set Up Emergent Cardioversion*1234Prepare and Administer Meds*1234Set Up and Interpret 12 Lead EKG*1234Administer Oxygen*1234Use of Apnea Monitor*1234Assess Lung Sounds*1234Incentive Spirometer*1234Nebulizer*1234Normal Physiology of Pulmonary Vascular System*1234Obtain Arterial Blood Gas*1234Result Interpretation*1234Pavulonized Patient*1234Pulse Oximetry*1234Suctioning*1234Use of Emergency Equipment*1234Insulin Preparation and Administration*1234Blood Glucose Monitoring*1234Equipment Used*1234Jejunostomy Care*1234NG Tube Insertion / Lavage*1234Normal Physiology of Renal and GI System*1234Ostomy / Stoma Care*1234Peritoneal Lavage*1234Poison Control*1234Wound Care Irrigations*1234Consent for Treatment of a Minor*1234Procedure for Patient Signing AMA*1234Disaster Protocols*1234Assist with Peritoneal Lavage*1234Misc. Trays / Instruments*1234Pelvic Tray*1234Cut Down Tray*1234Procto Tray*1234CVP Tray*1234Culdocentesis Tray*1234Thoracentesis Tray*1234Pediatrics*1234Administration of Medication*1234Oral*1234Subcutaneous*1234Intramuscular*1234Pediatric Nursing*1234Anorexic Patient Care*1234Assist with Lumbar Puncture*1234Respiratory Distress Syndrome*1234Broncho-pulmonary Dysplasia*1234Croup*1234Epiglottitis*1234Asthma*1234Cystic Fibrosis*1234Pneumonia*1234Near Drowning*1234Near SIDS*1234Chest Tubes*1234Reye's Syndrome*1234Meningitis*1234Hydrocephalus*1234Spina Bifida*1234Lead Play Therapy*1234Care of the Child with Seizures*1234Sickle Cell*1234Equipment*1234Apnea Monitor*1234Cardiac Monitor*1234Ventilator*1234ECMO*1234Care of the Child with*1234Child Abuse*1234Failure to Thrive*1234Cleft Palate*1234Post Tonsillectomy*1234Dying Infant / Child*1234Diabetes Mellitus*1234Psych Patients*1234 This iframe contains the logic required to handle Ajax powered Gravity Forms.