Pediatric Skills Checklist

Name(Required)
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 done

Blood / Blood Product Administration / Precautions(Required)
Calculation of Rates(Required)
Mcg / min(Required)
Mcg / kg / min(Required)
Mg / min(Required)
Hang IV Piggyback(Required)
Heparin Lock(Required)
Hyperalimentation(Required)
Peripheral / Central Line(Required)
Knowledge of Solution(Required)
Insertion of Central Line(Required)
Use of Broviac / Hickman / Groshong Catheters(Required)
Lab Assessment(Required)
Implanted Venous Access Ports(Required)
Dressing Changes(Required)
Insertion of Peripheral Line(Required)
Dressing Change(Required)
D / C Line(Required)
Universal Precautions(Required)
Isolation Procedures(Required)
Airborne Isolations(Required)
Wound / Blood Isolations(Required)
Specimen Collection(Required)
Arterial Line Blood Draw(Required)
Blood Culture(Required)
Capillary Blood Draw(Required)
Central Line Blood Draw(Required)
PICC Line Blood Draw(Required)
Sputum(Required)
Stool(Required)
Urine Culture(Required)
Urinalysis(Required)
Venipuncture(Required)
Wound Culture(Required)
Normal Anatomy of the Heart(Required)
Left Side(Required)
Right Side(Required)
Resuscitation(Required)
Team Member(Required)
Perform Defibrillation(Required)
Perform / Set Up Emergent Cardioversion(Required)
Prepare and Administer Meds(Required)
Set Up and Interpret 12 Lead EKG(Required)
Administer Oxygen(Required)
Use of Apnea Monitor(Required)
Assess Lung Sounds(Required)
Incentive Spirometer(Required)
Nebulizer(Required)
Normal Physiology of Pulmonary Vascular System(Required)
Obtain Arterial Blood Gas(Required)
Result Interpretation(Required)
Pavulonized Patient(Required)
Pulse Oximetry(Required)
Suctioning(Required)
Use of Emergency Equipment(Required)
Insulin Preparation and Administration(Required)
Blood Glucose Monitoring(Required)
Equipment Used(Required)
Jejunostomy Care(Required)
NG Tube Insertion / Lavage(Required)
Normal Physiology of Renal and GI System(Required)
Ostomy / Stoma Care(Required)
Peritoneal Lavage(Required)
Poison Control(Required)
Wound Care Irrigations(Required)
Consent for Treatment of a Minor(Required)
Procedure for Patient Signing AMA(Required)
Disaster Protocols(Required)
Assist with Peritoneal Lavage(Required)
Misc. Trays / Instruments(Required)
Pelvic Tray(Required)
Cut Down Tray(Required)
Procto Tray(Required)
CVP Tray(Required)
Culdocentesis Tray(Required)
Thoracentesis Tray(Required)
Pediatrics(Required)
Administration of Medication(Required)
Oral(Required)
Subcutaneous(Required)
Intramuscular(Required)
Pediatric Nursing(Required)
Anorexic Patient Care(Required)
Assist with Lumbar Puncture(Required)
Respiratory Distress Syndrome(Required)
Broncho-pulmonary Dysplasia(Required)
Croup(Required)
Epiglottitis(Required)
Asthma(Required)
Cystic Fibrosis(Required)
Pneumonia(Required)
Near Drowning(Required)
Near SIDS(Required)
Chest Tubes(Required)
Reye's Syndrome(Required)
Meningitis(Required)
Hydrocephalus(Required)
Spina Bifida(Required)
Lead Play Therapy(Required)
Care of the Child with Seizures(Required)
Sickle Cell(Required)
Equipment(Required)
Apnea Monitor(Required)
Cardiac Monitor(Required)
Ventilator(Required)
ECMO(Required)
Care of the Child with(Required)
Child Abuse(Required)
Failure to Thrive(Required)
Cleft Palate(Required)
Post Tonsillectomy(Required)
Dying Infant / Child(Required)
Diabetes Mellitus(Required)
Psych Patients(Required)

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