Cardiovascular Sonography Handbook

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 I understand that upon an accident involving personal exposure to human blood or bodily fluids (including a needle stick) that occurs during my externship/practicum I will immediately notify my supervisor at the medical facility and the instructor supervising my externship/practicum.  I understand that following an accident involving potential exposure to blood-borne pathogens

that I should seek medical testing (HBV and HIV) immediately from physician or emergency room of my choice.

 I understand that I am required to adhere to all City College and the Cardiovascular Sonography department guidelines.

 Students participating in externship programs at hospitals and other medical facilities will be subject to that medical facility’s policies and procedures relating to this status at that facility. The medical facility where the student/extern may have policies and procedures that include requirements that the extern be able to perform the essential functions of the externship job position with or without reasonable accommodation. It is up to the extern/student to ascertain the essential job functions of the position and determine whether or not a particular externship is or is not suitable for him or her.

 I understand that there is no compensation associated with externships.

 I have had the City College Medical Waste and Biohazard Policy explained to me and do fully understand that, in some classroom procedures, I am expected to comply with this policy as part of my education and assessment.  I have read and understood the City College Health, Externship and Clinical Policy.

 City College is accredited by the Accrediting Council for Independent Colleges and Schools (ACICS), an agency recognized by the Council for Higher Education Accreditation (CHEA) and meets the Cardiovascular

Credentialing International (CCI) requirements so that graduates of the program are eligible to take the Registered Cardiac Sonographer or Registered Vascular Specialist certification exam through CCI.

 I have read City College’s dress code for Cardiovascular Sonography and I understand that it is my responsibility to wear the assigned uniform and/or use the following protective clothing and/or gear when carrying out my clinical duties: gloves face mask/shields, lab coats, goggles, disposable gowns, fluid resistant clothing, head coverings, shoe coverings, lead aprons, and laser goggles. I have been instructed by my teacher as to the use of this clothing and/or gear and I realize failure to comply will result in disciplinary action.

____________________________________ ____________________________________

Student Name (Signature) Student Name (Print)

____________________________________ Date

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PROGRAM OVERVIEW

Welcome to City College’s Cardiovascular Sonography Program. The Cardiovascular Sonography Program at City College is a comprehensive entry-level program designed to prepare the student for a rewarding career in the field of diagnostic ultrasound. Cardiovascular Sonography is a non-invasive procedure using ultrasound imaging to examine a patient’s heart and blood vessels in order to diagnose any life threatening illness or

condition. It is performed by Sonographers, trained in identifying visual and auditory symptoms or irregularities of the heart and blood vessels.

The program is designed to include practical didactic lectures integrated with hands-on laboratory in the Ultrasound Training Center. The students will learn to operate a variety of equipment and have the opportunity to practice scanning on fellow students in order to develop skills prior to the 900 hours of clinical training. The dual-training program of both cardiac and vascular was developed to provide greater options to our graduates who can work in environments that demand skills in both specialties. Students will be required to complete 690 lecture hours, 240 lab hours and 900 hours of clinical training. The curriculum is comprised of 111 credits over 8 quarters (2 Years).Upon completion of the program you will be able to perform Cardiac Sonography and Vascular Studies as well as being eligible to sit for your respective registry examination.

Classroom instruction conducted on campus includes anatomy and physiology, medical terminology, ultrasound Physics, EKG principles, venous testing, Cerebrovascular Sonography, and Echocardiography. During the pre-clinical phase of the program, emphasis is placed on classroom and laboratory instruction as preparation for participation in the clinical phase. The clinical experience is received at a variety of locations including hospitals, clinics, diagnostic centers, and physician offices. The student functions under the supervision of the instructor, Cardiovascular Sonographer, in performing as a member of the Ultrasound Cardiac or Vascular Lab. The clinical phase includes further classroom instruction that will be scheduled, but emphasis is placed on extensive clinical experience in actual cardiac & vascular ultrasound procedures.

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CARDIOVASCULAR SONOGRAPHY PROGRAM DESCRIPTION AND OUTCOMES

The mission of City College’s Associate of Science in Cardiovascular Sonography program is to provide

didactic and clinical instruction that will enable individuals to perform as competent, entry-level Cardiovascular Sonographers ready to sit for the registry examination; and to help satisfy the need for Cardiovascular

Sonographers in the local community. Program Outcomes

To prepare competent entry-level Cardiovascular Sonography in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains.

Program Goals

 Be a self-sufficient Cardiovascular Sonographer who displays positive values, integrity and professionalism.

 Recognize and identify clinical findings in cardiac and vascular ultrasound Imaging.

 Ability to identify visual and auditory symptoms or irregularities of the heart and blood vessels.  Evaluate and analyze the hemodynamics of peripheral and abdominal blood vessels

 Demonstrate the ability to maintain and update all relevant ultrasound equipment and troubleshoot as necessary.

 Use independent judgment in recognizing the need to extend the scope of the procedure according to the diagnostic findings

 Provide an oral or written summary of the technical findings to the physician for medical diagnosis

PROFESSIONAL PRACTICE IN CARDIOVASCULAR SONOGRAPHY PROGRAM

The educational program at City College is designed to prepare you to meet the ASE and SVU Scope of practice in Cardiovascular Sonography. The complete scope of practice is presented here so that you, as a student, know what the expectations are for the competencies you will be prepared to achieve in your studies. The American Society of Echocardiography (ASE) and The Society of Vascular Ultrasound (SVU) are your professional organization.

Membership is strongly encouraged.

“The mission of the ASE is committed to excellence in cardiovascular ultrasound and its application to patient care through education, advocacy, research, innovation and service to our members and the public.” (Source: http://www.asecho.org/about-ase/about-us/)

“The mission of the SVU is to represent the best interests of SVU members and promote quality vascular ultrasound services by providing educational, scientific and literary activities to our members, patients and the public.” (Source: http://www.svunet.org/About/MissionandCodeofEthics)

(ASE) AMERICAN SOCIETY OF ECHOCARDIOGRAPHY SCOPE OF PRACTICE

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The purpose of this document is to define the Scope of Practice for Diagnostic Ultrasound Professionals and to specify their roles as members of the health care team, acting in the best interest of the patient. This scope of practice is a “living” document that will evolve as the technology expands.

Definition of the Profession:

The Diagnostic Ultrasound Profession is a multi-specialty field comprised of Diagnostic Medical Sonography (with subspecialties in abdominal, neurologic, obstetrical/gynecologic and ophthalmic ultrasound), Diagnostic Cardiac Sonography (with subspecialties in adult and pediatric echocardiography), Vascular Technology, and other emerging fields. These diverse specialties are distinguished by their use of diagnostic medical ultrasound as a primary technology in their daily work. Certification1 is considered the standard of practice in ultrasound. Individuals who are not yet certified should reference the Scope as a professional model and strive to become certified.

Scope of Practice of the Profession:

The Diagnostic Ultrasound Professional is an individual qualified by professional credentialing2 and academic and clinical experience to provide diagnostic patient care services using ultrasound and related diagnostic procedures. The scope of practice of the Diagnostic Ultrasound Professional includes those procedures, acts and processes permitted by law, for which the individual has received education and clinical experience, and in which he/she has demonstrated competency.

Diagnostic Ultrasound Professionals:

 Perform patient assessments

 Acquire and analyze data obtained using ultrasound and related diagnostic technologies  Provide a summary of findings to the physician to aid in patient diagnosis and management

 Use independent judgment and systematic problem solving methods to produce high quality diagnostic

information and optimize patient care.

From: http://www.asecho.org/practicefordiagnosticultrasoundprofessional/

(SVU) SOCIETY OF VASCULAR ULTRASOUND SCOPE OF PRACTICE

The purpose of this document is to define the Scope of Practice for Diagnostic Ultrasound Professionals and to specify their roles as members of the health care team, acting in the best interest of the patient. This scope of practice is a "living" document that will evolve as the technology expands.

Definition of the Profession

The Diagnostic Ultrasound Profession is a multi-specialty field comprised of Diagnostic Medical Sonography (with subspecialties in abdominal, neurologic, obstetrical/gynecologic and ophthalmic ultrasound), Diagnostic Cardiac Sonography (with subspecialties in adult and pediatric echocardiography), Vascular Technology, and other emerging fields. These diverse specialties are distinguished by their use of diagnostic medical ultrasound as a primary technology in their daily work. Certification1 is considered the standard of practice in ultrasound. Individuals who are not yet certified should reference the Scope as a professional model and strive to become certified.

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The Diagnostic Ultrasound Professional is an individual qualified by professional credentialing2 and academic and clinical experience to provide diagnostic patient care services using ultrasound and related diagnostic procedures. The scope of practice of the Diagnostic Ultrasound Professional includes those procedures, acts and processes permitted by law, for which the individual has received education and clinical experience, and in which he/she has demonstrated competency.

Diagnostic Ultrasound Professionals Perform patient assessments

 Acquire and analyze data obtained using ultrasound and related diagnostic technologies  Provide a summary of findings to the physician to aid in patient diagnosis and management

 Use independent judgment and systematic problem solving methods to produce high quality diagnostic

information and optimize patient care.

From: http://connect.svunet.org/SVUNET/Advocacy/SVUPositionPapers

TECHNICAL STANDARDS AND PERFORMANCE CRITERIA

The Cardiovascular Sonography Program has established technical standards and performance criteria that must be met by the students in the program. Information regarding anticipated work criteria is also included.

Technical Standards:

Each student must be able to:

1. Reach up to six (6) feet off the floor.

2. Communicate in a clear and concise manner in English language to people in various departments. 3. Read and apply appropriate instructions in treatment charts, notes, and records.

4. Lift fifty (50) pounds of weight, up and over head level.

5. Move immobile patients from stretcher to sonography table with assistance from department personnel. 6. Push standard wheel chair from waiting area or patient’s room to the ultrasound room.

7. Comprehend and apply clinical instructions given from departmental personnel. 8. Utilize keyboard for inputting clinical data into console, computers, and charts. 9. Visually monitor patients and review images in dimmed light.

10.Ability to hear within normal limits (aided or non-aided). 11.Ability to visualize colors.

12.Speech discrimination within functional limits for telephone and personal communication. 13.Visual acuity of 20/60 in at least one eye (with or without correction).

Mental & Visual Demands (Student and Sonographer):

1. Ability to work in a noisy environment with many interruptions. 2. Ability to remember and recall a large amount of information. 3. Ability to accurately read and transcribe illegible handwriting.

4. Ability to assess patient and other situations rapidly, determine the course of action, delegate activities to co-workers, and/or respond as appropriate.

5. Ability to use equipment safely and correctly, such as equipment locks, IV pumps, stretchers, etc. 6. Ability to explain procedures and patient preparations clearly and simply in person, over the telephone,

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7. Ability to hear, understand, and respond appropriately to comments, questions, and instructions given in person, over the telephone, and in writing.

8. Ability to determine colors as displayed on equipment as well as in relation to the patient’s condition. 9. Ability to calmly and politely cope in stressful situations, in emergency patient situations, or situations

with other staff members.

10.Ability to assess work demands; personally organize and perform or assign others to meet the demands. 11.Ability to effectively communicate in the medical environment with other health care professionals and

patients/family members.

12.Ability to apply critical thinking skills in regard to obtaining adequate clinical history from the patient and correlating that information with exam findings.

13.Ability to maintain patient confidentiality at all times. Work Environment to be Anticipated:

Routine and acute patient care situations in the assigned area of work such as diagnostic radiography, CT, MRI, Nuclear Medicine, Ultrasound, etc. Exposure to ionizing radiation, blood and body fluids, chemicals for

cleaning, medications, and pathogens. Contact with manual and electronic equipment such as keyboards, control panels, stretchers, IV pumps, computer terminals, facsimile machines, etc.

Patient care may include working with IV's, bed pans, urinals, and urinary catheterizations. Sonographers and students will perform scans of breasts, scrotums, endovaginal, or endorectal regions, and surgical procedures. Workload may require altered break/lunch schedules.

Nature of Work/Training Required:

Responsible and accountable for assessing, planning, implementing, and evaluating patient care assignment. Responsible and accountable for performing/supervising/delegating care and tasks. Assigned patients may vary in age from infancy through geriatrics. Hours of work and length of shift may vary from the established

schedule. Patients are assessed and decisions are made about changes in their conditions, verbal and written reports are made to others on the health care team. Care is coordinated and documented by the technologist. Technologists (not students) may be required to provide call-back coverage for the ultrasound departments. Potential Hazards of Work/Training:

 Increased risk for exposure to various diseases, viruses, etc. while in the patient care/clinical setting.  Increased risk for musculoskeletal injuries or repetitive strain injuries.

 Increased risk for carpal tunnel syndrome.

Qualifications for Employment: (may vary with employer)

 Certification by the American Registry of Diagnostic Medical Sonographers (ARDMS) to practice as a

Registered Diagnostic Cardiac Sonographer (RDCS) or Registered Vascular Technician (RVT). Certification by the Cardiovascular Credentialing International (CCI) to practice as a Registered Cardiovascular Sonographer (RCS) or Registered Vascular Specialist (RVS) are available in different imaging specialties in the medical sonography profession.

 Current CPR certification.

 Current infection control requirements as mandated by employer.  Current medical information.

 Current compliance with OSHA requirements and regulations regarding risk management, safety

training, universal precautions training, and bloodborne pathogen training.

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CARDIOVASCULAR SONOGRAPHY PROGRAM GRID BY QUARTER

Cardiovascular Sonography OUTLINE BY QUARTER Quarte

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COURSE

NUMBER COURSE NAME

LECTURE CONTACT HOURS LAB CONTACT HOURS EXTERN CONTACT HOURS TOTAL CONTACT HOURS TOTAL CREDIT HOURS PRE-REQUISITE S 1 CVT1125C Cardiovascular Pathophysiology Concepts 30 20 0 50 5 None

1 MAT1030 College Algebra 40 0 0 40 4 None

1 SLS1201 Personal Development 40 0 0 40 4 None

TOTAL HOURS ₁₁₀ ₂₀ ₀ ₁₃₀ ₁₃

2 DEP2004 Human Growth &

Development 40 0 0 40 4 None 2 CVT1502C EKG 30 20 0 50 4 CVT1125C 2 CVT1625C Echocardiography I 30 20 0 50 4 CVT1125C TOTAL HOURS ₁₀₀ ₄₀ ₀ ₁₄₀ ₁₂ 3 CVT1626C Echocardiography II 30 20 0 50 4 CVT1625C

3 ENC1100 College English 40 0 0 40 4 None

3 CVT1615C Ultrasound Physics I 30 20 0 50 4 MAT1030 3 MEA2235 Medical Law & Ethics 40 0 0 40 4 None

TOTAL HOURS ₁₄₀ ₄₀ ₀ ₁₈₀ ₁₆ 4 CVT1616C Physics II 30 20 0 50 4 CVT1615C 4 CVT1627C Echocardiography III 30 20 0 50 4 CVT1626C 4 STA2014 Statistics 40 0 0 40 4 MTB1103 or MAT1030 4 ENC1101 English Composition 40 0 0 40 4

ENC1100 or ENC1201 TOTAL HOURS ₁₄₀ ₄₀ ₀ ₁₈₀ ₁₆ Quarte r COURSE

NUMBER COURSE NAME

LECTURE CONTACT HOURS LAB CONTACT HOURS EXTERN CONTACT HOURS TOTAL CONTACT HOURS TOTAL CREDIT HOURS PRE-REQUISITE S 5 CVT1329C Venous Testing 30 20 0 50 4 _CVT1125C 5 CVT2628C Echocardiography IV 30 20 0 50 4 CVT1627C 5 CVT1325C Peripheral Arterial Testing 30 20 0 50 4 _CVT1125C

TOTAL HOURS ₉₀ ₆₀ ₀ ₁₅₀ ₁₂

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6 CVT2191 Clinical Externship I 0 0 300 300 10 CVT2628C

TOTAL HOURS ₃₀ ₂₀ ₃₀₀ ₃₅₀ ₁₄

7 CVT2192 Clinical Externship II 0 0 300 300 10 CVT2191 7 IDS2350 Critical Thinking 40 0 0 40 4 None

TOTAL HOURS ₄₀ ₀ ₃₀₀ ₃₄₀ ₁₄

8 CVT2193 Clinical Externship III 0 0 300 300 10 CVT2192 8 SLS2301 Professional Strategies 40 0 0 40 4

TOTAL HOURS ₄₀ ₀ ₃₀₀ ₃₄₀ ₁₄

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CARDIOVASCULAR SONOGRAPHY CLASSROOM, LABORATORY, AND CLINICAL RULES BEHAVIOR

Students are expected to demonstrate professional behavior at all times in the classroom, laboratory and at clinical sites. All students, teachers, visitors, and employees are to be treated with courtesy and respect. Inappropriate behavior or language is not permitted.

 Students are expected to be on time when reporting to classroom/laboratory sessions and clinical rotations.

 City College rules on Academic Integrity, as part of City College’s Conduct Policy, are strictly enforced. Refer to the City College Student handbook and the Catalog for detailed information about City

College’s Student Conduct Policy.

 Students are expected to stay in class for the entire meeting time. As such, students are encouraged to take care of all personal, non-class related activities prior to class, or during the assigned break.

 All cell phones must be on vibrate or turned off during class. If you need to make or take a call or text, please step out of the classroom. If you are aware that there will be a need for you to have access to your phone during class, it is polite to advise the instructor of this need at the beginning of class.  Smoking, eating, chewing gum, hard candy or drinking are ONLY allowed during break in designated

areas at the school and affiliated agencies.

 All students must notify their instructor, not less than 2 hours prior to clinical or class, if they will be absent or tardy.

 Please keep classroom conversations to a minimum. Excessive and non-class related conversation during lectures, labs and clinical may result in your being asked to leave the classroom or site. There is no early dismissal for lecture, lab or clinical, unless you have made prior arrangements with your instructor.

COURSEWORK

 Students are expected to have all required textbooks and supplies for the first class session.  Students are expected to attend ALL lecture, lab and clinical sessions.

 All student assignments must be turned in at the beginning of each class. Late work will not be accepted  If you are tardy or absent for a written exam, you must complete a make-up exam within one calendar

week, there is an automatic 10% deduction unless the student can document their mitigating circumstance.

 Students are responsible for making up any missed assignments or obtaining the information that was presented in class.

 All assignments will be given back to the student for review. Additionally, exams will be handed back for review purposes only. All exams MUST be returned to your instructor prior to leaving the classroom. Failure to return exams will be viewed as an infraction of Academic Integrity pursuant to City College’s

Conduct Policy.

CLASSROOM MAINTENANCE

All students are responsible for maintaining a neat and orderly classroom:

 Do NOT attempt to use or operate any equipment until you have received the appropriate instruction for its use.

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 When using equipment, treat it kindly. All equipment should be replaced in the appropriate storage area after use.

 Class or Laboratory sessions are not considered adjourned until the lab and classroom are in proper order.

 No food or drinks are allowed in the classroom or lab at anytime

CARDIOVASCULAR SONOGRAPHY DRESS CODE

1. Uniforms including Lab Coat must be worn whenever the student is on school grounds, at the clinical site, and on field trips unless other arrangements have been authorized by City College officials. 2. Uniforms are to be kept clean, neat, and professional at all times.

3. Scrub tops and ties on the pants are to be tucked into pants. 4. ID badges are to be worn at or near eye level.

5. Sweatshirts, sweaters or warm–up jackets may NOT be worn over scrubs.

6. Long sleeve shirts are NOT permitted to be worn under the scrub top. Only a T–shirt or an under shirt may be worn under the scrub top, providing that the sleeves do not extend below the sleeves of scrub top.

7. Shoes

a. Should be comfortable and suitable for standing for extended periods.

b. Shoes worn in the clinical setting must be constructed with non-skid, non-marking soles c. They are to be kept clean and in good repair.

d. Shoes should be all white.

e. Leather is preferred as it protects the feet from being cut.

f. Open–toed sandals, dress shoes, and clogs are NOT permitted for safety reasons.

8. Jewelry is limited to one small stud earring in each ear, and one short neck chain. No other jewelry is allowed. Watches, bracelets, and rings are not to be worn into or while at the clinical site.

9. Hair must be neatly combed, clean and arranged in a simple style. All hair (head and/or facial) must be completely covered prior to entering the surgical area. In keeping with the principles of aseptic

technique, excessive mousse, hair spray or gel is not permitted. Hats or caps are not to be worn outside the OR.

10.No perfume or cologne is permitted.

11.Fingernails are to be kept clean and neatly manicured (fingertip length). Artificial nails and nail polish are not permitted.

12.False eyelashes or any other type of temporary aesthetic products are prohibited within the surgical setting.

13.Personal hygiene is essential since students work very closely with others.

Students may be asked to leave a clinical site if they do not meet the dress code. This will count as an absence and subject to all the consequences of an unexcused absence.

Students preparing for a career in the health field bear the responsibility of conducting themselves and dressing in a manner that reflects professionalism. Proper attire and appearance enhances both your credibility and that of City College with clients, their families, and medical personnel. Professional conduct is expected at all times, e.g., not talking loudly, not chewing gum and no transaction of personal business in the clinical unit except for emergency situations.

Faculty and clinical instructors have the responsibility and reserve the right to judge the appropriateness of a student’s attire, and may modify the policy in accordance with agency guidelines and standards.

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CITY COLLEGE HEALTH, EXTERNSHIP AND CLINICAL POLICY

Students in the Cardiovascular Sonography Program are required to complete labs and externships in health settings. City College adheres to all policies set forth by the clinical sites inclusive of screenings, specific health requirements and notifications.

In order to adhere to these guidelines, City College has the following as entry and program requirements: 1. Proof of the following medical requirements:

• Current physical examination performed by an MD, DO or ARNP with a signed Health Clearance Form.

• Proof of immunity via documentation of immunization or titers for the following: -- Hepatitis B series. The first of three injections must be completed prior to admission. -- MMR (Measles, Rubella, and Mumps).

-- VZV (Varicella) vaccine – 2 injections. • Absence of Tuberculosis (TB)

-- Negative PPD skin test within the last 6 months (2-step PPD or single step PPD as part of an annual series) or a negative chest x-ray.

• A negative urinary drug screen indicating a 10 panel drug screen.

• A tetanus (Td) booster within the last ten years. Results of a Health Clearance Form and PPD must be updated yearly.

2. Student must provide proof that they hold personal health insurance throughout the program. 3. Student must have a VECHS background check with no findings.

4. Student must complete an Acknowledgement of Florida Statute Section 456.0635. 5. Students may be required by an externship site to have a flu shot prior to their clinical.

Note: Individual clinical sites may require additional screenings, health requirements and/or background checks.

ATTENDANCE

Students who are absent are required to make up the hours missed on clinical rotation during the current term. Excessive absences may lead to dismissal from the externship site. If a student is DISMISSED from an

externship site there is no guarantee clinical re-placement can be achieved within the 14 day attendance policy as set forth in City College Catalog. Students that are dismissed from a site due to attendance or behavior problems may immediately receive a failing grade for the current externship course.

PROCEDURE FOR CLINICAL EXTERNSHIP

Clinical Competency examinations are actual procedures performed on patients and observed by Program Faculty or Registered Cardiac or Vascular Sonographers.

The externship is undertaken following the successful completion of all classroom training and consists of 900 unpaid hours. Students will attend externship Monday through Friday for (4) hours each day, for a total of (5) days a week. Students will attend externship in an Allied Health Professional clinical site. Externship is only offered to active students who have completed their academics.

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The student is required to attend the Orientation Presentation prior to attending their first externship. Externship Documentation Package

During Externship Orientation the student will be required to complete the following:

 Provide Emergency Contact Information : Student information and emergency contact information  Provide evidence of updated Health Records: Such as Immunizations, Physical, Drug test, & Background

check.

 Complete an externship Student Schedule: Site schedule containing site address, contact person, phone number, and attending days and hours.

 Sign the Confidentiality Statement (HIPAA): Document stating their understanding towards HIPPA.  Sign the Externship Release of Liability Form: Document form stating student liability release.  Sign the Health Compliance: Document stating their understanding to OSHA regulations.

 Complete the Externship First Day Report: Document that needs to be faxed to the Externship Coordinator on the first day of externship at their clinical site.

 Receive copies of the Time Sheet: Hour Logs provided to the student in order to track their daily attendance and hour accumulation.

 Receive and review the Guidelines for Externship: Document stating externship guidelines understanding.

 _{Review the Certificate of Completion: Document stating externship completion.} Assigning the Student

Assigning the student is a fundamental & vital process for externship placement. In order to assign a student three major factors are considered.

1. GPA. The GPA gives the coordinator an idea of the student’s achievement level.

2. Attendance. Attendance is a reflection of the student’s sense of responsibility and interest. 3. Instructor’s feedback. Instructor feedback allows the coordinator to get to know the student on a

more personal level before meeting with the student.

These factors are very important so that the coordinator can appropriately place students at externship site. A combination of all these factors can provide the best ability to place each student accordingly. Students are to attend their externship site wearing school uniform and school ID at all times.

Placement Schedule

Each student is provided with a placement schedule that states the name of the site, the contact person, phone number, address, and the days and hours the student should attend. The student is to notify the coordinator and the assigned clinical site if he or she is to miss any day for any reason. The externship coordinator has the right to relocate a student at any given time. If necessary, the student will be notified ahead of time.

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Follow-Up & Time Sheets

The students are given time sheets or hour logs at the time of their externship orientation in order to track their daily attendance and hour accumulation. The student is to fax or hand-deliver their time sheets at the end of every week. Time sheets should be signed by the office supervisor, if not, it is not accepted. The student is to notify the coordinator and the assigned clinical site if he or she is to miss any day for any reason. It is the student’s responsibility to submit their externship time sheets at the end of every week. The externship consists of a total of 900 hours; this means twenty hours a week, four hours a day.

Completion Process

The completion process take place once the student has completed all their externship hours. At that time, a certificate of completion is given to them and a copy is to be placed on the student folder. All the externship documents should be signed by the coordinator including the student’s time sheets. The coordinator will contact the clinical site and ask for the student’s progress, feedback, and a recommendation letter if applicable.

Clinical Sites

Arrangements for clinical placements are handled in one of two ways. The Externship Coordinator makes the places the student in a site City College has an agreement with or the students may secure their own clinical site. Any clinical site secured by the student must be approved by the Externship Coordinator and Program Director before the student begins the externship.

Externship clinical sites may be any of the following: Physician offices, hospitals, medical centers, cardiology groups, rehabilitation centers, nursing homes, and diagnostic centers. Based on clinical site availability, students may be required to complete their externships at more than one clinical site. In such an event, the school makes no assurances as to when or if the sites may be available.

CLINICAL LAB GRADE

1. The “Clinical Lab Grade” is composed of the following:  50% - Scanning Abilities Evaluations  30% - Performance Evaluations  10% - Patient Care Evaluations  10% - Clinical Folder

2. Failure to complete all clinical cases and/or clinical externship for the designed term will result in a failing Clinical Lab Grade. The student will be placed on clinical probation for not meeting quarter requirements.

CLINICAL FOLDER

The student is responsible for providing all completed forms necessary for the clinical folder. The student is expected to turn in all paperwork in a timely manner as assigned by their instructor. Failure to have proper forms, incomplete forms, or failure to submit all data required will result in points being deducted from the grade.

The student will keep a daily experience log of all clinical experiences. Students must keep a daily running total of procedures and examinations that they either perform or assist with each day.

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PERFORMANCE EVALUATIONS

Performance evaluation forms are forms used by a Cardiac/Vascular sonographer to evaluate the clinical performance of students assigned in a specific clinical rotation.

1. The evaluation form must be completed by the Registered Cardiac/Vascular sonographer/clinical

coordinator for each 11 week rotation and submitted to the clinical instructor. The clinical instructor will pass the performance evaluations to the Program Director or Clinical Coordinator for summation and grading.

2. A minimum of 3 performance evaluations per quarter is required

3. Since performance evaluations are 30% of the clinical lab grade, a zero may result in a failing clinical lab grade for the course and the student may be placed on clinical probation.

CLINICAL EDUCATION REQUIREMENTS

Clinical Education rotations are designed to ensure that students meet the following objectives:  Demonstrate compassion and professional conduct at all times while working with patients.  Be able to communicate properly with patients.

 Be able to communicate and work with fellow students and Cardiovascular Sonographers.

 Exhibit professional conduct and adhere to dress codes at all times while assigned to the clinical area.  Be able to cope and function during stressful situations.

 Complete the required competencies within the specified time and retain proficiency

Clinical Education Requirements are designed to help the student learn to adjust to the requirements of the professional workforce. Students are required to do the following:

 Two weeks prior to clinical rotation meet with the clinical coordinator to discuss the clinical assignment.  Arrive on time for all clinical assignments.

 Call the clinical coordinator if sick or cannot be at their clinical assignment at least two hours prior to the start of the schedule rotation. If s/he cannot be reached, the student should call the program director.  Pass the physical requirements of the program.

 Rotate through all clinical assignments and gain working knowledge of the instrumentation, equipment, techniques and procedures done.

 Complete all clinical competency objectives on or before the required deadlines set each quarter.  Complete all clinical assignment before the start of the next semester. This includes making up

approved missed days during quarter breaks, etc.

 Maintain satisfactory clinical evaluations completed by staff Cardiovascular Sonographer and clinical instructors

Any infraction of the above rules will result in academic and/or disciplinary actions. CLINICAL ASSESSMENT

During the student’s clinical education the staff Cardiovascular Sonographer or Preceptor, Clinical Instructor, and Program Director will evaluate his/her performance. The student is evaluated on specific Cardiovascular Sonographer duties as well as on their overall performance. A student’s overall performance is assessed by the clinical instructor and the Cardiovascular Sonographer during each clinical rotation and at predetermined intervals.

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Completion of Preceptor Evaluations The student must:

 Request the preceptor complete a Weekly Externship Evaluation Form (unless told differently by the program director).

 Before giving the evaluation form to the preceptor fill in the following:

o Student Name o Facility o Date

o Type of procedure(s) performed

 Give the preceptor the form at least one hour before scheduled to leave the department. The Preceptor will:

 Score the student’s performance by placing a check in the column appropriate to the task.  If the student’s performance is unacceptable a written comment is required.

PROCEDURE FOR CLINICAL EXTERNSHIP/COMPETENCIES

1. Each student will receive copies of all clinical forms and the competency manual prior to starting new clinical rotations.

2. Since the program operates in an 11 week term clinical competencies will be assigned before each clinical education rotation.

3. Meeting clinical competency requirements involves the following: a. Doing clinical simulations

b. Obtaining Signatures for successfully performing patient procedures

c. Obtaining Signatures for performing and successfully assembling equipment needed for patients d. Demonstrating Clinical Competency

CARDIOVASCULAR SONOGRAPHY SAFETY FOR LAB AND CLINICAL

MEDICAL WASTE AND BIOHAZARD GUIDELINES

City College adheres to the highest standards of handling and disposing of medical waste and bio-hazardous materials. Each City College campus has an OSHA Compliance Officer that ensures that medical waste and biohazard waste are properly disposed of.

ALWAYS dispose of these items in sharps disposal containers:

Any medical needles

Syringe barrels (with or without needle)

Pasteur pipettes

Scalpel and razor blades Blood vials

Microscope slides and coverslips

NEVER dispose of these items in sharps disposal containers: Plastic items (except for syringes)

Beverage containers (no cans!)

Non-biologically contaminated laboratory glassware* Solvent/Chemical bottles

Light bulbs

Any paper materials Pipette tips

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Glassware contaminated with

infectious agents Aerosol cans or can of any type Scintillation vial

Any item with liquid (except for blood in vacutainers)

From: http://www.drs.illinois.edu/bss/factsheets/sharps.aspx

If you see blood, vomit or other biohazards, call Facilities for cleanup and safe disposal. Contact the Department Chair or notify the instructor if there are sharps.

INFECTIOUS DISEASES GUIDELINES

Each clinical facility is expected to practice universal precaution procedures in the care of patients with infectious diseases. The Cardiovascular sonographer student is educated in, and is expected to be knowledgeable in the practice of these precautions and care for these patients.

 Clinical grades are awarded according to student performance. Refusal to render care to any patient in a manner which follows the clinical facilities guidelines may result in dismissal from the program.

PROCEDURES FOR ACCIDENTAL EXPOSURE TO BLOOD OR BODY FLUID BLOODBORNE PATHOGENS / NEEDLESTICK POLICY

Students must comply with current CDC and OSHA guidelines for infectious disease control. Students receive updated information of standard precautions as they become available. Universal Precautions, CDC and OSHA Guidelines are reviewed annually and a post-test will be kept in the student file for documentation of clinical compliance.

In keeping with standard precautions, blood and certain body fluids of all clients are considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood borne pathogens. All students and faculty are professionally and ethically obligated to provide client care with compassion and respect for human dignity. No student or faculty may refuse to treat a patient solely because the patient is high risk for contracting, or is HIV positive, or has hepatitis, or any other infectious disease. The CDC recommends that standard precautions apply to blood and to body fluids containing visible blood, as well as semen and vaginal secretions, to tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic.

Standard precautions do not apply to nasal secretions, sputum, saliva, sweat, tears, urine, feces and vomitus unless they contain visible blood. However, current infection control practices already in existence include the use of gloves for digital examination of mucous membranes and endotracheal suctioning, and hand washing after exposure to saliva.

Students with exudative lesions or weeping dermatitis should refrain from all direct client care and from handling client-care equipment.

INITIAL RESPONSE TO EXPOSURE 1. Immediately apply first aid as needed:

 Allow to bleed freely; clean with 70% alcohol (for needle stick/puncture injury)  Wash thoroughly with soap and water

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 Eyes: irrigate and/or flush copiously with water 2. Document the incident, including:

 Route of exposure

oHow and when exposure occurred oIdentify source individual, if known

 Report exposure immediately to your instructor and appropriate supervisor in school or the clinical agency.

POST-EXPOSURE PROTOCOL FOR PROPHYLAXIS OF HBV AND HIV

The use of personal protective equipment, appropriate engineering controls, and proper work practices must be continually reinforced among faculty and students to prevent exposure incidents to blood or other potentially infectious materials (OPIM). However, if an incident occurs, faculty and students should report the incident as soon as possible and be thoroughly familiar with the procedures for testing, evaluation, and treatment. A potential exposure incident can include:

2. Percutaneous inoculation – needle stick or sharps

3. Non-needle percutaneous injury – open cuts or abrasions 4. Direct mucous membrane contact – accidental splash 5. Non-intact skin contact with blood or OPIM.

STUDENT HEALTH

Students are responsible for personal health care expenses, including those incurred as a result of participation in the Cardiovascular Sonography education program, and are required to carry their own health care insurance. Written acknowledgement of financial accountability and responsibility is a clinical requirement. Some clinical agencies may require proof of insurance. A lack of insurance may cause an alteration in a student’s schedule or delay in graduation.

PREGNANCY

1. It is the intention of the City College not to unfairly prejudice the interest of students who are pregnant. A student may choose to continue with her program during pregnancy with the

understanding that she is expected to satisfactorily meet the same standards of clinical and classroom performance as are all other students enrolled in the program.

2. A pregnant student wishing to remain in the program must sign a waiver releasing the school and any of its affiliated clinical agencies from ANY liability concerning her pregnancy or the unborn child. The student’s health care provider must also provide a written statement concerning any restrictions on activity or weight lifting, in order for the student to continue in the program. Restrictions that interfere with patient safety or learning objectives will require that the student is withdrawn from the course. The pregnancy waiver must be updated following each prenatal visit. 3. If at any time during pregnancy the student’s ability to meet City College performance standards is

questioned, the student may be required to submit a statement from her private physician. Such statement must indicate that the student is able to satisfactorily perform in the clinical or classroom area without undue detriment to herself and/or the unborn fetus/baby. Without such medical

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assurances, the student may be required to discontinue her program until said medical assurances have been received and accepted.

4. The above policies do not mitigate the student’s responsibility for maintaining her own well being as well as that of responsible behavior with respect to the fetus or unborn child. If at any time the student believes she is medically unable to continue with class/clinical responsibilities, the student should notify her instructor, academic advisor, or Program Director.

5. The student must be able to complete all course objectives in order to success fully complete the course. Students who are unable to complete the clinical requirements may register for the course at the next opportunity, space permitting. No spaces are saved for students not taking courses in their original sequence. Students who are not actively enrolled in classes for more than one (1) term must adhere to the catalog curriculum and policies in effect at the time the student resumes classes.

It is recommended that students who are pregnant read the following article from the American Journal of Nursing to be fully informed about any potential dangers to their pregnancy while pursuing their

coursework in a clinical setting.

http://journals.lww.com/ajnonline/Fulltext/2011/01000/Occupational_Hazards_for_Pregnant_Nurses.24.asp x

COMMUNICABLE DISEASE GUIDELINES

 Any student who has or contracts a communicable disease as so stated by a physician will be academically withdrawn from theory and clinical with an excused absence.

 Make-up work will be assigned on an individual basis.

 All theory and clinical work must be made up; i.e. test, assignments, and quizzes.

 It is the students’ responsibility to request make up work and to keep up with what he/she has missed.  Re-entry is contingent on a signed physicians’ statement stating the student is no longer communicable.

COMMUNICABLE DISEASE PREVENTION

All Cardiovascular Sonography students, in order to protect themselves, fellow health care personnel, and patients, will comply with each of the following:

 Uniforms and lab coats will be fresh each day.

 All equipment will be thoroughly cleaned, disinfected, or sterilized between patients according to appropriate procedures for each piece of equipment regardless of the patient’s diagnosis.

 Good hand washing practices will be followed before and after patient contact.

 Disposable gloves will be worn at all times when in direct or indirect patient. Disposable gloves are MANDATORY for all patient transfers.

 Masks will be work when it is likely that blood or body fluids could splash in the nose or mouth.  A gown will be worn should a splash of blood or body fluids onto the skin or clothing be anticipated.  Cuts, scratches, or other non-intact skin will be covered to avoid contact with blood or body fluids.  Goggles or other eye protection will be worn when a splash of blood or body fluid into the eye is

anticipated.

 Blood or body fluid inadvertently coming in contact with the skin should be quickly and thoroughly washed away.

 Students that experience exposure to blood or body fluid will report to their clinical instructor and follow clinical exposure protocol.

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EXTERNSHIP/CLINICAL TIMESHEET

Cardiovascular Sonography Program STUDENT EXTERNSHIP TIME SHEET

INSTRUCTIONS: Please complete your hours log DAILY and FAX it to the campus WEEKLY, by 5pm Friday. Enter the time you arrive and the time you leave at the end of your shift and a brief description of what you did. FAX to City College: 954-983-0118

Student Name: Student Phone: Site Name: Campus: Hollywood

Site Supervisor: Program: Cardiovascular Sonography

DATE TIME IN TIME

OUT TOTAL HRS DESCRIPTION Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total Hours

I certify that the above information is correct. This student has completed a total of _____ hours of externship for the week under my supervision.

Site Supervisor Externship Coordinator

Print Name: ___________________________ Print Name: _________________________________ Signature: ____________________________ Signature: _________________________________

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CLINICAL SKILLS CHECKLIST Date: ______________________

Student Name:__________________________________________ Email: ____________________________ Instructions: Please check the appropriate column that best describes your experience level for each knowledge competency and skill. Please use the rating scale below to evaluate yourself based on experiences within the last two years.

Self-Assessed Experience Rating Scale

N/A=Not Applicable 1=No Experience 2=Minimal Experience 3=Performs well/competent 4=Supervise and Teach

Technique 1 2 3 4 N/A

Patient Care

Bubble Study

Stress Echo

(ABI) Ankle-Brachial Index

Understands Ultrasound Physics

Echocardiography 1 2 3 4 N/A 2D M-Mode Color Flow PW/CW Doppler Parasternal Windows Apical Windows

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Subcoastal Windows

(TEE) Transesophageal Echo

Vascular 1 2 3 4 N/A 2D M-Mode Color Flow Doppler

Arterial Peripheral Upper Extremity

Arterial Peripheral Lower Extremity

Venous Peripheral Upper Extremity

Venous Peripheral Lower Extremity

Carotid Artery Duplex

Cerebrovascular Study

Aorta/illiacs

General 1 2 3 4 N/A

Quality Control of Equipment

Recognition of Malfunctions

Transducer Selection

Image Annotation

Universal Precaution

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CARDIOVASCULAR SONOGRAPHY SIMULATION AND COMPETENCY SHEET

Student's Name: ____________________________________ Date: ___________________ Evaluator: __________________________________________ Grade: __________________ Competency: ______________________ Simulation: _______________

This form will be used in conjunction with the checklist to evaluate the student's performance and issue a final competency grade. Clinical instructor/program facility will complete this form. The student must maintain a minimum grade of 85% to complete this competency.

The following scale will be used when grading each student:

3. Acceptable AUTOMATIC FAILURES:

2. Minor improvement 1. Not performing Universal Precautions

1. Major improvement 2. Improper Technical Factors

0. Unacceptable 3. Not properly identifying the patient

(Use not applicable N/A when appropriate) 4. Incorrect patient/ incorrect part

EVALUATION AND COMPETENCY Score: Initials: Date:

1. Did the student perform all aspects of the competency with

minimal guidance

2. Was the student present during the entire procedure

3. Was proper technique used

4. Did the student properly identify the patient 5. Assist with patient during procedure (EKG, Placement, Transfer, and

Positioning)

6. Ability to complete Cardia/Vascular protocol

7. Was troubleshooting performed with confidence from student 8. Does the student know the theory behind procedure and equipment

being used

Total Points:

Final Grade: Total number of points divided by number of fields required on this competency / simulation

Final Grade: ________ Comments:

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EXTERNSHIP GENERAL EVALUATION To be completed by Site Supervisor.

Student: ____________________________________________________________________________ Site: _______________________________________________________________________________ Date Started: _____________________ Date Ended: ___________________________ Please evaluate the above named student in the following areas.

Guidelines are as follows:

5= Excellent (Student performs task without supervision).

4= Above Average (Student performs tasks with minimal supervision). 3= Average (Student performs task on average level with some supervision). 2= Needs Improvement (Student needs constant supervision).

1= Not Passing (Student lack knowledge of task, unable to grasp concept). Performance. The student demonstrates:

ability to learn and retain information correct techniques in paperwork procedures knowledge of echocardiography & vascular procedures competence in having scanning abilities competence in charting of clinical procedures set-up and clean-up of patient care areas

sufficient speed in completing tasks care of instruments and equipment Attitude. The student demonstrates: interest in improving self

ability to adapt to new procedures punctuality/attendance

Initiative. The student demonstrates: ability to complete tasks

willingness to undertake appropriate additional duties ability to anticipate doctor’s/co-workers needs Neatness. The student demonstrates:

neatness in accomplishing work

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ability to put others at ease cooperation with staff diplomacy and tact with staff

emotional maturity to function under stress appropriate conversion with staff/patients use of correct terminology

sensitivity to patient comfort

Student appears to show strength in these areas:

__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________

Student work on developing these areas:

__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________

Note to Supervisors: Marking “Unsatisfactory” means that the student, in your opinion, is not prepared for the role of medical assistant. However, this does not necessarily mean the student cannot pass the course under certain conditions to be determined by City College.

The overall appraisal of the student: Outstanding  Above Average  Average  Unsatisfactory Signature: _________________________________________________________________________________ Print Name: ____________________________________________________Title: ______________________ Site: _____________________________________________________________________________________ Address: __________________________________________________________________________________ Phone Number: ___________________________________________________ Date: ____________________

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CARDIOVASCULAR SONOGRAPHY PROTOCOL ASSESSMENT Name of student: _____________________________________________________

To be completed by the instructor in conjunction with the medical director.

Check Yes (if they are able to acquire the image) or NO (unable to acquire image) on the following list. In order for the student to proceed to externship, he or she must complete the Cardiac protocol.

Parasternal Views YES NO

Parasternal Long Axis 2D

Zoom in Aortic & Mitral Valve

Parasternal Inflow 2D

Parasternal Inflow Color Flow

Doppler the Tricuspid valve with PW

Parasternal Long Axis 2D

Measure Aortic Root

Measure Left Atrium

Measure Septal Wall

Measure Left Ventricle

Measure Posterior Wall

Measure the same in M-Mode

Parasternal Short Axis Mitral Level

Parasternal Short Axis Papillary Level

Parasternal Short Axis Apex Level

Parasternal Short Axis Aortic Level 2D

Color Flow on Tricuspid Valve

Doppler the Tricuspid Valve with PW

Color Flow the Pulmonic Valve

Doppler the Pulmonic valve with PW

Zoom on Aortic Valve

Parasternal Long Axis Color Flow on Aortic & Mitral

Valves

Parasternal Long Axis Zoom Color Flow on Aortic & Mitral

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Apical Images YES NO

Apical 4 2D

Apical 5 2D

Apical 2 2D

Apical 3 2D

Apical 3 Color Flow Outflow Track

Apical 2 Color Flow on Mitral Valve

Apical 4 Color Flow on Mitral Valve

Asses the Mitral Valve with PW

Measure E and A Wave

Apical 5 Color Flow on LV Outflow Track

Asses the LV Outflow Track with PW

Asses the Aortic Valve with CW

Color Flow on Tricuspid Valve

Asses the Tricuspid Valve with PW

Apical 4 2D

Tissue Doppler on Mitral Valve

Tissue Doppler on Anterior Mitral Valve and Measure E Wave Tissue Doppler on Posterior Mitral Valve and Measure E Wave

Subcoastal Images YES NO

Subcoastal Apical 2D

Subcoastal Apical Color Flow on Mitral & Tricuspid Valves Measure IVC in 2D or M-Mode (Ask patient to sniff) M-Mode across IVC in expiration & Inspiration

_______________________________________ _________________________________________

Medical Director Program Director

_________________ ___________________

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