PEMAKAIAN ANESTESI BT SHUNT JANTUNG

" BLALOCK - TAUSSIG SHUNT"

Hari / Tanggal :
PATIENT BARCODE
Jam :
NO NAMA OBAT JUMLAH PAKAI SISA
1 RECOFOL 5
2 MORPHINE 1 ML 1
3 FENTANYL 2 ML 10
4 ECRON / ROCULAX 4
5 PROTAMIN 5
6 KALSIUM GLUKONAS 2
7 INOVAD 1
8 INVICLOT 1
9 DBL GLICERIL TRINITRAT (50mg/10 ml) / NTG 10 mg/10 ml 2\2
10 DOBUJEC 2
11 CORDARON 2
13 EPINEPHRINE 5
14 PERDIPINE 1
16 XYLOCARD 1
17 VASCON 1
18 FUROSEMIDE 0
19 CARDIOPLAGIA 0

NO CAIRAN JUMLAH PAKAI SISA

1 RL 2
2 ASERING 2
3 GELOFUSAL 1
4 NACL 25 ML 5
5 NACL 100 ML 2
6 NACL 500 ML 2
7 KCL 25 ML 1
8 D5 1/4 NS 500 ML 2
9 TOTILAC 250 ML 0
10

NO ALKES & SYRINGE JUMLAH PAKAI SISA

1 SYRINGE 20 ML 5
2 SYRINGE 50 ML 5
3 MICRO BURET 1
4 URINE BAG 1
5 ECG ADULD / PEDIATRIC 6
6 BLOOD SET 5
7 EXTENTION TUBE (diameter besar) 4
8 FEEDING TUBE TERUMO FR 8 -100 cm 1
9 SURFLO IV CAT 24 G X 2" 2
10 SURFLO IV CAT 22 G X 2" 2
11 SURFLO IV CAT 20 G X 2" 2
12 TEGADERM 1624 2
13 TEGADERM 1623 2
14 URINE BURET 1
15 JACKSON REES 0.5 L / 1 L 1\1
 PEMAKAIAN ANESTESI BT SHUNT JANTUNG " BLALOCK - TAUSSIG SHUNT"

TROLEY SPINAL ANASTESI

OT :

NO ITEM SEDIA SISA PAKAI

1 ALKOHOL 70% 100 CC IKAPHARMA 1
2 BETADIN 55 CC 1
3 CATAPRES INJEKSI 0
4 LIDOCAIN INJEKSI 3
5 MARCAIN HEAVY 0,5% 0
6 MARCAIN PDF INJEKSI 0
7 GAMMEX PF 6,5 / 7 / 7,5 / 8 1\1\1\1
8 DISP. SYRINGE 10 CC TERUMO 2
9 DISP. SYRINGE 5 CC TERUMO 2
10 DISP. SYRINGE 3 CC TERUMO 2
11 DISP. SYRINGE 1 CC TUBERCULIN TERUMO 2
12 SPINOCAN 25G / 26G 0
13 SPINOCAN 27G / PENCAN 27G 0\0
14 SPINOCAN 29G 0
15 CVC CERTOFIX TRIO V720 PROTECT ARROW 0
16 CVC 4 FR, 3 LUMENT (S413) / CVC 5 FR, 3 LUMENT 1\1
17 EPIDURAL PERIFIX 400 18G 0
18 ESPOCAN 0
19 MORPHINE 1
20 NaCl 25 ML / PRESURE INFUSOR BAG 500 ML 6\1
21 SOFSILK 3.0 SS-684 CUTTING / PROLENE 4-0 6682 / BISTURI NO.11 1\1
22 SURFLO IV CAT 22 G X 2" / 24 G X 2" 2\2
23 Artherial Leader Cath No. 3 Fr “VYGON” 0
24 TEGADERM 1626 / 1623 / 1610 3\1\1
25 MONITORING KIT "Edwards" 3 PANEL / 2 PANEL 1\1
26 PRESSURE TRANDUSER MONITORING KIT 1 PANEL "Philips" 1
27 BAJU STERIL "HOGY" SIZE 'M' 1
28 THERMADULUTION CATH 7 FR, 4 LUMENT (AH-05000) "ARROW" 0
29 PERCUTANEUS SHEATH INTRODUCER SET 8,5 FR "ARROW" 0
30
31
32
33

SERAH TERIMA BARANG SERAH TERIMA SISA PEMAKAIAN

PHAR-OT >< PERAWAT OT PERAWAT OT >< PHAR-OT

G SHUNT"
 PEMAKAIAN PERFUSI CABG JANTUNG
" CORONARY ARTERY BYPASS GRAFT "
" Team Perfusionist Adult"
Hari / Tanggal :
PATIENT BARCODE
Jam :
NO NAMA OBAT JUMLAH PAKAI SISA
1 INVICLOT 5000 IU INJ 5
2 FUROSEMIDE / LASIX 2
3 CARDIOPLAGIA 20 ML INJ 3
4 MEDIXON 500 MG INJ 3
5 PAPAVERIN HCL 4% INJ 1 CC 1
6 TRANEC 50 MG/ML INJ 5 ML 10

NO CAIRAN JUMLAH PAKAI SISA

1 RL 4
2 ASERING 10
4 NACL 25 ML 2
5 NACL 100 ML 1
6 NACL 500 ML 1
7 KCL 25 ML 2
8 MEYLON 8,4% INEKSI 25 ML 5
9 MANITOL 20% 250 ML 2
10 ALBUMIN 20% INFUS 100 ML 1

NO ALKES & SYRINGE JUMLAH PAKAI SISA

1 SYRINGE 3 ML 4
2 SYRINGE 5 ML 4
3 SYRINGE 10 ML 3
4 SYRINGE 50 ML 2
5 INFUS SET MAKRO 1
6 BLOOD SET 1
7 EXTENTION TUBE (diameter besar) 4
8 3WAYSTOCOCK BUNTUT 2
15 NEEDLE 18G X 1 1/2" 2
16 CAPIOX OXYGENERATOR (SX18R) 1