BAHAN HABIS PAKAI KEBIDANAN

NO TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN

1. SC  Handscoon 6 ½, 7, 7 ½ ,8 2, 2 ,2 ,1
 Bisturi 23 1
 Sufratul 1
 Polysorb no.1 1 ( sachet )
 Nacl 0,9 % 1
 Folley cath no.16 1
 Urine bag
 Aquadest 25 ml 1
 Spuit 10 cc 1
 Plain 2/0, 1 ,0 2, 2, 2 ( Sachet )
 Cromic 3/0, Cromic 1, 2, 2,
Cromic 2 2 ( Sachet )
 Silk 3/0, Silk 1 2, 2 ( Sachet )
 Hypavic 30 cm
 Safil 2/0 1
 Monosyn 1

2. KISTECTOMY  Handscoon 6 ½, 7, 7 ½, 8 2, 2, 2, 1
 Bisturi 23 1
 Sufratul 1
 Polysorb no.1 1 ( sachet )
 Nacl 0,9 % 2
 Folley cath no.16 1
 Urine bag 1
 Aquadest 25 ml 1
 Spuit 10 cc 1
 Plain 2/0, plain 0, plain 1 2, 2, 2 ( Sachet )
 Cromic 3/0, cromic 1, 2, 2,
cromic 2 3 ( Sachet )
 Silk 3/0 2 ( Sachet )
 Premilene no.1 1
 Premilene no.2 1
 Safil 2/0 1
 Hypavix 1
 NGT 16 1
 D 40 % 1

3. HISTERECTOMY  Handscoon 6 ½, 7, 7 ½, 8 2, 2, 2, 1
 Gaas 3m
 Bisturi 23 1
  Sufratul 1
 Polysorb no.1 1 ( sachet )
 Safil 2/0 1
 Nacl 0,9 % 2
 Folley cath no.16 1
 Urine bag 1
 Aquades 25 ml 1
 Spuit 10 cc 1
 NGT no.16 1
 Plain 2/0, plain 0, plain 1 2, 2, 2 ( sachet )
 Cromic 3/0, cromic 1, 2, 3,
cromic 2 3 ( sachet )
 Silk 3/0, silk 1, silk 2 2, 3, 3 ( sachet )
 Hipavix 30 cm
 D 40 % 1

Penanggung jawab ,

( HARTATI,A.Md Kep )
NIP.19751111 200012 2 002

BAHAN HABIS PAKAI T H T

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O
1. TONSIL  Handscoon 6, 7, 7 ½, 8 1,1,2,1
 Nacl 0,9 % 1
 Plain 0 2 sachet

2. FESS  Handscoon 6 ½, 7, 7 ½, 8 1, 2, 2, 1
 Nacl 0,9 % 2
 Aquadest 25 ml 1
 Pehacain 2 amp
 Lidocain 2 amp
 Epinefrine 2 amp
 Jarum spinal no.23 1
 Spuit 20 cc, 10 cc, 3 cc 1, 1, 1
 Sufratul 1
 Hipafix 1

3. CAPUM NASI  Handscoon 6 ½, 7, 7 ½, 8 1, 2, 2, 1

 Nacl 0,9 % 1
 Aquadest 25 ml 1
 Pehacain 2 amp
 Lidocain 2 amp
 Epinefrine 2 amp
 Spuit 10 cc, 5 cc 1,1
 Sufratul 2

4. FRAKTUR NASAL  Handscoon 6 ½, 7, 7 ½, 8 1, 2, 2, 1

 Sorban 4 “ 1
 Gips 4 “ 1
 Lidocain 1 amp
 Pehacain 1 amp
 Spuit 3 cc 1
 Sufratul 2
 Hipafix 5 cm
 Nacl 0,9 % 1

5. OMSK / OMP  Handscoon 6 ½, 7, 7 ½,8 1, 2, 2, 1

 Nacl 0,9 % 1
 Pehacain 2 amp
 Lidocain 2 amp
  Epinefrine 2 amp
 Spuit 10 cc 1
 Spuit 5 cc 1
 Safil no.4/0 Cutting 1 sachet
 Surgipro no.4/0 tapper 1 sachet
 Sufratul 1
 Hipafix 5 cm

6. HAEMAGIOM  Handscoon 6 ½, 7, 7 ½, 8 1, 2, 2, 1
FIBROMA  Safil no.3/0 tapper 1 sachet
 Nacl 0,9 % 1

Penanggung jawab,

( SUYANTO,A.Md Kep )
NIP.19740313 200312 1 005

BAHAN HABIS PAKAI ORTOPHEDI

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. OP.FRAKTUR  Handsoon 6 ½, 7 ½ 1, 4
HUMERUS  Bisturi no.15 1
  Betadine 100 cc
 Alkohol 50 cc
 Monosyn 3/0 1 sachet
 Polysorb 3/0 1 sachet
 Sufratul 1
 NGT no.10/12 1
 Elastis verban 6’’ 1
 Spuit 20 cc 1
 Nacl 0,9 % 1
 Safil 2/0 1

2. OP.FRAKTUR  Handscoon 6 ½, 7, 7 ½, 8 1, 1, 3, 2
CLAVICULA  Bisturi no.15 1
 Betadine 100 cc
 Alkohol 50 cc
 Monosyn 3/0 1 sachet
 Polysorb 3/0 1 sachet
 NGT No.10 1
 Sufratul 1
 Spuit 20 cc 1
 Nacl 0,9 % 1

3. OP.FRAKTUR  Handscoon 6 ½, 7, 7 ½, 8 1, 1, 3, 2
CRURIS  Bisturi no.15 2
 Betadine 200 cc
 Alkohol 50 cc
 Polysorb 3/0 1, 1 sachet
 Monosyn 3/0 2 sachet
 Safil 2/0 1
 NGT no.12, 14 1
 Sufratul 1
 Spuit 20 cc 1
 Elastis verban 1
 Nacl 0,9 % 1

4. OP.FRAKTUR  Handscoon 6 ½, 7, 7 ½, 8 1, 1, 3, 2
PALANG  Bisturi no.15 1
 Betadine 100 cc
 Alkohol 50 cc
 Polysorb 3/0 1 sachet
  Surgipro 4/0 2 sachet
 Safil 2/0 1
 Sufratul 1
 Nacl 0,9 % 1

5. AMPUTASI KAKI  Handscoon 6 ½, 7 ½ 1, 4

 Bisturi no.10 1
 Surgipro 2/0 2 sachet
 Polysorb 2/0 1 sachet
 Safil 1
 NGT 18 1
 Sufratul 1
 Spuit 20 cc 1
 Nacl 0,9 % 2
 Elastis verban 4 “, 6 “ 1

6. OP.TULANG  Handscoon 6 ½, 7 ½ 1, 4
BELAKANG  Bisturi no.10, 11 1, 1
 Polysorb 1, 2/0 1, 1 sachet
 Monosyn 2/0 (Cutting) 1 sachet
 Safil 1 1
 Sufratul 1
 NGT no.18 1
 Spuit 20 cc 1
 Nacl 0,9 % 2
 Spongostan 1

7. OP.TENDON  Handscoon no.6 ½, 7 ½ 1, 4

ARHILES  Bisturi no.15,11 1, 1
 Surgipro 0 ( tapper ) 1 sachet
 Surgipro 3/0 1 sachet
 Polysorb 3/0(Cutting) 1 sachet
 Safil no.1 1
 Betadine 150 cc
 Alkohol 50 cc

 Gips 6 “ 4
 Soban 6 “ 1
 Elastis verban 4 “, 6 “ 1
 Spuit 20 cc 1
 Nacl 0,9 % 1
8. OP.FRAKTUR  Handscoon 6 ½, 7 ½ 1, 4
FEMUR ANAK  Bisturi no.10 1
 NGT no.12 1
 Polysorb 3/0 (Cutting) 1 sachet
 Surgipro 3/0 1 sachet
 Safil 2/0 1
 Elastis verban 4 “ 1
 Sufratul 1
 Spuit 20 cc 1
 Nacl 0,9 % 1

9. OP.FRAKTUR  Handscoon 6 ½, 7 ½, 8 1, 3, 1
FEMUR DEWASA  Sufratul 1
 Surgipro 2/0 1 sachet
 Polysorb 2/0 (Cutting) 1 sachet
 Safil 1` 1
 NGT no.14 1
 Elastis verban 6 “ 1
 Spuit 20 cc 1
 Nacl 0,9 % 1

10. OP.ELBOW  Handscoon 6, 7 ½ 1, 4

 Bisturi no.15 1
 Polysorb 4/0(Cutting) 1 sachet
 Surgipro 3/0(Cutting) 1 sachet
 Safil 1
 Elastis verban 1
 Gips 4 “ 3
 Soban 4 “ 1
 Sufratul 1
 NGT no.10 1
 Nacl 0,9 % 1

11. OP.RADIUS/ULNA  Handscoon 6 ½, 7 ½ 1, 4

 Bisturi no.15 2
 Polysorb 4/0 1 sachet
 Surgipro 4/0 1 sachet
 Safil 3/0 1
 Monosyn 3/0 1
 Sufratul 1
 Elastis verban 4 “ 1
  NGT no.10 1
 Spuit 20 cc 1
 Nacl 0,9 % 1

Penanggung jawab,

( MUHARNI LAILAWATI,A.Md Kep )

NIP.19550618 197808 2 001

BAHAN HABIS PAKAI BEDAH MULUT

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. FRAKTUR  Pehacain 3 amp

 Gentamicin 1 amp
 Spuit 10 cc 1
 Spuit 3 cc 1
 NGT no.10 1
  Safil 4/0 1 sachet
 Polysorb 2/0 1 sachet
 Bon wage 1
 Aquadest 25 ml 1
 Nedle no.23 1
 Bisturi no.10 1

2. PALATO  Pehacain 4 amp

 Gentamicin 1 amp
 Spuit 10 cc 1
 Spuit 3 cc 1
 Polysorb 4/0 2 sachet
 Bon wage 1
 Aquadest 25 ml 1
 Bisturi no.15 2

3. LABIO SCHIZIS  Pehacain 2

 Gentamicin 1
 Spuit 10 cc 1
 Spuit 3 cc 1
 Nedle 23 1
 Safil 4/0 2 sachet
 Vicril 5/0 2 sachet
 Aquadest 1
 Bisturi no.15 1
 Penanggung jawab,

( ELLA ANGRAINI MUTIA,AMK )

NIP.19780418 200312 2 006

BAHAN HABIS PAKAI BEDAH UMUM

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. LAPARATOMI  Bisturi no.10 1

 Handscoon 7 ½, 6 ½ 3, 2
 Betadine 100 cc
 Alkohol 50 cc
 Plain no. 2/0 – 3/0 1 sachet
 Polysorb no. 2/0 1 sachet
 Surgipro 2/0 – 3/0 2 sachet
  Saide 3/0 2
 Safil no.1 1
 Safil no.0 1
 NGT no.18 1
 Kateter no.16 – 18 1
 Urine bag 1
 Safil no.1

2. OP.APPENDIK  Bisturi no.10 1

 Handscoon 7 ½, 7 3, 1
 Betadine 50 cc
 Alkohol 50 cc
 Plain no.2/0 – 3/0 1
 Saide no.2/0 – 3/0 1
 Cromic 2/0 – 3/0 1
 Kateter no.16 – 18 1
 Urine bag 1

3. OP.HERNIA  Scaple mesh no.10 1

 Handscoon 7 ½, 7 3, 1
 Betadine 50 cc
 Alkohol 50 cc
 Plain 2/0 – 3/0 1
 Cromic 2/0 – 3/0 1
 Saide / Silk 3/0 – 2/0 1
 Saide / Silk 2 2
 Monosyn 3/0 1
 Surgipro 3/0 1
 Kateter 1
 Urine bag 1

Penanggung Jawab,

( H.ABANG IMAN SANTOSA,A.Md Kep )

NIP.19770713 20031 1 005
 BAHAN HABIS PAKAI UROLOGI

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. TUR BPH  Handscoon 7 ½ 2 psg

 Folley kateter no.24 1
( Three way )
 Urine bag 1
 Infus set dewasa 1
 Alkohol 50 cc
 Betadine 50 cc
2. TUR TUMOR  Handscoon 7 ½ 2 psg
BULI  Folley catheter no.18 / 20 1
 Urine bag 1
 Alkohol 50 cc
 Betadine 50 cc

3. STRIKTUR  Handscoon 7 ½ 2 psg

URETRA (SAKSE)  Folley catheter no.16 1
 Urine bag 1
 Alkohol 50 cc
 Betadine 50 cc

4. BATU BULI  Handscoon 7 ½ 2 psg

( LITOTRIPSI )  Folley catheter no.20 1
 Urine bag 1
 Alkohol 50 cc
 Betadine 50 cc

Penanggung Jawab,

(Sy.ABDURRAKHIM,A.Md Kep )
NIP.19730907 199403 1 004

BAHAN HABIS PAKAI UROLOGI ( OPEN )

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. BATU GINJAL  Handscoon 7 ½, 7 2, 1 Sesuai kebutuhan

 Folley kateter no.18/16 1
 Urine bag 1
 Spuit 20 cc 1
 Spuit 5 cc 1
 Bisturi no.10 / no.11 1, 1
 Safil no.1 (Tapper) 1
 Polysorb no.4/0 (Tapper) 1
 Monosin no.3/0 (Cutting) 1
 Cut Gut Plain no.2/0 ½ mtr
  Cut Gut Plain no.3/0 ½ mtr
 Silk 2/0 ½ mtr
 NGT no.16 1
 NGT no.5 1
 Nacl 0,9 % 1 kolf
 Betadine 100 cc
 Alkohol 50 cc

2. BATU URETER  Handscoon 7 ½, 7 3 psg

( DISTAL /  Folley kateter no.18/16 1
PROKSIMAL )  Urine bag 1
 Spuit 20 cc 1
 Spuit 5 cc 1
 Bisturi no.10 / no.11 1, 1
 Safil no.2/0, no.1 (Tapper) 1, 1 Tergantung letak
 Polysorb no.4/0 (Tapper) 1 batu ( Proksimal /
 Prolene no.3/0 (Cutting) 1 distal )
 Cut Gut Plain no.2/0 ½ mtr
 Cut Gut Plain no.3/0 ½ mtr
 Silk 2/0 ½ mtr
 NGT no.16 1
 NGT no.5 1
 Nacl 0,9 % 1 kolf
 Betadine 100 cc
 Alkohol 50 cc

3. BATU BULI  Handscoon 7 ½ / 7 3 psg

 Folley catheter no.18 /20 1 Sesuai kebutuhan
 Urine bag 1
 Disp spuit 20 cc 1
 Disp spuit 3 cc 1
 Bisturi no.10 / 11 1/1
 Safil no 2/0 (Tapper) 1
 Prolene no 3/0 (Cutting) 1
 Cut gut cromic 3/0 1 mtr
 Cut gut plain 3/0 ½ mtr
 Nacl 0,9 % 1 kolf
 Alkohol 50 cc
 Betadine 50 cc
4. HIPOSPADIA  Handscoon no.7 ½ / 7 3 psg
 Folley catheter no 10 / 12 1 Tergantung usia
 Urine bag 1
 NGT no.8 / no 10 1
 Bisturi no.15 / no.11 1/1
 Polysorb no.6/0 Min 4
 Betadine 50 cc
 Alkohol 50 cc

5. VARICOCEL  Handscoon 7 ½ / 7 3 psg

 Bisturi no.10 1
 Silk no.2/0 1 mtr
 Cromic no.2/0 ½ mtr
 Plain no.3/0 ½ mtr
 Safil no.2/0 1 Bila perlu
 Alkohol 50 cc
 Betadine 50 cc

6. CA.PENIS  Handscoon 7 ½ /7 3 psg

 Folley catheter no.18 1
 Urine bag 1
 Disp spuit no.20 1
 Bisturi no.10 1
 Polysorb no.4/0 1 Bila perlu

 Cut gut cromic no.3/0 1 mtr

 Silk no.2/0 ½ mtr
 Alkohol 50 cc
 Betadine 100 cc

7. ORCHIDECTOMI  Handscoon 7 ½ / 7 3 psg

 Bisturi no.10 1
 Cut gut cromic no.3/0 1 mtr
 Silk no.2/0 ½ mtr
 Alkohol 50 cc
 Betadine 50 cc

8. VESICO VAGINAL  Handscoon no.7 ½ / 7 3 psg

VISTEL  Folley catheter no.16 / 18 1
  Urine bag 1
 Disp spuit 20 cc 1
 Bisturi no.10 / no.11 1/1
 Safil no.2/0 1
 Polysorb no.4/0 / 3/0 Min 2
 Premilene no.3/0 1
 Cut gut cromic no.3/0 1 mtr
 Cut gut palin no.3/0 ½ mtr
 Betadine 100 cc

Penanggung jawab,

( Sy.ABDURRAKHIM,A.Md Kep )
NIP.19730907 199403 1 004

BAHAN HABIS PAKAI BEDAH ANAK

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. APPENDIK  Handscoon 8, 7 ½ 1, 2
 Betadine 100 cc
 Alkohol 50 cc
 Bisturi no.15 1
 Silkam 2/0 1 mtr
 Side 3/0 ½ mtr
 Cromic 3/0 ½ mtr
 Plain 2/0 ½ mtr
 Nacl 0,9 % 1
 Polysorb 3/0 1
 Hipavix 20 cm
 Gaas 1 mtr
2. HERNIA  Handscoon 8, 7 ½ 1, 2
 Betadine 100 cc
 Alkohol 100 cc
 Bisturi no.15 1
 Gaas 2 mtr
 Silkam 3/0 ½ mtr
 Side 2/0 ½ mtr
 Plain 2/0 ½ mtr
 Cromic 3/0 ½ mtr
 Safil 3/0 1 mtr
 Nacl 0,9 % 1
 Hipavix 20 cm

3. HIIPOSPODIA  Handscoon 8, 7 ½ 1, 2
 Bisturi no.15 1
 Gaas 2 mtr
 Kateter no.8 1
 Urine bag 1
 NGT no.3,5 / 5 1,1
 Surgipro 5/0 ( Cutting ) 2
 Safil 5/0 ( Tapper ) 2
 Side 2/0 ½ mtr

4. TUMOR INTRA  Handscoon 8 / 7 ½ 2/2

ABDOMEN /  Betadine 100 cc
LAPARATOMI  Alkohol 100 cc
 Bisturi no.10 / 15 1/1
 Kasa 3 mtr
 Kateter no.8 1
 Urine bag 1
 Spuit 10 cc 1
 NGT no.3 ½ / 5 1
 Plain 2/0 1 mtr
 Side 3/0 2 mtr
 Cromic 3/0 1 mtr
 Polysorb 3/0 1 sachet
 Supratule 1

5. SUB TISSUE  Handscoon 8 / 7 ½ 1/2

TUMOR / STT  Betadine 100 cc
  Alkohol 50 cc
 Bisturi no.15 1
 Kasa 2 mtr
 Plain 2/0 1 mtr
 Side 3/0 1mtr
 Cromic 3/0 1 mtr

6. ATRESIANI  Handscoon 8 / 7 ½ 2/3

 Betadine 100 cc
 Alkohol 100 cc
 Bisturi no. 10 / 15 1/1
 Kasa 3 mtr
 Side 2/0 2 mtr
 Surgipro 3/0 2 sachet
 Cromic 3/0 1 mtr
 Kateter 1
 Urine bag 1
 Spuit 10 cc 1
 Supratule 1

7. HISPRONG /  Handscoon 8 / 7 ½ 2/3

DUHAMIL  Betadine 100 cc
 Alkohol 100 cc
 Bisturi no.10 / 15 1/1
 Kasa 3 mtr
 Kateter no.8 1
 Urine bag 1
 Spuit 10 cc 1
 NGT no.3 ½ / 5 1/1
 Side 2/0 1 mtr
 Plain 2/0 1 mtr
 Cromic 3/0 1 mtr
 Safil no 3/0 2 sachet
 Surgipro 3/0 1 sachet
 Supratule 1

8. SIRKUMSISI  Handscoon 8 / 7 ½ 1/2

  Betadine 100 cc
 Alkohol 100 cc
 Plain 3/0 1 mtr
 Kasa 1 mtr
 Salp mata 1

Penanggung jawab,

( TAHMID,A.Md Kep )
NIP.19710520 199201 1 001

BAHAN HABIS PAKAI BEDAH SARAF

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. EDH  Pehacain 4 amp

 Bisturi no.10 1 amp
 Spuit 20 cc 2
 Nedle no.23 1
 NGT no.12 1
 Spongostan 1
 Safil 2/0 2 sachet
 Polysorb 4/0 2 sachet
 Silkam 2/0 1
 Handscoon 5
 Bon wage 1
 Aquadest 1
 Nacl 0,9 % 1

2. VP SHUNT  Pehacain 4 amp

 Bisturi no.10 1
  Spuit 20 cc 2
 Nedle 1
 Saffil 4/0 2 sachet
 Handscoon 5
 Aquadest 1
 Nacl 0,9 % 1
 Silkam 2/0 1

3.  Pehacain 4 amp
ICH
 Bisturi no.10 1
 Busturi no.15 1
 Spuit 20 cc 2
 Nedle no.23 1
 NGT no.12 1
 Spongostan 1
 Saffil 2/0 (Tapper) 2 sachet
 Polysorb 4/0 (Tapper) 2 sachet
 Silkam 2/0 1
 Handscoon 5
 Bon wage 1
 Aquadest 25 ml 1
 Nacl0,9 % 1

N ALAT/BAHAN JUMLAH KETERANGAN

Dx/ TINDAKAN
O

4. BOR GATEN  Pehacain 2 amp

 Bisturi no.10 1
 Spuit 20 cc 1
 NGT no.12 1
 NGT no.8 1
 Polysorb 2/0 1 sachet
 Handscoon 4
 Silkam 2/0

Penanggung jawab,

( ELLA ANGRAINI MUTIA, AMK )

NIP.19780418 200312 2 006
 BAHAN HABIS PAKAI MATA

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. KATARAK  Handscoon 7 ½ 2
PTERIGIUM  Handscoon 6 ½ 2
GLAUKOMA  RL 1 kolf
 Infus set / tranfusi set 1
 Spuit 20 cc 1
 Spuit 10 cc 2
 Spuit 5 cc 1
 Spuit 1 cc 1
 Zalf mata 1
 Lidocain 3 amp
 Gentamicin 1 amp
 Dexamethason 1 amp
 Epineprine 1 amp
 Bisturi no.11 1
 Bisturi no.15 1
2. EVISERASI  Handscoon 7 ½ 2
ENUCLEASI  Handscoon 6 ½ 2
EKSENTRASI  RL 1 kolf
 Infus set / tranfusi set 1
 Spuit 20 cc 1
 Spuit 10 cc 2
 Spuit 5 cc 1
 Spuit 1 cc 1
 Zalf mata 1
 Lidocain 3 amp
 Gentamicin 1 amp
 Dexamethason 1 amp
 Epineprine 1 amp
 Bisturi no.11 1
 Bisturi no.15 1
 Spongestan 1
 Sufratul 1
 Cefotaxime 1

Penanggung jawab,

( NUNUNG TRI ASTUTI,A.Md Kep )

NIP.19800503 200502 2 004
 BAHAN HABIS PAKAI BEDAH TUMOR ( dr.Indra )

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

1. CA.MAMMAE  Handscoon 7 ½, 7, 6 ½ 2, 2, 2
 Bisturi no.10, 15 1, 1
 Supratule 1
 Elastis Verban 6 “ 1
 Aquadest 2 ltr
 NGT no.18 atau 16 2 bh
 Nacl 0,9 % 1
 Urine bag 1
 Catheter 16 1 Bila perlu
 Surgipro 4/0 1
 Cromic 2/0, 3/0 1,1
 Safil 3/0 atau 2/0 1
 Betadine 100 cc
 Alkohol 100 cc
2. FAM / SOFT  Handscoon 7 ½, 7, 6 ½ 1, 1, 1
TISSUE TUMOR  Bisturi no. 15 1
 Aquadest 1 ltr
 Betadine 100 cc
 Alkohol 100 cc
 Polysorb 3/0 1 Bila perlu
 Premilen 4/0 1
 Plain 3/0 1

3. STRUMA  Handscoon 7 ½, 7, 6 ½ 1, 1, 1
 Aquadest 1 ltr
 Supratule 1
 Bisturi no.10 1
 Urine bag 1
 Catheter no.16 1
 NGT no.12 1
 Premilene 4/0 1 Bila perlu
 Plain 3/0 1
 Side 2/0, 3/0 1, 1
 Cromic 3/0 1
 Betadine 100 cc
 Alkohol 100 cc

N
Dx / TINDAKAN ALAT / BAHAN JUMLAH KETERANGAN
O

4. BASAL CELL  Handscoon 7 ½, 7, 6 ½ 2, 2, 2

 Bisturi no.10, 15 1, 1
 Aquadest 1 ltr
 Side 3/0 atau 2/0 1 Bila perlu
 Monosyn 3/0 atau 4/0 1
 Safil 3/0 atau 4/0 1
 Supratule 1
 Betadine 100 cc
 Alkohol 100 cc

5. TUMOR PAROTIS  Handscoon 7 ½, 7, 6 ½ 1, 1, 1

 Bisturi no.15 1
 Aquadest 1 ltr
 Polysorb 3/0 1 Bila perlu
 Monosin 3/0 atau 4/0 1
 Silkam 3/0 1
 Supratule 1
 Betadine 100 cc
 Alkohol 100 cc

Penaggung jawab,

( DEDI ISKANDAR, A.Md Kep )

NIP.19740405 199603 1 002