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Diagnosa :…………………………………............

Yang Mengisi
Operator :…………………………………............ Perawat
Label identitas tempel disini
Jenis tindakan :……………………………
Jenis / nama obat / bahan Pakai Jenis / nama obat / bahan Pakai Jenis / nama obat / bahan Pakai
A. Pre Cath 39. Metapospar 320 ........... C. VASCULAR
1 Kateter no …………….... 40. Xolmetras 350 ............ cc 72. Merit Resolve
2 Kondom kateter ............. 41.  Lidocain 2% 73. Vert
3 Urobag 42. Heparin ................. cc 74. Neff Percutaneus Acces
4 Chest lead 43. Mess no….............. 75. Biliary Drainage Cateter
B. Durante Cath 44. Vicryl no ………………
JR ........................ 45. Silkam…
JL ........................ 46. Safil…
2.Catheter AL1 6F 47. Proline no …………….. TPM
3.Catheter MPA1 ........................ 48. Nacl 0,9 % 500 cc Bipolar catheter
4. Cardiac Pigtail ......................... 49. Nacl 0,9 % 100 cc Bipolar Bisawi
5. Ultimete 1 5F 50. Spuit 1 cc Heath Port
6. Prelude Sheat .......................... 51.  Spuit 3 cc Bunaskan
7. Prelude Transradial 6F 52. Spuit 5 cc
8. Prelude Sheat 7F9 (long sheat) 53.  Spuit 10 cc
9.  Angiographic Needle 54. Spuit 50 cc lupi E. Post Cath
10. Pressure Line 30 cm 55. Kasa steril
11. Pressure Line 152 cm 56. Underpad non steril
12. Manifold 3 port 57.  Underpad steril
13. Guide wire 0.035 58. Tensocrap ….cm
14. Merit Assecoris kit 59. Glove steril
15 IDK 60.  Glove steril 7
BOSTON 61. Glover steril 7,5
16 Conecting Tubing 180 62. Tutup kepala F. Lain Lain
17 Conecting Tubing 50 63. Masker
18 Conecting Tubing 120 64. Non Rebreathing Mask
19 Hemostasis Valve Yconnector 65. Nasal Canule
20. Manifold 3port Nugra 66. Kateter suction
21 Balon Inflation Device 67. Baterai
22 Guide Wire Angled/hidropilik 68. Hipavix
23 Tranduser 69.  Tranfusi set
X J wire Nugra 70. Betadine
71. ThreeWay stop cock
Guiding STIKER
24. Boston Runway CLS/JL/JR 3.5 ……..
25. Cordis JL/JR/XB/AL.....
26. Heart Rail II BL / JL / JR ……..
Wire
Wire XT / XT A
27. Terumo Rantrough NS
28. Sion Blue
29. Pilot
Baloon
30. Shapphire II Pro / Scoreflex
31. Boston Emerge Push/Maverick
32. Foxtrot Pro
33. Boston NC Emerge
34. NC Sapphire
STENT
35. DES Boston Promus Element
36. Firebird / Firework
37. Combo Plus
38. Cre 8
39. Evro Sure

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