CHECKLIST PENGGUNAAN BHP IDIK

Nama Pasien/No RM : ..............................................................

Tgl Tindakan : .............................................................. Tempel stiker jika ada
Jenis Tindakan : ...........................................................
DPJP : ..............................................................

N
JENIS BHP JUMLAH STIKER/MERK
O

1 DIAGNOSTIC CATHETER

2 GUIDING CATHETER

3 GUIDE WIRE

4 BALOON

5 STENT
NO JENIS BHP JUMLAH STIKER/MERK

1 MERIT NEEDLE ANGIOGRAFI 18 GA

2 INTRODUCER SHEATH

3 MERIT MANIFOLD 3 PORT

4 INQ-WIRE

5 Angle tip hydrophilic

6 Extension tube 120 cm / 60 cm

7 Y-Conector

8 Indeflator + y valve

NO JENIS BHP JUMLAH NO JENIS BHP JUMLAH

1 BETADINE 15 ML 21 MICROPORE
2 ALKOHOL 70% 100 ML 22 SPUIT 50 CC
3 ALKOHOL SWAB 23 SPUIT 20 CC
4 ELEKTRODA ECG 24 SPUIT 10 CC
5 NS 500 ML 25 SPUIT 5 CC
6 HANDSCOON STERIL 26 SPUIT 3 CC
7 HANDSCOON NON STERIL 27 SPUIT 1 CC
8 Tensocrepe 15 cm/ 7,5 cm 28 KASSA STERIL
9 MASKER BEDAH 29 KASSA NON STERIL/ GULUNG
10 NURSE CAP 30 MESS NO.11
11 APRON PLASTIK 31 LIDOCAIN
12 SKIREN 32 NASAL / NRBM / RBM
13 3 WAY STOPKOCK 33 HYPAFIX 15 X 5 CM
14 KONTRAS META/ULTRA/XOLMET 50 ML 34 NICHIBAND/ TR BAND
15 KONTRAS META/ULTRA/XOLMET 100 ML 35 Extension panjang / pendek
16 Infusion set 36 Plastik steril idik
17 Transfusion set 37 Wfi 25 ml
18 Surgical gown 38 Transofix
19 Extension panjang / pendek 39 Heparin
20 Egemen 40 Surflo no.20

Circular Ners

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