Tindakan Operasi : Tgl/Jam Operasi :

No NAMA INSTRUMEN Sebelum Sebelum Tutup Sesudah

Operasi Rongga Operasi
1 Ring klem
2 Duk Klem
3 Pinset anatomis 14 cm
4 Pinset anatomis 20 cm
5 Pinset anatomis delicate 18 cm
6 Pinset chirurgi 14 cm
7 Pinset chirurgi 20 cm
8 Pinset chirurgi Delicate 18 cm
9 Gunting mayo
10 Gunting metzenbaum
11 Scalpel Handle No 4 (pemegang mess)
12 Scalpel Handle No 3 (pemegang mess)
13 Klem Haemostatic Forcep 16 cm
14 Klem Haemostatic Forcep 20 cm
15 Kochker Haemostatic Forcep 14 cm
16 Kochker Haemostatic Forcep 20 cm
17 Langen Beck
18 Peritoneum Klem
19 Doyen intestinal Klem
20 Babcock Tissue Forcep
21 Kogel Tang
22 Wertheim Hysterectomy Klem
23 Needle Holder
24 Set Jarum Bedah
25 Deppers
26 Kassa
27 Kassa Besar/B Kass
28 Gunting jaringan besar
29 Gunting Benang
30 Koker Panjang
31 Koker sedang
32 Mosquito / pean sedang
33 Mosquito / pean besar
34 Mosquito / pean kecil
35 Desinfeksi klem

KESIMPULAN : Lengkap / Tidak Lengkap *

Catatan :

Circulating Nurse Scrub Nurse Assistant Operator

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