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CEKLIS MONITORING ALAT/ BAHAN/ JARUM KAMAR BEDAH

Nama Pasien : Operator :


Tgl Lahir : Asisten I :
Tgl Operasi : Asisten II :
Jenis Operasi : Scrub Nurses :
NO NAMA INSTRUMEN JML AWAL TAMBAHAN JUMLAH AKHIR

PAKAI SISA

1. Kassa X Ray / Non X Ray

2. Virkan Kassa X Ray / Roll Kassa X Ray

3. Jarum/ Surgical needles/ Jarum atraumatic

4. Yoderm / Holding Forcep / penser Clamp

5. Towel Clamps

6. Anatomis Forcep

7. Chirurgis Forcep

8. Klem Bengkok / Hemostatic Forceps

9. Klem Lurus / Hemostatic Forceps

10. Masquito Bengkok

11. Masquito Lurus

12. Kocher Forcep

13. Peritoneum Klem

14. Alis Klem / Babcoock

15. Steel Depper / Kweetzer Klem

16. Gunting Jaringan

17. Gunting Benang

18. Gunting Tali Pusat

19. Needle Holder

20. Sadel Hak

21. Langenback

22. O Hak

23. Hak Dalam

24. Speculum

25. Canule Suction

26.

27.

( Perawat Circuler ) ( Scrub Nurse )

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