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  • Form Paket TPM & Coro

    Uploaded by

    Odi Saputra
    15 views2 pages
    This document lists the items in temporary pacemaker (TPM) and coronary/PCI procedure packs. It includes supplies like saline, lidocaine, sheaths, leads, needles, sutures, electrodes, drapes and consumables. The packs are checked and signed out by pharmacy and cath lab staff and returned after use with signatures.

    Original Description:

    berisi list bahan habis pakai ruang cathlab

    Original Title

    Form Paket Tpm & Coro

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    This document lists the items in temporary pacemaker (TPM) and coronary/PCI procedure packs. It includes supplies like saline, lidocaine, sheaths, leads, needles, sutures, electrodes, drapes and consumables. The packs are checked and signed out by pharmacy and cath lab staff and returned after use with signatures.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    15 views2 pages

    Form Paket TPM & Coro

    Uploaded by

    Odi Saputra
    This document lists the items in temporary pacemaker (TPM) and coronary/PCI procedure packs. It includes supplies like saline, lidocaine, sheaths, leads, needles, sutures, electrodes, drapes and consumables. The packs are checked and signed out by pharmacy and cath lab staff and returned after use with signatures.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    PAKET TEMPORARY PACEMAKER (TPM)

    RUANG CATHLAB

    TANGGAL :
    NAMA PASIEN :
    NO.RM :
    DIAGNOSA :
    NO OBAT DAN BHP PERMINTAAN SERAH TERIMA KET
    1 NACL 0,9% 500ML
    2 LIDOCAIN 2%
    3 SPUIT 10 ML
    4 SHEAT FEMORAL 6F
    5 LEAD TPM 6F/ BIPOLAR PACHING
    6 IMAGE COVER GUARDIAN
    7 NEEDLE PUNCTURE ANGIOGRAFI
    8 BENANG SILK 2.0
    9 MESS NO.11
    10 ELEKTRODA
    11 PLASTIK ALAS FEMORAL
    12 HANDSCOON STERIL 6,5
    13 HANDSCOON STERIL 7
    14 HANDSCOON STERIL 7,5
    15 POVIDON 60ML

    NAMA & TTD PETUGAS PENGAMBIL PAKET


    FARMASI :
    PETUGAS CATHLAB :

    NAMA & TTD PETUGAS PENGEMBALI PAKET


    FARMASI :
    PETUGAS CATHLAB :
    PAKET KORO/ PCI
    RUANG CATHLAB

    TANGGAL :
    NAMA PASIEN :
    NO.RM :
    DIAGNOSA :
    NO OBAT DAN BHP PERMINTAAN SERAH TERIMA KET
    1 SPUIT 3/ 5/ 10/ 20
    2 POVIDONE 60ML
    3 NACL 0,9% 500ML
    4 LIDOCAIN 2%
    5 HANDSCOON STERIL 6,5/ 7/ 7,5
    6 SHEAT FEMORAL 6F
    7 SHEAT RADIAL 6F
    8 J WIRE DIAGNOSTIK
    9 M WIRE DIAGNOSTIK
    10 INFUSET MAKRO
    11 BLOODSET
    12 MANIFOLD
    13 THREEWAY(MARQUIS)
    14 EXTENTION TUBE 152 CM
    15 EXTENTION TUBE 50ML
    16 INDEFLATOR SET
    17 TR BAND
    18 NEEDLE ANGIOGRAFI
    19 GUARDIAN COVER IMAGE
    20 MESS NO.11
    21 ELEKTRODA
    22 PLASTIK ALAS RADIAL
    23 HEPARIN VIAL
    24 NITROGLISERIN (NTG)
    25 TRANSOFIX
    26 ELASTIK PERBAN 3INC/ 4INC/ 6INC
    27 KONTRAS 50ML .......................
    28 KONTRAS 100ML .....................
    29
    30
    31
    32
    33
    34

    NAMA & TTD PETUGAS PENGAMBIL PAKET


    FARMASI :
    PETUGAS CATHLAB :

    NAMA & TTD PETUGAS PENGEMBALI PAKET


    FARMASI :
    PETUGAS CATHLAB :

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