Label Identitas

Kelas / Ruangan :

DAFTAR PEMAKAIAN OBAT DAN ALAT KESEHATAN

Operasi : Operator :
Tanggal : Anestesi :
Jenis Operasi : Khusus / Besar / Sedang / Kecil
Sifat : Cito Elektif
OT :

No Nama Barang jumlah No Nama Barang jumlah

1 Alkohol swab 41 Infusan Futrolit
2 Bisturi 11 / 15 / 20 / 22 42 Gelafusal
3 Povidone iodine 60 ml 43 Syringe 1cc / 3cc / 5cc / 10cc / 50cc / cath tip
4 Alkohol 70% 100cc 44 Perfussor
5 Paket kassa 1 / 2 / 3 / 4 / 5 45 Three Way Stopcock
6 Pencil Kauter 46 Cathejel
7 Neutral Pad 47 opsite
8 Suction Connecting Tube 48 Hypapix 10cmX500cm
9 Hansaplast 49 Fixomul 10cmX500cm
10 Otsu WFI 25ml 50 Mesh Hernia
11 Folley Catheter NO ....... 2 Way / 3 Way 51 Spongostan
12 Urine Bag 52 PD Wash / Octenic
13 POLYSORB 3-0 75CM C-14 TSL693 53 Nasal O2 Adult / Pediatric
14 POLYSORB 3-0 75CM CV-25 TGL182 54 Non RM / Rebreathing Mask
15 POLYSORB 3-0 75CM V-20 TGL122 55 Gamex no 6 / 6 1/5 / 7 / 7 1/5 /8
16 POLYSORB 2-0 90CM GS-21 TCL923 56 Endoloop
17 POLYSORB 1 VIO 90CM GS25 TCL905 57 Stapler haemoroid
18 POLYSORB 2 90CM GS24 TCL911 58 Biosyn no / Monosyn
19 CHROMIC GUT 1 75CM BP-27 TCG48 59 Apron Plastik
20 CHROMIC GUT 0 75CM GS-21 TCG812 60 Stomach tube NO....
21 CHROMIC GUT 1 90CM GS-21 TCG925 61 deeper craniotomy
22 CHROMIC GUT 2 75CM GS-25 TCG866 62 surgicel
23 CHROMIC GUT 2-0 90CM GS-21 TCG923 63 bonewax
24 CHROMIC GUT 3-0 75CM V-20 TGG122 64 CUTTISEL / URGOTUL
25 PLAIN GUT 2-0 75CM GS-21 TCG843 65 sanbehest 130
26 SURGIPRO 2-0 75CM C-15 TSP685 66 velban 3/4/6
27 SURGIPRO 3-0 45CM C-14 TSP684 67 gypsona no 3/4/6
28 SURGIPRO 4-0 45CM C-13 TSP683 68 armsling S/M/L
29 SURGIPRO 5-0 45CM C-13 TSP661 69 Tensocrep no 3/4/6
30 MONOSOF 10-0 30CM SE-140-8 N2718K 70
31 MONOSOF 2-0 75CM C-15 TSN664 71
32 MONOSOF 3-0 90CM C-14 TSN648 72
33 SOFSILK 1 75CM GS-21 TCS425 73
34 SOFSILK 2-0 45CM C-15 TSS685 74
35 SOFSILK 2-0 75CM V-30 TGS823 75
36 SOFSILK 3-0 45CM C-14 TSS684 76
37 SOFSILK 3-0 75CM V-20 TGS832 77
38 Infusan NS 100cc / 500cc / 1000cc 78
39 Infusan RL 79
40 Infusan Ring AS 80
 DAFTAR PEMAKAIAN ANESTESI
Operasi :
Tanggal :
OT :

NO NAMA BARANG
1 PROANES
2 ATRACURIUM
3 SEDACUM
4 PETHIDIN
5 FENTANYL
6 KEATOROLAC
7 KETESSE
8 FETIXSUP
9 KETAMIN
10 INTERSURGICAL NO .......
11 ETT NO ....
12 REINFORCED TRACHEAL TUBE NO
13 BUNASCAN/BUPIVACAIN/RECAIN
14 OXYTOCYN
15 METHERGIN
16 DEXAMETHASONE
17 PLASMINEX
18 METHYLPREDNISOLONE
19 SANMOL INFUS
20 ELEKTRODA
21 DUROGESIC PEDS
22 OPPA
23 ATROFIN SULFAT
24 EPHEDRIN
25 EPHINEPRINE
26 WAT6R FOR INJECTION
27 SPUIT 1CC/3CC/5CC/10CC/20CC/50CC
28 SPINOCAIN 25/26/27
29 NOKOBA
30 CATAPRES
31
32
33
34