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PEMAKAIAN OBAT-OBATAN & ALKES KAMAR BEDAH ELEKTIF

No. CAIRAN Pemesanan Jumlah Paraf No. OBAT-OBATAN LAIN Pemesanan Jumlah Paraf
Terpakai OK Farmasi Terpakai OK Farmasi
1. NaCI0,9% fls fls 1. Oxygen (O2) ltr ltr
2. Dextrose 5% fls fls 2. Sodium Penihotal amp amp
3. NaCI0,125% & Dex fls fls 3. Ketalar / Ivanes cc cc
5% 4. Suesinil Colin cc cc
4. NaCI 0,45% & Dex fls fls 5. Pethidine amp amp
5% 6. Pentanyl amp amp
5 Ringer Lactal fls fls
6 Ringer Solution fls fls 7. Sulfas Antropin amp amp
7 Potacol Solution fls fls 8. Prostigmine amp amp
8. Asering fls fls 9. Valium 10 amp amp

9. Dextan 70% fls fls 10. mg/Diazepam


Qualisine amp amp
10. Dextan 10% fls fls 11. Lidonest 2% / 6% amp amp
11. 12. Pavulon v v
13. Halothane cc cc
No. ALAT-ALAT Pemesanan Jumlah Paraf 14. Recofol / presopol amp amp
Terpakai OK Farmasi 15. Safol amp amp
1. D. Dexon, No bh bh 16. Fortanes amp amp
2. Infuset bh bh 17. Miloz amp amp
3. Spuit 1/3/5/10 bh bh 18. Aerane amp amp
4. Spuit 2-/50/100 bh bh 19. Sevo amp amp
5. Needle, No bh bh 20. Lidodex 5% amp amp
6. Spinal Needle, No bh bh 21. Lidocain 2% fls fls
7. Nelaton Catheter, No bh bh 22. Marcain Heavy 0,5 amp amp
23. Xylocain amp amp
8. Foley Balon Catheter, bh bh 24. Pehacain 2% amp amp
No 25. Atacrium / Tracium amp amp
9. Maagsing, No bh bh 26. Dormicum amp amp
10. Urine Bag bh bh 27. Efedrin amp amp
11. Gypsona 3*/4*/6* bh bh 28. Ulsikur amp amp
12. Kapas Orthoped bh bh 29. Adrenalin amp amp
3*/4*/6* 30. Oradexon amp amp
13. Electrode disposible bh bh 31 Effortil amp amp
14. Skin Tractions A/D bh bh 32. Cyntocinon amp amp
15. bh bh
16 Suction
3 W StopCatheter
Cock bh bh 33. Methergin amp amp
17. Selang Suction bh bh 34 Vit. K amp amp
18. ETT No bh bh 35. Ditranex/ Cyclokafron amp
19. Handscoen bh bh
6/6,5/7,07/7,5/8,0 36. kalnex amp amp
20. Pisau Operasi bh bh 37. Lasix / Inpungan amp amp
10/11/15/22/24 38. Aquadest 25 fls fls
21. Topi / Masker bh bh 39. Supratulle lbr lbr
22. Kass Op bh bh 40. Bethadine zalf secukupnya
23. bh bh 41. Bethadine Sol cc cc
42. Jy Jelly tube tube
No. BENANG LAIN Pemesanan Jumlah Paraf 43. H2 02 3% cc cc
Terpakai OK Farmasi 44. Formalin 10% cc cc
1. D. Dexon, No set set 45. Alkohol cc cc
2
Merisik, No set set
3. Syde, No. mtr mtr Antibiotica
3/0,2/0,0.1.2.3
4. Ethilon/Monosof No set set
5. Prolone / Surgipro set set
6. Vieryl / Polysorb No set set Anti muntah
7. Monocryl / Biosyn set set
8. Catgut Plain No. mtr mtr
3/0,2/0,00,1,2,3
9.
10. Marsilene
Cromic, No.No. set
mtr set
mtr Konsumsi
3/0,2/0,00,1,2,3
11. Bonwax / Surgicell set set
12 Silk No. set set
13.
14. Diketahui Ditulis Oleh,
Note : Harap ditulis dengan huruf & angka yang jelas
Bekerjalah dengan cermat dan tepat (....................................) (...........................................)

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