SECTION "R" PAGES
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Section R: Page 002
PHYSICIAN INDUSTRIES CREATE A KIT

EPIDURAL NEEDLES
17G x 3-1/2"
18G x 3-1/2"
18G x 6"
20G x 2-1/2"
20G x 3-1/2"
22G x 3-1/2"
Removable Wing
Fixed Wing
Hustead
Metal Hub
Plastic Stylet
Metal Stylet

LOSS FOF RESISTANCE SYRINGES
Plastic Syringe 7cc LL
Plastic Syringe 7cc LS
Glass Syringe 5cc LL
Glass Syringe 5cc Ls
Other________________

SYRINGES
Syringe 3cc LL
Syringe 3cc LS
Syringe 5cc LL
Syringe 5cc LS
Syringe 10cc LL
Syringe 10cc LS
Syringe 20cc LS
Syringe 20cc LL
Syringe 1cc LS
Other________________

NEEDLES
Needle 18G x 1-1/2" (Pink)
Filter Needle 19G x 1-1/2" (Clear)
Needle 20G x 1-1/2" (Blue)
Needle 21G x 1-1/2" (Green)
Needle 22G x 1-1/2" (Black)
Needle 25G x 5/8" (Blue)
Needle 27G x 1/4" (Gray)
Filter Straw
Other______________________

SPINAL NEEDLES
18G x 3-1/2"
20G x 3-1/2"
22G x 3-1/2"
22G x 5"
22G x 6"
22G x 7"
22G x 8"
25G x 3-1/2"
Other_____________________

MEDICATIONS
Sodium Chloride 0.9% 10ML Ampule
Lidocaine 1% 5ML Ampule
Lidocaine 1.5% w/ 1:200. EPI Ampule
Lidocaine 1% 30ML Vial Ampule
Lidocaine 2% 10ML Ampule
Bupivicaine ______ % 10ml
Other_____________________

DRAPES AND TOWELS
Fenestrated Drape
Small Fenestrated Drape w/ Tape
Utility Drape w/ Tape
Clear Fenestrated Drape
Absorbent Towel
Blue O.R. Towels
C-ARM Drape
Other_____________________

PREP PRODUCTS
Sponge Applicators
Povidone Iodine 1 oz. Packet
Povidone Iodine Triple Swabs
Pair Surgeon Gloves
Gauze 4" x 4" 8 Ply
Gauze 3" x 3" 12 Ply
Adhesive Bandage
Needle Stick Pad
Other________________

EXTENSION SETS
Extension Set 6" Minibore
Extension Set 12" Minibore
Extension Set 20" Minibore
Other________________

FORMED TRAYS
Large Shallow Prep
Single Shot Tray
Single Deck Epidural Tray
Other________________

CONTINUOUS EPIDURAL
20G Epidural Catheter
Flat Filter
Other________________

MISCELLANEOUS
Skin Marker
Inflation Syringe

NAME: ________________________________

HOSPITAL:________________________________

DEPARTMENT:_______________________________

CITY:_______________________________

ADDRESS:_______________________________

PHONE / FAX:________________________________

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