PANDUAN PRAKTIK KLINIS (PPK) PANDUAN PRAKTIK KLINIS (PPK)
PROSEDUR TINDAKAN PROSEDUR TINDAKAN RS MITRA KELUARGA CIBUBUR RS MITRA KELUARGA CIBUBUR
BEKASI BEKASI 2016 2016
Prosedur Pemasangan Central Vena Catheter Prosedur Pemasangan Central Vena Catheter 1.
1. PPenengegertrtiinn (De!ni"i) (De!ni"i)
Kteter #en "entr$ %$& "e'&
Kteter #en "entr$ %$& "e'& teter *ng %ite+,tteter *ng %ite+,t n
n e%$+ e%$+ #en #en 'e"r 'e"r %i %i $e&er $e&er (#en (#en -g$r -g$r internintern t
t #en #en -g$r -g$r e"tern) e"tern) %% %% (#en (#en "'/$#in)"'/$#in) $engn (#en '"i$i/) t ,& (#en e+r$i").11 $engn (#en '"i$i/) t ,& (#en e+r$i").11 2
2.. IInn%%ii""ii 11.. MMnniittrriinng g TTeennn n eenn ""eennttrr$ $ ((//eennttrr$ $ ##eenn" " ,,rree""""rree CP)
CP) 2.
2. Pe+'Pe+'erin erin nti'nti'iti/ iti/ intrintr#en #en -ng-ng3,n-3,n-ngng 4.
4. Pe+Pe+'erin 'erin ntrintri"i ,"i ,rentrenter$ -er$ -ngng3,n-3,n-ngng 5.
5. KKe+e+tterer,,ii .
. Pe+Pe+'erin 'erin 't *'t *ng /en%ng /en%erng +eerng +en*e'n*e''n ,'n ,&$e'it&$e'iti"i" %$+
%$+ #en #en ,erier ,erier (/"ti/) (/"ti/) "e,erti7"e,erti7 •
• C$/i+ /&$ri%eC$/i+ /&$ri%e •
• C&e+t&er,*C&e+t&er,* •
• 8*,ertni/ "$ine8*,ertni/ "$ine •
• Pt""i+ C&$ri%ePt""i+ C&$ri%e •
• A+i%rneA+i%rne 6.
6. P$P$""++,&,&erere"e"i"i" 9
9.. DDii$*$*""ii"" :.
:. TTrn"rn"""i %ri %r& 'e& 'er$r$ngng ;.
;. KKe'te't&n &n n "e" in "e" intr#ntr#en *nen *ng 'er$g 'er$ng t tng t terer " +ener"
" +ener"
10.Ke't&n n t&er,* intr#en "t "e" #en 10.Ke't&n n t&er,* intr#en "t "e" #en
,erier
,erier ti% ti% %i+nginn%i+nginn 4
4.. KKnnttrr IInn%%ii""ii AABBSSOOLLUUTT •
• Pen$n %ri ,"ienPen$n %ri ,"ien •
• Ine"i %i %er& ,e+"ngnIne"i %i %er& ,e+"ngn •
• ri"i nt+i ri"i nt+i *ng "$it ,% $"i *ng "$it ,% $"i ,e+"ngn,e+"ngn •
• S,erir #en /# "*n%r+e (e</e,t e+r$ #en"S,erir #en /# "*n%r+e (e</e,t e+r$ #en" $ine) $ine) RELATI= RELATI= • • Cg$,t&*Cg$,t&* •
• Ine"i "i"te+iIne"i "i"te+i •
• #entri/$r ""i"t %e#i/e %i"e'e$& nn#entri/$r ""i"t %e#i/e %i"e'e$& nn •
• Pre"en/e in%>e$$ing /t&eter" t ,/ing >ire"Pre"en/e in%>e$$ing /t&eter" t ,/ing >ire" ,% %er& ,e+"ngn
,% %er& ,e+"ngn 5
5.. PPeerr""ii,,nn 11.. PP""iieen %n %nn??tt ee$$rrgg % %ii--ee$$""n tn t--nn i inn%%ii""ii +,$i"i %n ,er>tn "e" #en "entr$ ter"e't. +,$i"i %n ,er>tn "e" #en "entr$ ter"e't. 2.
2. Srt ,Srt ,er"eter"et-n ti-n tin%n%n %ii"i %n %ii"i %n %itn %itn%tn%tngni ngni $e&$e& %ter ,e$"n tin%n (,ertr) %n
%ter ,e$"n tin%n (,ertr) %n ,"ien?e$rg.
,"ien?e$rg. 4.
• Steri$e +" g$#e" n% g>n • Mnitr &e+%in+i
• I $ine ,erier %engn ter,"ng /irn • Steri$e ,re, "$tin (e.g. /&$r&e<i%ine) • Steri$e %r,e"
• S,it @+L "teri$e %engn -r+ 2@ r 40 nt ne"te"i $$
• L/$ ne"t&eti/ ("$$* 1 $i%/ine) • 22@gge 1.@in/& nee%$e
• 1:@ r 20@gge intr#en" /t&eter (#er nee%$e) n "*ringe r 1:@gge &$$>@'re nee%$e
• Pre""re t'ing
• Guidewire
• N. 11 "/$,e$ '$%e
• Central venous catheter >it& %i$tr • 4.0 "tre n /tting nee%$e
5. Pe+"ngn "e" #en "entr$ &en%n* %i$n %i rng tin%n *ng %i$eng,i %engn +nitr EKG "ert $t %n 't re""it"i P"ien %i,"i"in gr $et #en "entr$ $e'i& ",er!"i$ %n +%& %i%,t. . P% ,e+"ngn "e" %i #.-g$ri" intern t
"'$#i ,"ien +eneng e "i"i 'er$>nn %n ,% ,nggng ntr e% ",$ %i'eri 'nt$ ,enggn-$ "e&ingg $e&er "e%iit e"ten"i.
6. Penggnn $tr"ngr! 'i "e/r $ng"ng "t ,r"e%r +,n ti% $ng"ng ("e'e$+ ,r"e%r) %,t +e+'nt ,r"e%r ,e+"ngn "e" #en %n +engrngi +,$i"i.
9. A$t ,e$in%ng %iri +en/, +"er tt, e,$ '- tin%n %n "rng tngn "teri$ %i"i,n nt
,ertr . Pr"e%r
Tin%n
1. Ce "e+ ,er$tn "e'e$+ +$i.
2. Steri$i""i %n tt,i re *ng n %iin"er"i %engn "ngt &ti@&ti.
4. P$,"i "" "'/$#i$ri" %n /e &'ngnn* ,% in/i"r "tern$i". Bi$ -ri %ite+,tn "e/r "'/$#i$ri" ,% ,"i"i $ter$ ter%,t "" *ng -e$" ntr /$#i/$ %n /"t II. Gern -ri e r& +e%i$ +en- in/i"r "tern$i" %n -ri n ter&+'t ,% -ng +e%i$ /$#i/$. Ini %$& +. "'/$#i" *ng 'er-$n %ri /"t I +en- ,er+n inerir /$#i$ +e+'erin ,$ *ng 'i ,"i"i /"t I %i+n ter$et #en "'/$#i
te+,e$n ,r'e USG *ng "%& %i$,i"i ,$"ti "teri$.
5. Letn -ri te$n- ,% in/i"r "tern$i" %n i' -ri ,% %er& ,erte+n ntr /$#i/$ %n /"t I. In!$tr"i ne"te"i $$ ($i%in 1) %engn -r+ 2@gge 2 /+ $ter$ i' -ri %n 0 /+ e %$ e r& /$#i/$ t te,t %i $ter$ %ri in"er"i +. "'/$#i /"t I.
. en 'er-$n %i '>& /$#i/$ +en- in/i"r "tern$i". Gnn -r+ 1:@gge *ng &$" %engn "*ringe +$ +"n -r+ +en" $it %i'gin $ter$ i' -ri %n 0 /+ %i '>& /$#i$ *ng %i+"% nt +e+'t ,"i"i &*$ ,% 'gin 'e$ng in/i"r "tern$i". P"i"i -r+ &rint$ (,r$e$ %engn $nti) nt +en/eg& ,ne+t&r" %n 'e#e$ +eng&%, et" t e r& i ,"ien nt +en/eg& teter +" e r& $e&er. A",ir"i -r+ $e'i& %$ ,ert&nn -r+ "e/r /er+t ,% te,i '>& /$#i$. i ti% % %r& #en *ng ter",ir"i "ete$& ,en"n "+,i /+ tri ,e$n@,e$n
"+'i$ %i",ir"i -i +"i& 'e$+ % -g $ngi "e$i $gi %n ,'i$ +"i& 'e$+ 'er&"i$ ,in%& e r& ntr$ter$ n tet,i ,eri" t t&r" %&$ "e'e$+ %i$n nt +e$i&t %n* ,ne+t&r"
6. Bi$ %r& ter",ir"i + ,"i"i #en "'/$#i te$& %i%,tn %n n$ t -r+
"e$%inger %i,ert&nn ,% ,"i"in* %engn +nt,
9. S",n >t ,"ng teter t %i$tr %n teter "e$n-tn* $e,"n >t
:. Ln %engn &ti@&ti nt +eng&in%ri it +"n* %r nt it "e'in* -ng teter ti% %i'irn ter'.
6. P"/ Pr"e%r Tin%n
1. Ce '&> ",ir"i %r& 'e'" +e$$i teter %n tete"n 'er-$n %engn $n/r.
2. Kntr$ $et teter %engn t t&r". 4. g e'er"i&n te+,t ,e+"ngn CC 9. Tingt E#i%n/e I?II?III?I :. Tingt Re+en%"i A?B?C
;. Pene$& Kriti" 1. Dr. A&+% Irn S,.An (K) IC 2. Dr. E%>in R"$i S,.An (K) IC 4. Dr. M. R$* S,.An (K) IC 10.In%itr
Pr"e%r Tin%n
1. Rntgen t&r< ,"t tin%n 2. Cirn +eng$ir $n/r
4. Dr& tertri %engn +%&
11.Ke,"tn 1. &tt,7??>>>.,r/e%re"/n"$t./+?+e%i/$@
,r/e%re"?/entr$@#en"@$ine@,$/e+ent@AN@012@ ,r/e%re.",<
2. =n%+ent$ Criti/$ Cre S,,rt =rt& E%itin 2009
PANDUAN PRAKTIK KLINIS (PPK) PROSEDUR TINDAKAN RS MITRA KELUARGA CIBUBUR
BEKASI 2016
Prosedur Anestesia Umum 1. Pengertin
(De!ni"i)
Ane"te"i U++ %$& tin%n +eni%n r" n*eri?"it "e/r "entr$ %i"erti &i$ngn* e"%rn %n %,t ,$i& e+'$i (re#er"i'e$). K+,nen ne"te"i *ng i%e$ ter%iri 7 &i,nti n$ge"i re$""i tt.
2. In%i"i 1. Innt n "i +%
2. De>" *ng +e+i$i& ne"te"i ++ 4. Pe+'e%&nn* $" ? e""ten"i 5. Pen%erit "it +ent$
. Pe+'e%&n $+
6. Pe+'e%&n %i+n ne"te"i $$ ti% ,rti" t ti% +e+"n
9. Ri>*t ,en%erit t"i ? $ergi 't ne"te"i $$ :. Pen%erit %engn ,eng'tn ntig$nti
4. Kntr In%i"i Tergntng ee r+$gi ,% rgn *ng +eng$+i e$inn (&r" &in%rn ,e+in 't t %"i" %irngi?%itrnn).
• Hepar 7 't &e,tt"i?'t *ng t"i" ter&%, &e,r.
• Jantung 7 't @ 't *ng +en%e,re"i +ir%? +enrnn $irn %r& rner.
• Ginjal 7 't *ng %ie"re"i %i gin-$.
• Paru 7 't *ng +erng"ng "ere"i ,r?'rn"
• Endokrin 7 &in%ri 't *ng +eningtn %r g$ %r&? &in%rn ,e+in 't *ng +erng"ng ""nn "r "i+,ti" ,% %i'ete" ,en*it basedow ren 'i" +en*e''n ,eninggin g$ %r&.
5. Per"i,n ) ANAMNESIS
1. I%enti!"i ,"ien +i"$7 n++r $+t
,eer-n 'gin t'& *ng n %i,er"i ri>*t ,er"i "e'e$+n*
2. Inr+e% Cn"ent.
4. Ri>*t ,en*it *ng ,ern& t "e%ng %i%erit *ng +ngin %,t +en-%i ,en*$it %$+ ne"te"i ntr $in 7 ,en*it $ergi ,en*it ,r@ ,r
rni ("+ 'rni$ 'rniti") ,en*it -ntng &i,erten"i ,en*it &ti %n ,en*it gin-$.
5. Ri>*t 't@'t *ng "e%ng t te$& %ignn *ng +ngin +eni+'$n inter"i %engn 't@ 't ne"te"i.
. Ri>*t ,er"i %n ne"te"i *ng ,ern& %i$+i ,% >t *ng $$ 'er, $i %n "e$ng >t. A,& "t it +eng$+i +,$i"i "e,erti7 $+ ,$i& "%r +e+er$n ,er>tn inten"i ,"/ 'e%& %$$.
6. Ke'i"n 'r "e&ri@&ri *ng +ngin %,t +e+,engr&i -$nn* ne"te"i "e,erti 7 +er +in+ +in+n 'er$&$ ,e+i nr'.
PEMERIKSAAN =ISIK
Pe+eri"n e%n gigi@ge$igi tin%n ' +$t $i%& re$ti#e 'e"r "ngt ,enting nt %iet&i ,& n +en*$itn tin%n $ring",i int'"i. Le&er ,en%e %n -g n +en*$itn $ring",i int'"i.
Pe+eri"n rtin $in "e/r "i"te+ti tentng e%n ++ tent ti% '$e& %i$e>tn "e,erti in",e"i ,$,"i ,er"i %n "$t"i "e+ "i"te+ rgn t'& ,"ien.
lasi!kasi "tatus #isik
K$"i!"i *ng $i+ %ignn nt +eni$i e'grn !"i "e"erng i$& *ng 'er"$ %ri The American Society of Anesthesiologists (ASA). K$"i!"i !"i ini 'n $t ,rirn ri"i ne"te"i ren %+, "+,ing ne"te"i ti% %,t %i,i"&n %ri %+, "+,ing ,e+'e%&n.
Ke$" I 7 P"ien "e&t rgni !"i$gi ,"iitri 'ii+i
Ke$" II 7 P"ien %engn ,en*it "i"te+i ringn t "e%ng.
Ter+" -g "e+ ,"ien *ng 'er"i :0 t&n. Ke$" III 7 P"ien %engn ,en*it "i"te+i 'ert "e&ingg ti#it" rtin ter't".
Ke$" I 7 P"ien %engn ,en*it "i"te+i 'ert ti% %,t +e$n ti#it" rtin %n ,en*itn* +er,n n/+n e&i%,n "eti, "t
Ke$" 7 P"ien "ert *ng %i,erirn %engn t tn, ,e+'e%&n &i%,n* ti% n $e'i& %ri 25 -+.
P% 'e%& cito t e+ergen"i 'i"n* %i/nt+n &r E.
PEMERIKSAAN LABORATORIUM .
1. Dr& 7 8' 8t &itng -eni" $e"it g$ngn %r& >t ,e+'en %n ,er%r&n.
2. Urine 7 ,rtein re%"i "e%i+en
4. =t t&r 7 tert+ nt 'e%& +*r 5. EKG 7 rtin nt +r 50 t&n
. E$er$it (Ntri+ K$i+ C&$ri%) 6. Di$n ,e+eri"n &"" 'i$ %
in%i"i+i"$7 .EKG 7 ,% n %n %e>" F 50t&n %engn tn%@tn% ,en*it
r%i#"$er. '.=ng"i &ti ('i$ir'in r'i$in %"'.) 'i$ %i/rigi %n* gnggn ng"i &ti. /.=ng"i gin-$ (re+ retinin) 'i$ %i/rigi %n* gnggn ng"i gin-$.
PERSIAPAN DI 8ARI OPERASI . OPERASI ELEKTI=
1. Peng"ngn $+'ng ,enting nt +en/eg& ",ir"i i"i $+'ng ren regrgit"i ? +nt&. Unt %e>" %i,"n 6@: -+ "e'e$+
,er"i "e%ng n ? '*i 5@ -+.
2. Gigi ,$" ? ,rte"e $in &r" %itngg$n "e'' %,t +en*+'t -$n n" %n +enggngg. 4. Per&i"n %n "+eti &r" %i$e," ?%i&,"
"e'' n +enggngg ,e+ntn "e$+ ,er"i.
5. P"ien +" +r 'e%& +e+i ,in &"" 'er"i& %n $nggr %n +%& %i$e,". . Mintn i-in ,er"i %ri ,"ien t e$rgn*. 6. S%& ter,"ng -$r ? "e" intr#en
+enggnn i# /t&eter rn +ini+$ 1: t +en*e"in e%n ,"ien %i+n %i,i$i& rn *ng ,$ing +"i+$ 'i" %i,"ng. . Pr"e%r
Tin%n
1. Di$n ,e+"ngn +nitr tenn %r& n%i %n "tr"i O2
2. Di$n ,e+eri"n !"i $ng -i %ite+n ,er'&n %n ti% +e+nginn nt
%i$n ,e+'e%&n e$eti + ,e+'e%&n %,t %itn% nt %i$n ,enge$$n $e'i& $n-t.
4. i ,"ien ge$i"&?/e+" %i'erin ,re+e%i"i7 .Mi%$+ %"i" 009@01 +g?gBB i# '.P%
n SA 00100@01 +g?gBB +i%$+ 01 +g?gBB et+in 4@+g?gBB i+ t "e/r intr #en SA 001 +g?gBB +i%$+ 009 +g?gBB
5. Se'e$+ %i$n in%"i %i'erin "igen 6 $iter?+enit %engn +"er (,re "igen"i) "e$+ +enit.
. O't in%"i *ng %ignn "e/r intr#en7 .Ket+in (%"i" 1@2 +g?gBB) '.Pent&t$ (%"i" 5@ +g?gBB) /.Pr,$ (%"i" 1@2 +g?gBB)
6. P% ,en%erit '*i t n *ng 'e$+ ter,"ng "e" intr#en in%"i %i$n
%engn in&$"i +e+i gent in&$"i *ng ti% irit"i t +erng"ng -$n n" "e,erti
&$t&ne t "e#Hrne.
9. Se$+ in%"i %i$n +nitr tn% #it$ (tenn %r& n%i +,n "tr"i "igen). :. P% "" ,er"i *ng +e+er$n ,e+e$i&rn
-$n n" %i$n int'"i en%tr/&e$ t'e. ;. Pe+e$i&rn ne"te"i %i$n %engn
+enggnn "" tri" ne"te"i ('$n/e
ne"t&e"i) *it 7 "e%"i n$ge"i %n re$""i. 10.Pe+e$i&rn ne"te"i %,t +enggnn gent
#$ti$e (&$t&ne enHrne +,n i"Hrne) t TIA (Tt$ Intr#en Ane"te"i) %engn
+enggnn et+in t ,r,$.
11.P% ,e+'e%&n *ng +e+er$n re$""i tt %i'erin ,e+e$i&rn %engn 't ,e$+,& tt nn %e,$ri""i.
OPERASI DARURAT (EMERGENC)
1. Di$n ,er'in e%n ++ "e,ti+$ +ngin "e,n-ng ter"e%i >t.
2. Di$n ,e+eri"n $'rtri+ "tn%r% t ,e+eri"n ,enn-ng *ng +"i& +ngin
%,t %i$n.
4. P% ,er"i %rrt %i+n ti% %i+nginn nt +enngg "ein $+ + ,eng"ngn $+'ng %i$n $e'i& ti %engn /r
+erng"ng +nt& %engn ,+r!n t +e+"ng ,i, n"g"tri.
5. Di$n in%"i %engn +et%e r,i% "Jen/e in%/tin +enggnn ""ini$ $in %engn %"i" 1 2 +g ?gBB.
. Pe+e$i&rn ne"te"i %n +nitring ne"te"i *ng $inn* "e"i %engn ,er"i e$eti 6. P"/ Pr"e%r
Tin%n
1. E"t'"i %i$n "ete$& ,en%erit "%r. 2. Sete$& ,er"i ,en%erit %ir>t %n %i$n
,eng>"n tn% #it$ "e/r ett %i rng ,e+$i&n.
4. Pen%erit %i,in%&n %ri rng ,e+$i&n e 'ng"$ "ete$& +e+en&i riteri (A$%rete "/re : nt ,en%erit %e>" t Ste>rt S/re nt ,en%erit '*i ? n).
5. A,'i$ ,"t@,er"i %i,er$n ,eng>"n
&e+%in+i "e/r ett + %i$n %i rng inten"i (ICU).
9. Tingt E#i%n/e I?II?III?I :. Tingt
Re+en%"i
A?B?C
;. Pene$& Kriti" 1. Dr. A&+% Irn S,.An (K) IC 2. Dr. E%>in R"$i S,.An (K) IC 4. Dr. M. R$* S,.An (K) IC 10.In%itr Pr"e%r
Tin%n
Tn%@tn% $ini" nt e%$+n ne"te"i *ng ti% +e+%i 7
1. Peningtn tenn %r&.
2. Peningtn reen"i %en*t -ntng.
4. P"ien +engn*&?+ene$n %n +en*eringi. 5. Ter%,t ,ergern.
. Bereringt.
11.Ke,"tn • D'"n M.B.e%. D&r+ A. Penuntun Praktis Anestesi. EGC rt 1;;5
• Gni">r Si$i"ti G. Farmakologi dan Terapi (Basic Therapy Pharmacology). A$i& B&"7 Bgin =r+$gi =KUI. rt 1;;
• Ltie SA %. Petunjuk Praktis Anestesiologi. E%i"i Ke%. Bgin Ane"te"i$gi %n Ter,i Inten"i =KUI. rt 2010
• ert& M. PokokPokok Anestesi. EGC rt 2010
PANDUAN PRAKTIK KLINIS (PPK) PROSEDUR TINDAKAN
RS MITRA KELUARGA CIBUBUR BEKASI
2016
Prosedur Pemasangan $ahurkar 1. Pengertin
(De!ni"i)
T&e MA8URKAR 12=r. Kteter %'$e?tri,,$e $+en teter %iin%i"in nt &e+%i$i"i" %n ,&ere"i". 8$ ini %irn/ng nt %i$e>ti $irn /irn *ng t nt %i$i"i" t ,&ere"i" %engn +nt %ri $+en etig nt in" (tri,,$e $+en).
2. In%i"i 1. P$"+,&ere"i" 2. Di$*"i"
4. Kntr In%i"i ABSOLUT
• Pen$n %ri ,"ien
• Ine"i %i %er& ,e+"ngn
• ri"i nt+i *ng "$it ,% $"i ,e+"ngn • S,erir #en /# "*n%r+e (e</e,t e+r$
#en" $ine) RELATI
• Cg$,t&* • Ine"i "i"te+i
• #entri/$r ""i"t %e#i/e %i"e'e$& nn
• Pre"en/e in%>e$$ing /t&eter" t ,/ing >ire" ,% %er& ,e+"ngn
5. Per"i,n 1. P"ien %n?t e$rg %i-e$"n t-n in%i"i +,$i"i %n ,er>tn "e" #en "entr$
ter"e't.
2. Srt ,er"et-n tin%n %ii"i %n %itn%tngni $e& %ter ,e$"n tin%n (,ertr) %n
,"ien?e$rg. 4. A$t *ng %i"i,n
• Steri$e +" g$#e" n% g>n • Mnitr &e+%in+i
• I $ine ,erier %engn ter,"ng /irn • Steri$e ,re, "$tin (e.g. /&$r&e<i%ine) • Steri$e %r,e"
• S,it @+L "teri$e %engn -r+ 2@ r 40 nt ne"te"i $$
• L/$ ne"t&eti/ ("$$* 1 $i%/ine) • 22@gge 1.@in/& nee%$e
nee%$e) n "*ringe r 1:@gge &$$>@'re nee%$e
• Pre""re t'ing • Guidewire
• N. 11 "/$,e$ '$%e
• $ahurkar dou%le&tripple lumen • 4.0 "tre n /tting nee%$e
5. Pe+"ngn "e" #en "entr$ &en%n* %i$n %i rng tin%n *ng %i$eng,i %engn +nitr EKG "ert $t %n 't re""it"i P"ien %i,"i"in gr $et #en "entr$ $e'i& ",er!"i$ %n +%& %i%,t.
. P% ,e+"ngn "e" %i #.-g$ri" intern t "'$#i ,"ien +eneng e "i"i 'er$>nn %n ,% ,nggng ntr e% ",$ %i'eri 'nt$ ,enggn-$ "e&ingg $e&er "e%iit e"ten"i.
6. Penggnn $tr"ngr! 'i "e/r $ng"ng "t ,r"e%r +,n ti% $ng"ng ("e'e$+ ,r"e%r) %,t +e+'nt ,r"e%r ,e+"ngn "e" #en %n +engrngi +,$i"i.
9. A$t ,e$in%ng %iri +en/, +"er tt, e,$ '- tin%n %n "rng tngn "teri$ %i"i,n nt ,ertr
. Pr"e%r Tin%n
1. Ce "e+ ,er$tn "e'e$+ +$i.
2. Steri$i""i %n tt,i re *ng n %iin"er"i %engn "ngt &ti@&ti.
4. P$,"i "" "'/$#i$ri" %n /e &'ngnn* ,% in/i"r "tern$i". Bi$ -ri %ite+,tn "e/r "'/$#i$ri" ,% ,"i"i $ter$ ter%,t "" *ng -e$" ntr /$#i/$ %n /"t II. Gern -ri e r& +e%i$ +en- in/i"r "tern$i" %n -ri n ter&+'t ,% -ng +e%i$ /$#i/$. Ini %$& +. "'/$#i" *ng 'er-$n %ri /"t I +en- ,er+n inerir /$#i$ +e+'erin ,$ *ng 'i ,"i"i /"t I %i+n ter$et #en "'/$#i te+,e$n ,r'e USG *ng "%& %i$,i"i ,$"ti "teri$.
5. Letn -ri te$n- ,% in/i"r "tern$i" %n i' -ri ,% %er& ,erte+n ntr /$#i/$ %n /"t I. In!$tr"i ne"te"i $$ ($i%in 1) %engn -r+ 2@gge 2 /+ $ter$ i' -ri %n 0 /+ e %$ e r& /$#i/$ t te,t %i $ter$ %ri in"er"i +. "'/$#i /"t I.
. en 'er-$n %i '>& /$#i/$ +en- in/i"r "tern$i". Gnn -r+ 1:@gge *ng &$" %engn "*ringe +$ +"n -r+ +en" $it %i'gin $ter$ i' -ri %n 0 /+ %i '>& /$#i$ *ng %i+"% nt +e+'t ,"i"i
&*$ ,% 'gin 'e$ng in/i"r "tern$i". P"i"i -r+ &rint$ (,r$e$ %engn $nti) nt +en/eg& ,ne+t&r" %n 'e#e$ +eng&%, et" t e r& i ,"ien nt +en/eg& teter +" e r& $e&er.
A",ir"i -r+ $e'i& %$ ,ert&nn -r+ "e/r /er+t ,% te,i '>& /$#i$. i ti% % %r& #en *ng ter",ir"i "ete$& ,en"n "+,i /+ tri ,e$n@,e$n
"+'i$ %i",ir"i -i +"i& 'e$+ % -g $ngi "e$i $gi %n ,'i$ +"i& 'e$+ 'er&"i$ ,in%& e r& ntr$ter$ n tet,i ,eri" t t&r" %&$ "e'e$+ %i$n nt +e$i&t %n* ,ne+t&r"
6. Bi$ %r& ter",ir"i + ,"i"i #en "'/$#i te$& %i%,tn %n n$ t -r+
"e$%inger %i,ert&nn ,% ,"i"in* %engn +nt,
9. S",n >t ,"ng teter t %i$tr %n teter "e$n-tn* $e,"n >t
:. Ln %engn &ti@&ti nt +eng&in%ri it +"n* %r nt it "e'in* -ng teter ti% %i'irn ter'.
6. P"/ Pr"e%r Tin%n
1. Ce '&> ",ir"i %r& 'e'" +e$$i teter %n tete"n 'er-$n %engn $n/r.
2. Kntr$ $et teter %engn t t&r". 5. g e'er"i&n te+,t ,e+"ngn CC 9. Tingt E#i%n/e I?II?III?I
:. Tingt
Re+en%"i
A?B?C
;. Pene$& Kriti" 1. Dr. A&+% Irn S,.An (K) IC 2. Dr. E%>in R"$i S,.An (K) IC 4. Dr. M. R$* S,.An (K) IC 10.In%itr Pr"e%r
Tin%n
1. Rntgen t&r< ,"t tin%n 2. Cirn +eng$ir $n/r
4. Dr& tertri %engn +%&
11.Ke,"tn 1. &tt,7??>>>.,r/e%re"/n"$t./+?+e%i/$@
,r/e%re"?/entr$@#en"@$ine@,$/e+ent@AN@012@ ,r/e%re.",<
2. =n%+ent$ Criti/$ Cre S,,rt =rt& E%itin 2009
4. &tt,7??>>>.en%$$&e$t&/re./+?,geBi$%er.",< /ntentID10:900>e'PgeID0t,i/ID95294' re%/r+'"07121624:1049706;;4270
