Sterile Procedure Tray

• Sterile gloves
• Sterile fenestrated drape
• Vas-dissecting hemostat (forceps)
• Atraumatic ring clamp
• Disposable battery cautery unit placed inside a sterile glove
• 2 in. of 4 × 4 gauze
• 2 pairs of straight hemostats
• 1 curved hemostat
• Surgical clip (Hemoclip) applicator
• 1 container (clip) of medium metal surgical clips (Hemoclips)
• Iris scissors

Source: Adapted from Zuber TJ. Office procedures forms: the AAFP collection—quick reference guides for family physicians. Baltimore: Williams & Wilkins, 1999:110.