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Agilia® Partner Syringe Selection (Database 5.0.6 - new device orders) Please select from the list below the various syringes types available within your hospital/unit then sign and date the form. The selected syringe types and sizes will then be made available for use on your Agilia SP MC, Agilia SP TIVA or Agilia SP PCA. Please ensure any selections are WITHIN the GREY boxes beside each syringe. Any selections outside of these boxes will be considered as not required for your devices. 50/60mL syringes
20mL syringes
30/35mL syringes
BD Perfusion 50mL
BD Plastipak 30mL
BD Plastipak 20mL
BD Plast. Amber 50mL
Braun Omnifix 30mL
BD Precise 20mL
BD Plastipak 50mL
Codan 30mL
Braun Omnifix 20mL
BD Precise 50mL
m.devices 30mL
Braun OPS 20mL
Braun Omnifix 50mL
MONOJECT Rigid 35mL
Codan 20mL
Braun OPS 50mL
MONOJECT Soft 35mL
LS Nipro Disp 20mL
Codan 50mL
Terumo SS*30LE1 30mL
m.devices 20mL
LS Nipro Eccentric 50mL
MONOJECT Rigid 20mL
m.devices 50mL MONOJECT Rigid 60mL MONOJECT Soft 60mL Nipro Syringe 50mL SCHOTT TopPac 50mL Terumo SS*50LE 50mL Terumo SS+50L1 50mL Terumo SS-60L 60mL (equivalent to SS+60L^)
5/6mL syringes BD Plastipak 5mL BD Syringe 5mL Braun Omnifix 5mL Codan 5mL LS Nipro Disp 5mL MONOJECT Rigid 6mL MONOJECT Soft 6mL Terumo SS+05L 5mL
MONOJECT Soft 20mL NiproPlast 20mL SCHOTT TopPac 20mL Terumo SS-20L2 20mL (equivalent to SS+20L^) Please note: syringe brands are listed solely for the purposes of customising the Agilia pump to your hospital/unit’s needs. This flyer is not intended to promote these brands. ^ Data on file
10/12mL syringes BD Plastipak 10mL
Sign Off
BD Syringe 10mL
Name:
Braun Omnifix 10mL Codan 10mL LS Nipro Disp 10mL
Position: Organisation:
MONOJECT Rigid 12mL
Contact Number:
MONOJECT Soft 12mL
Date:
Nipro Syringe 10mL SCHOTT TopPac 10mL Terumo SS-10L 10mL (equivalent to SS+I0L^)
Signature: * Please note any changes to your syringe list in the future may incur a charge. This is to cover the administration and engineer time to update your devices.
Fresenius Kabi is bound by the Australian Privacy Principles contained in the Commonwealth Privacy Act 1988 and the New Zealand Privacy Principles contained in the Privacy Act 1993. These Principles are designed to protect the confidentiality of personal information and the privacy of individuals by regulating the way personal information is managed. Fresenius Kabi is committed to protecting personal information provide to us and ensuring that your privacy is always respected. Subject to the exceptions set out in the Australian Commonwealth Privacy Act 1988 and the New Zealand Privacy Act 1993, you may seek access to the personal information the Fresenius Kabi holds about you. All requests for access to your personal information should be directed to Fresenius Kabi by email or by writing to the address below. Fresenius Kabi will endeavour to respond within 14 days of receipt of the request in writing. In certain circumstances, Fresenius Kabi is entitled to deny access. If access is denied, reasons for the denial of access will be given in writing. If you have questions about Fresenius Kabi and privacy, would like to update your personal details held by Fresenius Kabi or wish to access information held by Fresenius Kabi about you, please contact us using the details below.
Fresenius Kabi Australia Pty Limited Level 2, 2 Woodland Way Mount Kuring-gai NSW 2080 Telephone: 1300 732 001 www.fresenius-kabi.com/au PM2020.702v1 Published February 2020
Fresenius Kabi New Zealand Limited 60 Pavilion Drive Mangere Auckland 2022 Telephone: 0800 144 892 www.fresenius-kabi.com/nz