MONTANA STATE PRISON
ATTACHMENT A
Execution Equipment and Material Checklist: Execution by Injection
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Number ITEM CODE
6 Sodium Pentothal, 1 gm. kit, (50 mg/ml)* A
20 Pancuronium Bromide, 10 mg/5 ml vial* A
3 Diazepam (Valium), 2 ml Dosette syringe A
20 Syringe, 60 cc Lur Lock B
10 Syringe, 10 cc Lur Lock B
10 Syringe, 5 cc Lur Lock B
40 18 Ga., 1 ½” needles B
20 25 Ga., 1 ½” needles B
50 14 Ga., 1 ¼" angiocath B
50 16 Ga., 1 ¼" angiocath B
50 18 Ga., 1 ¼" angiocath B
8 Normal Saline, IV bag, 1000 cc B
8 Solution Injection set; 106” long with Y sites B
16 Extension set, 35” B
2 Stethoscopes B
3 Boxes of alcohol preps B
24 Rolls of Kling B
4 1” adhesive tape, B
4 2” adhesive tape, B
3 pr Bandage scissors B
12 IV start Kits (gauze, dressing, CloraPrep, tape, tourniquet) B
3 pr Surgical gloves size 7 ½, (sterile) B
3 pr Surgical gloves size 8 (sterile) B
1 Box Gloves, 100 Large (nonsterile) B
12 Surgical masks B
3 pr Hemostats B
6 3” ace wraps B
100 Gauze pads (sterile) B
1 Clean up kit B
1 Flashlight with batteries B
6 Batteries (flashlight spares) B
1 Tourniquet B
1 Large Sharps container B
2 Small Sharps container B
*Drugs listed may be substituted with another equivalent type drug
if drug listed becomes unavailable. Refer to TM 1/05.12 E4
