□ □ □ E N/A 18 g Yes No □ E N/A □ □ 20 g Yes No □ E N/A □ □ 22 g Yes No □ □ □ E N/A 24 g Yes No 4. Central venous access kit (with pediatric catheters) D N/A □ □ Yes No 5. Infusion Device/Pump E 2 □ □ Yes No Intraosseous Access Equipment: 6. Infant E 2 □ □ Yes No □ Manual Intraosseous Needle □ EZ-IO® Intraosseous Infusion System □ (please indicate) □ □ E 2 Yes No
□ 18 g E N/A □ Yes □ No □ 20 g E N/A □ Yes □ No □ 22 g E N/A □ Yes □ No □ 24 g E N/A □ Yes □ No 4. Central venous access kit (with pediatric catheters) D N/A □ Yes □ No 5. Infusion Device/Pump E 2 □ Yes □ No 6. Intraosseous Access Equipment: Infant E 2 □ Yes □ No □ Manual Intraosseous Needle □ EZ-IO® Intraosseous Infusion System □ (please indicate) E 2 □ Yes □ No
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