FDA Adverse Event Malfunction Summary report: N

2FR SL W/O GW BULK NON

MDR report key: 15147798 · Received August 2, 2022

Report

Report Number
3006260740-2022-03015
Event Type
Malfunction
Date Received
August 2, 2022
Date of Event
July 18, 2022
Report Date
November 9, 2022
Manufacturer
C.R. BARD, INC. (BASD) -3006260740
Product Code
LJS
PMA / PMN Number
UNK
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
BR
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE MANUFACTURER HAS RECEIVED THE SAMPLE AND IS PENDING EVALUATION. RESULTS ARE EXPECTED SOON. A LOT HISTORY REVIEW (LHR) REVIEW IS NOT POSSIBLE; THE MANUFACTURING LOT NUMBER THAT WAS PROVIDED IS INCORRECT/INVALID.

Additional Manufacturer Narrative · 0

THE INFORMATION PROVIDED BY BD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BD. THE FOLLOWING WERE REVIEWED AS PART OF THIS INVESTIGATION: PATIENT SEVERITY, APPLICABLE PREVIOUS INVESTIGATION(S), SAMPLE ANALYSIS, APPLICABLE FMEA DOCUMENTS, APPLICABLE MANUFACTURING RECORDS, AND LABELING. BASED ON A REVIEW OF THIS INFORMATION, THE FOLLOWING WAS CONCLUDED: THE COMPLAINT OF A CATHETER LEAK IS CONFIRMED BUT THE EXACT CAUSE REMAINS UNKNOWN. ONE VIDEO SAMPLE OF A 2 FR PERQCATH CATHETER WAS PROVIDED FOR EVALUATION. THE CATHETER IS BEING HELD OVER A SINK AND IS BEING INFUSED WITH A CLEAR FLUID. THE FLUID IS OBSERVED TO LEAK AT THE PROXIMAL END OF THE CATHETER EXTENDING FROM THE MOLDED WINGED HUB. THE LEAK IS SPRAYING OUTWARDS. THE CHARACTERISTICS OF THE LEAK LOCATION IN THE CATHETER COULD NOT BE CLOSELY INSPECTED FROM THE VIDEO PROVIDED. SINCE A LEAK WAS OBSERVED IN THE VIDEO SAMPLE PROVIDED, THE COMPLAINT IS CONFIRMED BUT THE EXACT CAUSE REMAINS UNKNOWN. A LOT HISTORY REVIEW (LHR) OF REDS2498 SHOWED ONE OTHER SIMILAR PRODUCT COMPLAINT(S) FROM THIS LOT NUMBER.

Additional Manufacturer Narrative · 0

H11: SECTION A THROUGH F - THE INFORMATION PROVIDED BY BD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BD. THE FOLLOWING WERE REVIEWED AS PART OF THIS INVESTIGATION: PATIENT SEVERITY, COMPLAINT AND LOT HISTORY REVIEW, APPLICABLE PREVIOUS INVESTIGATION(S), SAMPLE (IF AVAILABLE), APPLICABLE MANUFACTURE RECORDS, AND APPLICABLE FMEA DOCUMENTS. BASED ON A REVIEW OF THIS INFORMATION, THE FOLLOWING WAS CONCLUDED: THE COMPLAINT OF A DAMAGED CATHETER WAS CONFIRMED. THE PRODUCT RETURNED FOR EVALUATION WAS ONE 2 FR PER-Q-CATH. THE DAMAGE OBSERVED IN THE RETURNED SAMPLE WAS CHARACTERISTIC OF OVER-PRESSURIZATION (BURST) DAMAGE. THIS CAN OCCUR THROUGH THE USE OF SYRINGES SMALLER THAN 10ML, BY FLUSHING AGAINST AN OCCLUSION, OR DUE TO EXCESSIVE FORCE APPLIED DURING INFUSION PROCEDURES. THE RETURNED PRODUCT SAMPLE WAS EVALUATED, AND A SPLIT WAS OBSERVED IN THE CATHETER TUBING AT THE DISTAL END OF THE STRAIN RELIEF. THIS CATHETER DAMAGE WAS TYPICAL OF A BURST, AND THE CHARACTERISTICS OBSERVED WHICH SUPPORTED THIS TYPE OF FAILURE INCLUDED: 'C' SHAPED SPLIT. TENSILE WEAKNESS AT THE FRACTURE SITE (DUE TO MATERIAL BALLOONING PRIOR TO BURST) GRANULAR FRACTURE SURFACE TEXTURE (TYPICAL OF TEARING FAILURE MODES). AN EXAMINATION OF THE CATHETER STRUCTURE REVEALED NO POTENTIAL DAMAGE/DEFECT RELATED TO MANUFACTURE OF THE PRODUCT. H3 OTHER TEXT : EVALUATION FINDINGS ARE IN SECTION H11.

Description of Event or Problem · 0

IT WAS REPORTED PICC WAS INSERTED ON (B)(6) 2022 FOR ATB WITH OXACILLIN FOR 21 DAYS (D11). TODAY, (B)(6) 2022, A NURSE SENT ME A VIDEO DEMONSTRATING THAT THE SILICONE PRESENTS PARTIAL FRACTURE NEAR THE FIXATION WING, AN INCIDENT OBSERVED DURING THE FLUSHING PERFORMED BY THE SAME PROFESSIONAL.

Description of Event or Problem · 0

IT WAS REPORTED PICC WAS INSERTED ON (B)(6) 2022 FOR ATB WITH OXACILLIN FOR 21 DAYS (D11). TODAY, 7/18/2022, A NURSE SENT ME A VIDEO DEMONSTRATING THAT THE SILICONE PRESENTS PARTIAL FRACTURE NEAR THE FIXATION WING, AN INCIDENT OBSERVED DURING THE FLUSHING PERFORMED BY THE SAME PROFESSIONAL. ADDITIONAL INFORMATION: WAS THERE ANY HARM TO THE PATIENT/HEALTH WORKER? THE LOSS OF A CENTRAL CATHETER BEFORE THE END OF THE PROPOSED THERAPY IS ALWAYS A HARM TO THE PATIENT. THE MEDICATIONS THAT THE PATIENT WAS RECEIVING ORDERED ADMINISTRATION VIA A CENTRAL CATHETER, BUT THE PATIENT CONTINUED ON PERIPHERAL VENOUS CATHETER THERAPY. WAS THERE A NEED FOR MEDICAL AND/OR SURGICAL INTERVENTION DUE TO THE EVENT (IMAGING EXAMS, SURGERY, MEDICATION ADMINISTRATION, ETC)? NO HAS THERE BEEN BLOOD OR CHEMOTHERAPY EXPOSURE TO MUCOUS MEMBRANES OR SKIN? NO HOW WAS THE PROCEDURE COMPLETED? PARTIALLY FRACTURED PICC WAS REMOVED FROM THE PATIENT.

Description of Event or Problem · 0

IT WAS REPORTED PICC WAS INSERTED ON 07/12/22 FOR ATB WITH OXACILLIN FOR 21 DAYS (D11). TODAY, 7/18/22, A NURSE SENT ME A VIDEO DEMONSTRATING THAT THE SILICONE PRESENTS PARTIAL FRACTURE NEAR THE FIXATION WING, AN INCIDENT OBSERVED DURING THE FLUSHING PERFORMED BY THE SAME PROFESSIONAL. ADDITIONAL INFORMATION: WAS THERE ANY HARM TO THE PATIENT/HEALTH WORKER? THE LOSS OF A CENTRAL CATHETER BEFORE THE END OF THE PROPOSED THERAPY IS ALWAYS A HARM TO THE PATIENT. THE MEDICATIONS THAT THE PATIENT WAS RECEIVING ORDERED ADMINISTRATION VIA A CENTRAL CATHETER, BUT THE PATIENT CONTINUED ON PERIPHERAL VENOUS CATHETER THERAPY. WAS THERE A NEED FOR MEDICAL AND/OR SURGICAL INTERVENTION DUE TO THE EVENT (IMAGING EXAMS, SURGERY, MEDICATION ADMINISTRATION, ETC)? NO. HAS THERE BEEN BLOOD OR CHEMOTHERAPY EXPOSURE TO MUCOUS MEMBRANES OR SKIN? NO. HOW WAS THE PROCEDURE COMPLETED? PARTIALLY FRACTURED PICC WAS REMOVED FROM THE PATIENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2430743 2FR SL W/O GW BULK NON CATHETER,INTRAVASCULAR,THERAPEUTIC,LONG-TERM GREATER THAN 30 DAYS LJS C.R. BARD, INC. (BASD) -3006260740 N/A REDS2498

Patients

Seq Age Sex Outcome Treatment
1 Unknown Other