INFUSOMAT®
Report
- Report Number
- 9610825-2023-00421
- Event Type
- Malfunction
- Date Received
- September 8, 2023
- Report Date
- September 8, 2023
- Manufacturer
- B BRAUN MELSUNGEN AG
- Product Code
- FRN
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- FR
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
- Health Professional
- Yes
Narratives
THIS REPORT HAS BEEN IDENTIFIED AS B. BRAUN INTERNAL REPORT NUMBER: (B)(4). NOTE: THIS REPORT IS BEING FILED FOR AN ITEM NUMBER THAT IS NOT SOLD IN THE UNITED STATES, HOWEVER SIMILAR ITEMS ARE SOLD IN THE UNITED STATES BY B. BRAUN MEDICAL, INC. PROBLEM: DELIVERY ACCURACY OUT OF TOLERANCE FLOW RATE. 1. GENERAL INFORMATION: COMPLAINT: (B)(4). EXAMINATION CARRIED OUT BY: (B)(6). 2. INFORMATION TO THE SAMPLE: 2.1 MODEL: INFUSOMAT SPACE, 2.2 ARTICLE NUMBER: 8713050, 2.3 SERIAL NUMBER/BATCH: (B)(6), 2.4 SOFTWARE VERSION: N030004, 2.5 HOURS OF OPERATION:1884, 2.6 FURTHER INFORMATION: N/A. 3. INVESTIGATION RESULTS: 3.1 HISTORY INSPECTION: THE DEVICE HISTORY FILES WERE READ AND ANALYZED. SINCE THE CUSTOMER DID NOT GIVE A DATE OF THE INCIDENT, THE LAST INFUSIONS WERE GIVEN WITH THE MENTIONED TIME (02:00 HOURS) EXAMINED .THE INFUSIONS ON (B)(6) 2023 WERE EXAMINED. BOTH INFUSIONS HAD THE IDENTICAL SETTINGS (VTBI 533 ML, TIME 02:00 HH:MM = RATE 266,5 ML CALCULATED) THE INFUSIONS WERE STOPPED CORRECTLY WITH THE CORRECT VOLUME (ACT. VOLUME INFUSED 533,02 ML). NO ABNORMALITIES COULD BE DETECTED IN THE HISTORY. 3.2 VISUAL INSPECTION: A VISUAL INSPECTION WAS PERFORMED. THE COVER CAPS ON THE SCREW PILLARS, AND THE TECHNICAL SEAL (P1 12/2019) ON THE LOWER HOUSING WERE INTACT AND UNDAMAGED. THE DEVICE WAS SLIGHTLY DIRTY BUT NO VISIBLE DAMAGE ARE TO LOCATE. BETWEEN THE OPERATING UNIT ISPS AND THE FRONT FRAME ISPS LIQUID RESIDUES COULD BE FOUND, FURTHER NO DEFECTS COULD BE FOUND. 3.3 FUNCTIONAL INSPECTION: A FUNCTIONAL TEST WAS PERFORMED. THE DEVICE PASSES THE SELF-TEST. A SPACE LINE WAS INSERTED, AND THE PUMP IDENTIFIED THE LINE, AND IT COULD BE SELECTED FROM THE MENU. IT WAS POSSIBLE TO PUT THE PUMP IN OPERATION. 3.4 PRESSURE INSPECTION: IN CHECKING THE DOWNSTREAM-SENSOR THE ELECTRONIC PRESSURE CUT-OFF AND THE MECHANICAL PRESSURE LIMITATION OF THE DEVICE WERE TESTED, ACCORDING TO THE REQUIREMENTS OF THE TECHNICAL SAFETY CHECK. THE ELECTRONIC PRESSURE CUT-OFF WAS CHECKED: PRESSURE STAGE 2: IS: 0,33 BAR (SHOULD BE: 0,1-0,7 BAR). PRESSURE STAGE 9: IS: 0,92 BAR (SHOULD BE: 0,8-1,4 BAR). THE MECHANICAL PRESSURE CUT-OFF WAS CHECKED: PMAX: IS: 2,00 BAR (SHOULD BE: 1,8-2,5 BAR). PMIN: IS: 1,64 BAR (SHOULD BE: >1,5 BAR). SAFETY CLAMP WAS CHECKED: PMIN: IS: 1,88 BAR (SHOULD BE: >1,2 BAR). THE DEVICE MATCHES THE REQUIRED VALUES AND STANDARDS. ALL MEASURED VALUES ARE WITHIN OUR SPECIFICATION. 3.5 FLOW RATE INSPECTION: A DELIVERY ACCURACY MEASUREMENT ACCORDING TO IEC 60601-2-24 WAS ARRANGED. HERE A NOMINAL FLOW RATE OF 100 ML/H WAS CHOSEN. THE ASSESSED AVERAGE DEVIATION "A" OF THE SECOND OPERATING HOUR WAS MEASURED AND RESULTED IN A VALUE OF -1,56%. (ACCURACY OF SET DELIVERY RATE SHOULD BE: ± 5 % ACCORDING TO IEC/EN 60601-2-24) THE DEVICE MATCHES THE REQUIRED VALUES AND STANDARDS. ALL MEASURED VALUES ARE WITHIN OUR SPECIFICATION. 3.6 DISASSEMBLING: THE DEVICE WAS DISASSEMBLED, AND THE INSIDE WAS INVESTIGATED. NO DAMAGE OR CONTAMINATION (NO LIQUID RESIDUE ON THE MOTHERBOARD) WAS FOUND. 3.7 TEST EQUIPMENT: DESCRIPTION: TYP NR.: LAB.-ID.-NR. N/A, N/A, N/A. 3.8 FOR EXAMINATION USED DISPOSABLES: DESCRIPTION: REF.: LOT: SPACE LINE, 8700036SP, 23D18E8ST5. 4. JUDGMENT: 4.1 THE COMPLAINT COULD NOT BE CONFIRMED. SUMMING UP ALL TESTS, THE INFUSOMAT SPACE OPERATES WITHIN OUR SPECIFICATION. NO PRODUCT DEVIATION. ADDITION INFORMATION: N/A.
AS REPORTED BY THE USER FACILITY INFORMATION BY BBM SALES ORGANIZATION IN FRANCE: "FLOW RATE". ACCORDING TO THE CUSTOMER: "DOESN'T DELIVER THE RIGHT RATE : VOLUME PROGRAMMED FOR 2HOURS. AT THE END OF THE 2 HOURS IT REMAINS APPROXIMATELY 180ML IN THE BAG".
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1113009 | INFUSOMAT® | PUMP, INFUSION | FRN | B BRAUN MELSUNGEN AG | 8713050 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Unknown |