Description of Event or Problem · 1
PATIENT HAD CT SCAN, WHICH SHOWED VENTRICULOMEGALY AND DISCONNECTED CATHETER. ACUTE SHUNT MALFUNCTION RESULTING IN NEED FOR URGENT SURGERY. THE UNDERLYING CATHETER WAS SKELETONIZED USING ELECTROSURGICAL CAUTERY AND NOT CONNECTED TO THE VENTRICULAR CATHETER. THIS WAS REMOVED, WITH VALVE AND ABOUT 8 INCHES OF TUBING WITH THE REST SNAPPED OFF. WITH THE ENTIRE VENTRICULAR SYSTEM SHOWN, WE COULD NOT SEE THE VENTRICULAR CATHETER. SO AFTER A LONG LOOK AROUND WITH ENDOSCOPE, WE WERE UNABLE TO RETRIEVE THE CATHETER. COULD SEE A FAIRLY THICK MEMBRANE THAT THE CATHETER MUST HAVE FALLEN BEHIND; HOWEVER, THERE WAS A HIGHER RISK BECAUSE THERE WAS VEINS ON IT AND WAS NOT FELT TO BE WORTH OPENING THIS UP.EXTERNAL VENTRICULAR DRAIN WAS PLACED INTO THE VESTIBULE OF THE VENTRICLE BROUGHT OUT THROUGH A SEPARATE STAB INCISION.====================== HEALTH PROFESSIONAL'S IMPRESSION======================CT SCAN, SHOWED VENTRICULOMEGALY AND DISCONNECTED CATHETER, WHICH RESULTED IN NEED FOR URGENT SURGERY.====================== MANUFACTURER RESPONSE FOR VENTRICULAR SHUNT CATHETER, MEDTRONIC BIOGLIDE======================THIS IS A KNOWN PROBLEM, THE MANUFACTURER IS AWARE OF THIS PROBLEM AND HAS ISSUED A RECALL ON THIS BIOGLIDE CATHETER, (FDA RECALL #'S Z-1124-2009 TO Z-1151-2009).