FDA Adverse Event Injury Summary report: N

AVI

MDR report key: 2459 · Received January 25, 1993

Report

Report Number
2459
Event Type
Injury
Date Received
January 25, 1993
Date of Event
November 17, 1992
Report Date
December 22, 1992
Manufacturer
3M
Product Code
FRN
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

THE DEVICE IN QUESTION WAS DELIVERING TPN AND LIPIDS TO A NEONATE AND IS REPORTED TO HAVE DELIVERED A DANGEROUSLY HIGH LEVEL OF TPN DURING AN HOUR AND A HALF PERIOD. THE TPN SOLUTION WAS BEING ADMINISTERED THROUGH A AT A RATE OF 3.7 ML/HR, COINCIDENTAL WITH LUPID ADMINISTRATION THROUGH CHANNEL B.AT 11:00 AM THE STATUS OF BOTH INFUSIONS WAS ALSO NOTED TO BE APPROPRIATE. AT NO TIME DURING THE MORNING SHIFT WERE THE SETTINGS ON EITHER CHANNEL ALTERED. AT 12:30 CHANNEL A WAS NOTED TO BE INDICATING "EMPTY BAG" AND THE CORRESPONDING BURRETTE WAS FOUND TO BE EMPTY. AT THIS TIME THE PUMP CONTROL PANEL WAS NOTED TO INDICATE; A VOLUME INFUSED-ML" OF 89; "VOLUME LIMIT-ML" WAS 8888; AND "RATE-ML/HR" WAS 8888. CHANNEL B WAS FOUND TO BE OPERATING NORMALLY.OTHER APPARATUS CLINICALLY IN USE AT THE SAME TIME THE INCIDENT OCCURRED WERE: AN INFRASONICS INFANT STAR INCUBATOR, A NELLCOR PULSE OXIMETER, AN AIR-SHIELDS ATHENA PHYSIOLOGIC MONITOR, AND AN OHIO INCUBATORDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: FAIR CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-JUL-92. SERVICE PROVIDED BY: INDEPENDENT SERVICE ORGANIZATION. SERVICE RECORDS AVAILABLE.IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, ELECTRICAL TESTS PERFORMED, MECHANICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED. RESULTS OF EVALUATION: DESIGN - HUMAN FACTORS, CENTRAL PROCESSING UNIT/OPERATING SYSTEM FAILURE/BUG. CONCLUSION: DEVICE FAILURE OCCURRED AND WAS RELATED TO EVENT, DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE USE CONTINUED WITH RESTRICTIONS/LIMITATIONS, USER EDUCATION PROVIDED. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 AVI INFUSION PUMP FRN 3M 885 N/A

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention