FDA Adverse Event Malfunction Summary report: N

BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES

MDR report key: 8174111 · Received December 18, 2018

Report

Report Number
1024879-2018-01505
Event Type
Malfunction
Date Received
December 18, 2018
Date of Event
December 3, 2018
Report Date
February 26, 2019
Manufacturer
BECTON, DICKINSON & CO., (BD)
Product Code
JKA
UDI-DI
50382903679862
PMA / PMN Number
BK050036
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

INVESTIGATION SUMMARY: ERRONEOUS POTASSIUM RESULTS CAN BE CAUSED BY MANY SOURCES, INCLUDING CERTAIN PATIENT PATHOLOGICAL CONDITIONS, IMPROPER SPECIMEN COLLECTION, SPECIMEN PROCESSING, AND SPECIMEN TRANSPORT. SPECIMEN COLLECTION FACTORS THAT CAN CONTRIBUTE TO ERRONEOUS POTASSIUM RANGE FROM PROLONGED TOURNIQUET TIME AND IMPROPER VENIPUNCTURE TECHNIQUE TO TRANSFERRING A SAMPLE FROM A SYRINGE DRAW OR IV CATHETER. SPECIMEN PROCESSING FACTORS INCLUDE VIGOROUS MIXING OR SHAKING OF THE SPECIMEN, NOT ALLOWING THE SPECIMEN TO CLOT FOR THE RECOMMENDED AMOUNT OF TIME, PROLONGED CONTACT OF SERUM OR PLASMA WITH CELLS, AND EXPOSURE TO EXCESSIVE HEAT OR COLD. FINALLY, MECHANICAL TRAUMA AND OTHER ADVERSE CONDITIONS DURING TRANSPORT OF TUBES CAN RESULT IN ERRONEOUS POTASSIUM RESULTS. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH 8120676, REORDER NUMBER 367986. PRODUCT WAS MANUFACTURED AT THE BD SUMTER SITE MAY, 2018. PRODUCT QUALITY IS EVALUATED DURING THE MANUFACTURING PROCESS WITH PRESCRIBED VARIABLE AND ATTRIBUTES INSPECTIONS. ALL INSPECTIONS WERE IN COMPLIANCE WITH REQUIREMENTS.

Description of Event or Problem · 0

IT WAS REPORTED THAT BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES WERE GIVING ERRONEOUS RESULTS. NO SERIOUS INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Additional Manufacturer Narrative · 1

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED, BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED.

Description of Event or Problem · 1

IT WAS REPORTED THAT BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES WERE GIVING ERRONEOUS RESULTS. NO SERIOUS INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1016622 BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON, DICKINSON & CO., (BD) 8120676 50382903679862

Patients

Seq Age Sex Outcome Treatment
1 Other