MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW CVC SET: 16 GA X 8" (20 CM); CATHETER PERCUTANEOUS

Catalog Number ES-04301

Device Problems Migration or Expulsion of Device (1395); Off-Label Use (1494)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 12/30/2022

Event Type  malfunction  

Manufacturer Narrative

(b)(4).

Event Description

It was reported "the drainage tube was inserted in the emergency room on (b)(6) 2022.The patient accidentally pulled out the right thoracic drainage tube while turning over in a lateral position on the evening of (b)(6) 2022.The patient has not informed the nurse yet.Around 2am, the patient requested the nurse to disinfect and change the dressing of the drainage tube, but the nurse found that the patient's drainage tube had come out and was fixed with a seamless thread.After the nurse disinfected the wound and changed the dressing, they informed the on duty doctor and the doctor checked the patient by the bedside." the patient's condition was reported as fine.

Manufacturer Narrative

(b)(4).Complaint verification testing could not be performed as it was reported that the sample is not available for return.A device history record review was performed and no relevant findings were identified.Without the device to evaluate the complaint could not be confirmed and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.

Event Description

It was reported "the drainage tube was inserted in the emergency room on (b)(6) 2022.The patient accidentally pulled out the right thoracic drainage tube while turning over in a lateral position on the evening of (b)(6) 2022.The patient has not informed the nurse yet.Around 2am, the patient requested the nurse to disinfect and change the dressing of the drainage tube, but the nurse found that the patient's drainage tube had come out and was fixed with a seamless thread.After the nurse disinfected the wound and changed the dressing, they informed the on duty doctor and the doctor checked the patient by the bedside." the patient's condition was reported as fine.

• Brand Name: ARROW CVC SET: 16 GA X 8" (20 CM)
• Type of Device: CATHETER PERCUTANEOUS
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL CR, A.S.; jamska 2359/47; zdar nad sazavou 591 0 1; EZ 591 01
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 17105397
• MDR Text Key: 317772180
• Report Number: 3006425876-2023-00560
• Device Sequence Number: 1
• Product Code: DQY
• Combination Product (y/n): N
• Reporter Country Code: CH
• PMA/PMN Number: K862056
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,User Facility,Company Representative,Distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/15/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/12/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: ES-04301
• Device Lot Number: 71F21L0047
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 06/30/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 11/04/2021
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: NOT REPORTED; NOT REPORTED