MAUDE Adverse Event Report: BARD ACCESS SYSTEMS HEMOSPLIT,14.5 FR,ST,27CM,T CUFF,STAND; DIALYSIS CATHETER

Model Number 5733274

Device Problems Stretched (1601); Material Protrusion/Extrusion (2979)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 07/09/2020

Event Type  malfunction  

Manufacturer Narrative

As the lot number for the device was provided, a review of the device history records is currently being performed.The return of the sample is pending; however photo has been provided for review.The investigation of the reported event is currently underway.Expiry date (05/2021).

Event Description

It was reported that the tube of the catheter allegedly bulged.The procedure was completed using another device.There was no reported patient injury.

Event Description

It was reported that post catheter placement in right internal jugular vein, the tube of the catheter allegedly bulged.The procedure was completed using another device.There was no reported patient injury.

Manufacturer Narrative

H10: manufacturing review: a lot history review was performed.This is the only complaint to date for this lot number.Therefore, a device history record review is not required.Investigation summary: one hemosplit long-term dialysis catheter was returned for evaluation.Visual, microscopic and functional testing were performed.Stretching to the red luer extension leg was noted distal to the distal end of the luer.The sample was returned with both clamps disengaged.The tissue cuff was intact and had residue.Both lumens were patent to infusion and aspiration with no issue.The investigation is confirmed for the bulged catheter, as a bulge on the red luer extension leg was clearly noted.A definitive root cause could not be determined based upon the available information.Labeling review: a review of product labeling documentation (e.G.Procedural instructions, indications, warnings, precautions, cautions, possible complications, contraindications, nursing guide, and unit label) did not find any product labeling inadequacy.H10: d4 expiry date (05/2021), g4.H11:section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.

• Brand Name: HEMOSPLIT,14.5 FR,ST,27CM,T CUFF,STAND
• Type of Device: DIALYSIS CATHETER
• Manufacturer (Section D): BARD ACCESS SYSTEMS; 605 n. 5600 w.; salt lake city UT 84116
• MDR Report Key: 10361452
• MDR Text Key: 201580590
• Report Number: 3006260740-2020-02761
• Device Sequence Number: 1
• Product Code: MSD
• UDI-Device Identifier: 00801741013034
• UDI-Public: (01)00801741013034
• Combination Product (y/n): N
• PMA/PMN Number: K030020
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 11/29/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 5733274
• Device Catalogue Number: 5733274
• Device Lot Number: REDY4020
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/11/2020
• Initial Date Manufacturer Received: 07/13/2020
• Initial Date FDA Received: 08/04/2020
• Supplement Dates Manufacturer Received: 11/03/2020
• Supplement Dates FDA Received: 11/29/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1