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.The following were reviewed as part of this investigation: patient severity, complaint and batch history, applicable previous investigation(s), applicable manufacturing records, ecg printout analysis and applicable fmea documents.Based on a review of this information, the following was concluded: the complaint of a discrepancy between the ecg printout and an incidental x-ray was inconclusive due to the sample condition.An ecg printout from a 5fr t/l powerpicc provena catheter placement was returned for evaluation.The p-wave was present, identifiable, and consistent.However, the p-wave in the external waveform was inverted.The wave did appear to peak in the intravascular waveform and does appears to be consistent with a caj placement.However, only the user would be able to tell if they inserted the picc tip deep enough to see the p-wave maximize and then start to diminish or display an initial negative deflection.Because the baseline has an inverted p-wave, the ecg should not be used for confirmation.Possible contributing factors for the inverted p-wave could be an incorrect lead placement (switched leads) or the patient may be in a junctional rhythm.A junctional rhythm may have an inverted p-wave in lead 2.With proper external lead placement (lead 2), the black lead is placed on the right shoulder and the red lead is on the left lower abdomen at the mid-axillary line.The p-wave in lead ii (lead 2) would always have an upright p-wave.Since the printout did not contain the correct p-wave in the external waveform, the instructions for use in this case would be to do a chest x-ray.In addition, without a copy of the radiographic images, a review of the images could not be independently conducted.Possible contributing factors for an ecg printout indicating the incorrect catheter tip location could include patient physiology (e.G., heart rhythm anomalies), the 3cg tcs not properly reading the stylet/ecg (e.G., noise on the signal), or clinical procedure.Possible contributing factors for actual or perceived changes in catheter tip location in the radiographic images could include imaging technique (e.G., projection, patient position, and respiratory pattern), patient movements, or catheter securement method.As the complaint could not be independently confirmed, it will be considered inconclusive.However, the complaint has been recorded and will continue to be monitored as part of ongoing trending.H3 other text : evaluation findings are in section h.11.
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