MAUDE Adverse Event Report: C.R. BARD, INC. (BASD) -3006260740 POWERPICC PROVENA CATHETER WITH SHERLOCK 3CG; CATHETER,INTRAVASCULAR,THERAPEUTIC,LONG-TERM GREATER THAN 30 DAYS

Model Number	N/A
Medical Device Problem Codes	Incorrect, Inadequate or Imprecise Result or Readings (1535); Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/06/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported the picc was placed using sherlock 3cg and was discovered to be 6cm off in tip location, despite having been confirmed in the proper place by the 3cg technology.It was stated this was discovered by an incidental x-ray that the patient received unrelated to the picc placement.
Additional Manufacturer Narrative
The manufacturer has received the sample and will evaluate.Results are expected soon.A lot history review (lhr) of refv1434 showed one other similar product complaint(s) from this lot number.The complaints for this lot number (refv1434) have been reported from the same facility.
Additional Manufacturer Narrative
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.The p-wave did appear to peak in the intravascular waveform and does appears to be consistent with a caj placement.Negative deflections were not noted on the 3 complexes on the printout.However, as the printout is a snapshot in time, 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.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 recorded as inconclusive.However, the complaint has been documented and will continue to be monitored as part of ongoing trending.
Event or Problem Description
It was reported the picc was placed using sherlock 3cg and was discovered to be 6cm off in tip location, despite having been confirmed in the proper place by the 3cg technology.It was stated this was discovered by an incidental x-ray that the patient received unrelated to the picc placement.

• Brand Name: POWERPICC PROVENA CATHETER WITH SHERLOCK 3CG
• Common Device Name: CATHETER,INTRAVASCULAR,THERAPEUTIC,LONG-TERM GREATER THAN 30 DAYS
• Manufacturer (Section D): C.R. BARD, INC. (BASD) -3006260740; 605 north 5600 west; salt lake city 84116
• Manufacturer (Section G): BARD REYNOSA S.A. DE C.V. -9617592; blvd. montebello #1; parque industrial colonial; reynosa, tamaulipas 88780 ; MX 88780
• Manufacturer Contact: kelsey erickson ; 605 north 5600 west; salt lake city 84116 ; 8015950700
• MDR Report Key: 13726411
• Report Number: 3006260740-2022-00697
• Device Sequence Number: 12258607
• Product Code: LJS
• UDI-Device Identifier: 00801741112720
• UDI-Public: (01)00801741112720
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K053501
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/29/2022

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
• Operator of Device: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: S1385108D
• Device Lot Number: REFV1434
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/03/2022
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/18/2022
• Supplement Date Received by Manufacturer: 04/29/2022
• Initial Report FDA Received Date: 03/10/2022
• Supplement Report FDA Received Date: 05/07/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/01/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 70 YR
• Patient Sex: Male