MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW PICC SET 2-LUMEN: 5 FR X 19-5/8IN (50 CM; CATHETER, INTRAVASCULAR, THER

Catalog Number	PR-05052-HP
Medical Device Problem Codes	Obstruction of Flow (2423); Material Deformation (2976)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/31/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the catheter is examined, and a small notch is observed, so a test with saline solution is performed, with adequate flow through both lumens.According to pr-cme-20, a single puncture is made in the left cephalic vein using the direct puncture technique, advancing with little difficulty through the dilator.After advancing the dilator, there is no problem, and once inside the vessel, it advances 40 cm.An attempt to flush the lumens is unsuccessful, so it is withdrawn from the vessel with some turbulence.A new catheter is requested, through the same vein using the dilator, and the new catheter is advanced the full 50 cm of the total length of a double-lumen catheter.It is placed to determine the position of the tip, obtaining good venous return through the lumens and easy flow of fluids." there was no patient consequences.No medical intervention required.The patient's current condition is reported as "fine".
Additional Manufacturer Narrative
(b)(4).
Additional 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 or Problem Description
It was reported that "the catheter is examined, and a small notch is observed, so a test with saline solution is performed, with adequate flow through both lumens.According to pr-cme-20, a single puncture is made in the left cephalic vein using the direct puncture technique, advancing with little difficulty through the dilator.After advancing the dilator, there is no problem, and once inside the vessel, it advances 40 cm.An attempt to flush the lumens is unsuccessful, so it is withdrawn from the vessel with some turbulence.A new catheter is requested, through the same vein using the dilator, and the new catheter is advanced the full 50 cm of the total length of a double-lumen catheter.It is placed to determine the position of the tip, obtaining good venous return through the lumens and easy flow of fluids." there was no patient consequences.No medical intervention required.The patient's current condition is reported as "fine".

• Brand Name: ARROW PICC SET 2-LUMEN: 5 FR X 19-5/8IN (50 CM
• Common Device Name: CATHETER, INTRAVASCULAR, THER
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL DE MEXICO S.A. DE C.V.; ave. washington 3701; colonia panamericana, chihuahua; chihuahua 31200 ; MX 31200
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 23466910
• Report Number: 9680794-2025-00900
• Device Sequence Number: 13292508
• Product Code: LJS
• UDI-Device Identifier: 10801902095388
• UDI-Public: (01)10801902095388(11)250320(17)270228(10)14F25B0332(21)
• Combination Product (Y/N): N
• Initial Reporter Country: CO
• PMA/510(K) Number: K042126
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/10/2025

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 Catalogue Number: PR-05052-HP
• Device Lot Number: 14F25B0332
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/10/2025
• Supplement Date Received by Manufacturer: 11/26/2025
• Initial Report FDA Received Date: 11/04/2025
• Supplement Report FDA Received Date: 12/04/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/20/2025
• 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
• Concomitant Medical Products and Therapy/Usage Dates: NOT REPORTED.; NOT REPORTED.
• Patient Sex: Unknown