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According to the complainant: "the us354 monopolar cord was plugged into the power source in the operating room.The operating room team hurt a 'pop' and the cord was broken into two pieces.This is not a new cord, nor could we tell how old it was because the lot number is not on the actual cord, just the packaging, but it was not new." a delay of three minutes was also reported.No patient complications were reported as a result of this event.
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This adverse event is filed under aic reference (b)(4).The sample was submitted to the manufacturer for evaluation.The returned sample showed signs of prior use.The monopolar plug was separated near the strain relief at the instrument end of the cord, and the internal conductor exhibited heat damage.Lot information was not provided, so the exact age of the cord could not be determined, and a device history record (dhr) review was not possible.Based on the cord's condition, it appeared that the sample has been used multiple times.Based on the investigation findings, the reported issue most likely resulted from improper handling and/or use beyond life expectancy.If the cord is removed from the surgical instrument by pulling on the cord rather than the plug, it can weaken over time.This can also happen at the end of the strain relief with repeated use.Over time, this can weaken the internal conductors, leading them to break.Eventually, there are only a few conductors holding the connection together.When the same amount of current is pushed through fewer conductors, heat will be generated which can cause the remaining conductors to burn and break.As a result, the reported failure could not be confirmed to be a manufacturing related issue.We will maintain this report for further references and continue to monitor other reports for similar occurrences.If any additional pertinent information becomes available, a follow up will be submitted.
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