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On or about (b)(6) 2013, plaintiff underwent placement of an angiodynamics smart port in the left subclavian, with model number ct80stpd.The smart port was compromised of a port body and a polyurethane catheter.The smart port was implanted by dr.(b)(6), m.D., (b)(6) hospital, in (b)(6).On or about (b)(6) 2024, plaintiff presented to (b)(6) hospital, in (b)(6), for removal of the smart port.During the procedure, dr.(b)(6) was unable to remove the catheter, leaving it retained from the left ankle reticular soft tissues to the left brachiocephalic vein, prior to the midline.
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The customer's reported complaint description of catheter tubing fractured and detached during the port explant procedure cannot be confirmed.No port/catheter tubing device was returned for evaluation.Without receiving product for evaluation, we are unable to definitively determine a root cause for this incident.It was reported that the patient had a fibrin sheath and a retained catheter fragment.The stuck catheter (catheter tubing encased in the fibrin sheath) is likely a contributing factor to the catheter fracture and detachment during the port explant procedure.Device history record review of the packaging/catheter lots revealed no quality related issues or manufacturing deficiencies at the time of manufacture.There have been no other reported complaints for the indicated packaging/catheter lots for similar catheter fractured and detached issue.The catheter and locking connector (e.G.Blue boot) are provided as separate components within the port assembly kit.The end user attaches the catheter tubing to the port (and secures junction with the locking connector) during the implantation procedure.Since the port was in situ for more than 11 years and event description states that the physician was unable to remove the [entire] catheter (i.E.Retained catheter) - indicates that a fibrin sheath (encasing the catheter tubing) and/or pinch-off syndrome are potential root causes for the catheter tubing fracture/detachment.Both of these are cautioned against in the port directions for use (dfu).Labeling review: the directions for use (dfu) that is supplied with the port device, contains the following statements: contraindications: · catheter insertion in the subclavian vein medial to the border of the first rib, an area which is associated with higher rates for pinch-off.Warnings: · do not use syringes smaller than 10 ml when accessing the port as system damage can occur.Flushing occluded catheters with small syringes can create excessive pressures within the port system.· failure to ensure patency of the catheter prior to power injection studies may result in port system failure and patient injury may occur.· do not power inject through a port system that exhibits signs of clavicle-first rib compression or pinch-off as it may result in port system failure and patient injury may occur.· absence of a blood return or a poor blood return can be a sign of a potential complication such as occlusion, kinking, breakage, pinch-off syndrome, fibrin formation, thrombosis or malposition.This should be evaluated prior to device usage.A blood return should be present prior to usage of device for any therapy or testing.· if the patient complains of pain, or there is swelling when the device is flushed or when medication or contrast media is administered, evaluate the device for infiltration, proper needle placement, and potential complications such as occlusion, kinking, breakage, pinch-off syndrome, thrombosis or malposition.Failure to assess these complaints or observations can lead to device failure.Potential complications: use of an angiodynamics port system involves potential risks normally associated with the insertion or use of any implanted device or indwelling catheter including but not limited to: catheter disconnection or migration.Catheter embolization.Catheter fragmentation.Catheter pinch-off.Drug extravasation (leakage).Fibrin sheath.Catheter placement considerations: warning: avoid medial catheter placement into subclavian vein through percutaneous technique.This placement could lead to catheter occlusion, damage, rupture, shearing, or fragmentation due to compression of the catheter between the first rib and clavicle.Catheter shearing has been reported when the catheter is inserted via a more medial route in the subclavian vein.Pinch-off syndrome: pinch-off syndrome signs may include difficulty in aspirating blood, resistance to flushing or infusion of medications or fluids that improves with position changes, infraclavicular pain and/or swelling with catheter flushing or infusion palpitations, sudden onset chest pain, cardiac arrhythmias, extra heart sound, chest wall swelling at the port pocket, vein insertion site, pain in shoulder or port area not associated with swelling, cough, paresthesia of arm on side of catheter withdrawal occlusion or swishing sound with catheter flushing.A review of the angiodynamics complaint system noted no adverse trends for this complaint type and product family.This type of complaint continues to be monitored for trends.Reference (b)(4).
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