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It was reported that "on (b)(6) 2025, (b)(6) hospital, neurosurgery department, the doctor found the swg kinked during use on the patient." the user changed to a new set to resolve the issue.There was no patient harm or injury.No medical intervention required.The patient's current condition is reported as "fine".
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(b)(4) the customer returned one opened cvc kit, including one swg assembly, arrow raulerson syringe (ars) , and a catheter analysis.Signs of use in the form of biological material were observed on the guidewire.The guidewire was observed to have three kinks throughout the body.The distal j-bend was misshapen but intact.Microscopic examination confirmed the kinks in the guidewire body.Both welds were present and were observed to be full and spherical.The kink in the guidewire was located 23mm, 261mm, and 280mm from the proximal end.The overall length of the guidewire measured 454mm, which is within the specification limits of 450mm - 458mm per the guidewire product drawing.The outer diameter of the guide wire measured 0.79mm, which is within the specification limits of 0.788mm - 0.826mm per the guidewire product drawing.The guidewire was functionally tested per the product instructions for use (ifu).The ifu provided with this kit instructs the user, "advance guidewire into arrow raulerson syringe approximately 10 cm until it passes through syringe valves or into introducer needle." the guidewire was advanced through the returned ars and lab inventory 18ga introducer needle to functionally test the sample.The guidewire passed through both components with little to no resistance in the undamaged areas.Resistance was met at the locations of the kinks.A manual tug test confirmed that both the distal and proximal welds were intact.A device history record review was performed, and no relevant findings were identified.The ifu provided with the kit describes suggested techniques to minimize the likelihood of guide wire damage during use.The instructions caution, "do not apply excessive force in placing or removing catheter or guidewire.Excessive force can cause component damage or breakage.If damage is suspected or withdrawal cannot be easily accomplished, radiographic visualization should be obtained and further consultation requested." the report that the guidewire kinked during use was confirmed through examination of the returned sample.The guidewire had three kinks throughout the body.The returned guidewire met all relevant dimensional/functional requirements, and a device history record review did not identify any manufacturing-related issues.Based on the condition of the guidewire and the report that the damage was observed during use, unintentional use error caused or contributed to this event.Teleflex will continue to monitor and trend for reports of this nature.
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It was reported that " on (b)(6) 2025, (b)(6) hospital, neurosurgery department, the doctor found the swg kinked during use on the patient." the user changed to a new set to resolve the issue.There was no patient harm or injury.No medical intervention required.The patient's current condition is reported as "fine".
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