(b)(4).Method: the complaint rt340 breathing circuit was returned to fisher & paykel healthcare (fph) in (b)(4) and was visually inspected.Results: visual inspection revealed that the evaqua expiratory limb had a hole approximately 11 cm from the patient end connector.A lot check revealed two other similar complaints for lot date 130617.Conclusion: based on our visual inspection, the subject expiratory limb appeared to have been punctured with a blunt object.All rt340 breathing circuits are visually inspected and pressure tested for leaks before releasing for distribution.Any breathing circuit which fails is discarded.In addition, tube weighing and bond strength testing are performed every 15 minutes.If any faults are detected the whole batch is placed on hold for investigation.This suggests that the subject breathing circuit was damaged after it was released for distribution.The key difference between the evaqua breathing circuits and conventional breathing circuits is that the expiratory limb of the evaqua circuits such as the rt340 is composed of a thin, semi-permeable film specially designed to allow water vapour from expired ventilatory gas to pass through.The evaqua expiratory tube has a protective mesh which prevents damage to the walls of the tube, however the evaqua tubing can be more susceptible to damage than conventional circuits when exposed to rough handling or damage caused by sharp and blunt objects and non-fph circuit hangers.The user instructions that accompany the rt340 adult dual heated evaqua breathing circuit state the following: - "perform a pressure and leak test on the breathing system and check for occlusions before connecting to a patient." - "set appropriate ventilator alarms." - "fit only the supplied fisher & paykel healthcare circuit hanger with care to avoid circuit damage.".
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