Model Number 4415 |
Device Problem
Improper Flow or Infusion (2954)
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Patient Problem
No Consequences Or Impact To Patient (2199)
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Event Date 02/27/2018 |
Event Type
malfunction
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Manufacturer Narrative
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(b)(4).Per field service representative (fsr), the user facility has taken the unit out of service.This complaint is related to (b)(4)/ medwatch #1828100-2018-00145.
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Event Description
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It was reported that during use of the device for a cardiopulmonary bypass (cpb) procedure, the water flow was low.As a result, an alternate device was employed.The surgical procedure was completed successfully.There was no delay, no blood loss, nor adverse consequences to the patient.
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Manufacturer Narrative
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The reported complaint was confirmed.The field service representative (fsr) verified the reported issue.He replaced valves two, three and the main pump assembly.The reported issue remained.As per fsr, the replaced parts were disposed of and the unit was taken out of service.If additional information becomes available on this complaint that would alter the facts and/or conclusion, a supplemental report will be filed accordingly.
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Manufacturer Narrative
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The field service representative (fsr) was unable to duplicate the complaint.He verified the unit had good flow over the cold plate.The unit operated to the manufacturer's specifications.
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Event Description
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Additional information received indicated that the event happened during set-up for a cardiopulmonary bypass (cpb) procedure.Per clinical review: during set-up for a cpb procedure on (b)(6) 2018, it was noticed by the team that the unit had low water flow and insufficient warming.The team opted to changed out the unit for a fully functioning one before the surgery started.The incident with the heater cooler did not delay the start of the surgical procedure.There was no blood loss or harm associated with the event, for the unit was not used on the procedure.
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Search Alerts/Recalls
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