[4896025]
During an intravenous (iv) catheter insertion procedure the clinician noted that the catheter was leaking back into the dressing after applying the clear cover dressing. The clinician noted blood seepage in between the slip luer fittings of the catheter and the iv start kit's 6 inch extension set. The clinician attempted to seat the mating sections but the threads would not mesh and the connection felt loose. The clinician exchanged both iv line and extension set and the iv placed without further incident. There have been prior and subsequent failures on this iv catheter and iv start kit. The user has been replacing the iv start kit's extension set with an alternate manufacturer and the iv catheter mates with no leaks or cross threading. However, the infusion center nursing later complained that the iv start kit's themselves were now leaking no matter which extension set was being used. The reported catheter and extension set have been sent to biomed for reporting to the manufacturer for analysis. At this time the infusion center staff is monitoring all iv catheter and extension set connections and assembly process as well as follow up with the manufacturer's involved. The staff is understandably concerned and nervy right now on these issues. This has happened at least 8 times in this department in the last 4 weeks. These are seasoned infusion care nurses so this whole event is out of character for them. Some of the common nursing complaints is that the threaded sections feel as if they are not meshing correctly or if they so twist together correctly they feel loose.
Patient Sequence No: 1, Text Type: D, B5