EXTRACORPOREAL SINGLE PATIENT SYSTEM HRI 5900-0009-3880

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-08-09 for EXTRACORPOREAL SINGLE PATIENT SYSTEM HRI 5900-0009-3880 manufactured by Baxter-extracorporeal Medical Specialities, Inc..

Event Text Entries

[3897] Emploee states that all of pre-treatment safety checks were deformed and proceeded to place patient on dialysis at 1:00 pm. At 3:00 nurse noted that patient's arterial and venous pressures were significantly elevated. 200 cc bolus of normal saline administered pressure levels at acceptable level. 4:00 pm it was note pressure levels up again. 4:15 another 200cc bolus normal saline given. Nurse placed clamp on saline line afterwards. 4:25 it was noted that saline bag was empty. Patient stated "i feel funny in my chest". Venous and arterial lines clamped off manually. Patient placed on side per standard protocol for a suspected air infusion. Patient went into respiratory arrest and a code was called. Patient transferred to hospital. Died may 13, 1993. Nurse states that she put clamp on the saline line after the 4:15 pm administration of saline. When she went to patient to manually clamp off the lines, after the bag was noted to be empty, she said that she saw the clamp lying on the floor. Question the possibility that the clamp did not click closed. During the investigation it was noted that a week prior to the incident the motherboard was shorted out in the area tha controls the internal alarm system. The motherboard is in a very vulnerable position and easily accessed by foreign substances that could cause a short in the systemdevice not labeled for single use. Patient medical status prior to event: satisfactory condition. There was not multiple patient involvement. Device serviced in accordance with service schedule. Date last serviced: 01-mar-93. Service provided by: user facility biomedical/bioengineering department. Service records available. No imminent hazard to public health claimed. Invalid data - whether device used as labeled/intended. Device was evaluated after the event. Method of evaluation: actual device involved in incident was evaluated, electrical tests performed, mechanical tests performed, performance tests performed, visual examination. Results of evaluation: component failure, electrical problem, foreign material contamination, failure to follow instructions, incorrect technique/procedure, unanticipated short term complication of procedure, alarm failure, component failure. Conclusion: device failure occurred and was related to event, device failure indirectly contributed to event, user error contributed to event. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: device repaired and put back in service, device temporarily removed from service, user education provided, inserviced by other facility staff. The device was not destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number6254
MDR Report Key6254
Date Received1993-08-09
Date of Report1993-06-15
Date of Event1993-05-10
Date Facility Aware1993-05-10
Report Date1993-06-15
Date Reported to FDA1993-06-15
Date Added to Maude1993-08-20
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameEXTRACORPOREAL SINGLE PATIENT SYSTEM
Product CodeLLB
Date Received1993-08-09
Model NumberHRI 5900-0009-3880
OperatorOTHER HEALTH CARE PROFESSIONAL
Device AvailabilityY
Implant FlagN
Device Sequence No1
Device Event Key5941
ManufacturerBAXTER-EXTRACORPOREAL MEDICAL SPECIALITIES, INC.


Patients

Patient NumberTreatmentOutcomeDate
101. Death 1993-08-09

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