inforMED
MalfunctionDWQ

TRIVEX

Received Nov 7, 2009 · Event occurred Sep 21, 2009

Report 1548230 · MDR key 1548230

Device

Generic name

Laser, Endovenous Device

Manufacturer

Inavein, Llc

Catalog number

*

Lot number

*

Product problems

  • Device Inoperable
  • Improper Device Output

Patient

39 YR

  • No Consequences Or Impact To Patient

Narrative

Description of Event or Problem

PATIENT WAS SCHEDULED FOR A LEFT SAPHENOUS VEIN RIGHT FEMORAL ARTERY WITH TRIVEX, PRONE AND SUPINE. THE TRIVEX MACHINE WORKED PERFECTLY FOR THE FIRST HALF OF THE CASE WHILE THE PT WAS IN THE PRONE POSITION. THE PATIENT WAS TURNED, AND PROCEEDED ON WITH THE SUPINE PORTION OF THE CASE. THE TRIVEX WAS WORKING WELL FOR ABOUT 20 MINS OR SO AND THEN THE RESECTOR PORTION STOPPED WORKING. AT THIS TIME, THE RESECTOR WAS RE-EXAMINED. THE RESECTOR HANDPIECE WAS TAKEN APART AND THE NON-DISPOSABLE PORTION HAS A WHEEL THAT SPINS TO TURN THE BLADE ON THE DISPOSABLE RESECTOR. THE WHEEL WAS NOT SPINNING. THE TRIVEX MACHINE WAS TURNED OFF AND ON SEVERAL TIMES. THE HANDPIECES WERE PLUGGED AND UNPLUGGED. AT THIS POINT THE LIGHTS ON THE MACHINE (THAT ARE SUPPOSED TO BE GREEN) HAVE TURNED ORANGE AND WILL NOT TURN BACK TO GREEN. BIOMED AND CHARGE NURSE WERE NOTIFIED. BIOMED TECH CAME TO THE OR TO INSPECT THE MACHINE. SHE DID ALL THE THINGS THAT WE DID AS WELL. WE ALSO OPENED A NEW DISPOSABLE AND NON-DISPOSABLE HANDPIECE RESECTOR. THESE CHANGES DID NOT HELP. TECH LEFT THE ROOM TO READ THE MANUAL ON THE TRIVEX. SHE CAME BACK AND STATED THAT FROM OUR DESCRIPTION, THE RESPONSES FROM THE MACHINE AND THE MANUAL, THAT IT APPREARED TO BE A MOTHERBOARD FAILURE. SURGEON FINISHED THE REST OF THE CASE WITH STAB PHLEBECTOMIES. NO IMMEDIATE HARM CAME TO THE PT FROM THE MACHINE NOT WORKING.

Description of Event or Problem

PATIENT WAS SCHEDULED FOR A LEFT SAPHENOUS VEIN RIGHT FEMORAL ARTERY WITH TRIVEX, PRONE AND SUPINE. THE TRIVEX MACHINE WORKED PERFECTLY FOR THE FIRST HALF OF THE CASE WHILE THE PT WAS IN THE PRONE POSITION. THE PATIENT WAS TURNED, AND PROCEEDED ON WITH THE SUPINE PORTION OF THE CASE. THE TRIVEX WAS WORKING WELL FOR ABOUT 20 MINS OR SO AND THEN THE RESECTOR PORTION STOPPED WORKING. AT THIS TIME, THE RESECTOR WAS RE-EXAMINED. THE RESECTOR HANDPIECE WAS TAKEN APART AND THE NON-DISPOSABLE PORTION HAS A WHEEL THAT SPINS TO TURN THE BLADE ON THE DISPOSABLE RESECTOR. THE WHEEL WAS NOT SPINNING. THE TRIVEX MACHINE WAS TURNED OFF AND ON SEVERAL TIMES. THE HANDPIECES WERE PLUGGED AND UNPLUGGED. AT THIS POINT THE LIGHTS ON THE MACHINE (THAT ARE SUPPOSED TO BE GREEN) HAVE TURNED ORANGE AND WILL NOT TURN BACK TO GREEN. BIOMED AND CHARGE NURSE WERE NOTIFIED. BIOMED TECH CAME TO THE OR TO INSPECT THE MACHINE. SHE DID ALL THE THINGS THAT WE DID AS WELL. WE ALSO OPENED A NEW DISPOSABLE AND NON-DISPOSABLE HANDPIECE RESECTOR. THESE CHANGES DID NOT HELP. TECH LEFT THE ROOM TO READ THE MANUAL ON THE TRIVEX. SHE CAME BACK AND STATED THAT FROM OUR DESCRIPTION, THE RESPONSES FROM THE MACHINE AND THE MANUAL, THAT IT APPREARED TO BE A MOTHERBOARD FAILURE. SURGEON FINISHED THE REST OF THE CASE WITH STAB PHLEBECTOMIES. NO IMMEDIATE HARM CAME TO THE PT FROM THE MACHINE NOT WORKING.