VYGON

Description of Event or Problem

NNP [NEONATAL NURSE PRACTITIONER] WAS PLACING AN UMBILICAL VENOUS CATHETER. THE NUMBERS ON THE CATHETER WORE OFF AS SOON AS SHE TOUCHED THEM. IT WAS DIFFICULT FOR HER TO KNOW HOW DEEP THE LINE WAS. WAS NOT REMOVED FROM SERVICE AS CATHETER WAS ALREADY INSERTED INTO UMBILICUS AND CATHETER WAS FUNCTIONAL. WAS MORE BENEFICIAL TO BABY TO LEAVE IN RATHER THAN REPLACE WITH A NEW CATHETER. DEPTH WAS ESTIMATED. INITIALLY HAD ISSUE FLUSHING AND DRAWING BACK ON CATHETER. LINE WAS PULLED BACK TO LOW LYING AND THEN REMOVED WHEN PIV [PERIPHERAL INTRAVASCULAR LINE] WAS PLACED. (UNFORTUNATELY, PACKAGING AND DEVICE WERE BOTH DISCARDED.)