inforMED
MalfunctionLHC

INTRATEMP THERMABASIN DRAPE

Received Jun 5, 2018 · Event occurred May 10, 2018

Report 3013401749-2018-00004 · MDR key 7571298

Device

Generic name

Fluid Warming And Slush Drapes

Model number

ITB100

Lot number

UNKNOWN

Product problems

  • Crack
  • Crack

Patient

Not reported

  • No Known Impact Or Consequence To Patient
  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

ONE SAMPLE WAS RECEIVED 5/18/18 IN (B)(6). THE SAMPLE WAS OPENED, RED BAGGED AND CONTAMINATED. PHOTOS WERE TAKEN TO SHOW THE CRACK IN THE BOTTOM OF THE BASIN. THE SAMPLE IS BEING DISCARDED APPROPRIATELY AND WILL NOT BE SENT TO (B)(6). A SCAR WAS ISSUED TO THE SUPPLIER FOR THIS COMPLAINT. THE INVESTIGATION IS PENDING A RESPONSE FROM THE SUPPLIER.

Description of Event or Problem

END USER REPORTED BASIN HAS A CRACK IN IT. MEDWATCH FORM MW5077290 WAS RECEIVED ON 5/30/18 WITH THE FOLLOWING INFORMATION: ECOLAB INTRATEMP WARMING UNIT USED DURING SURGERY TO REPAIR AN ABDOMINAL AORTIC ANEURYSM. UPON TEAR DOWN OF STERILE FIELD, IT WAS NOTED THAT BASIN HAD A SMALL CRACK IN THE UNDERNEATH OF BASIN. CRACK WAS UNABLE TO BE VISUALIZED FROM STERILE PORTION. THE PHYSICIAN WAS NOTIFIED, INFECTIOUS DISEASE WAS CONSULTED, BASELINE BLOOD CULTURES WERE OBTAINED AND PATIENT WAS PLACED ON FURTHER ANTIBIOTIC THERAPY FOR 2 WEEKS. THE PATIENT WAS STABLE WITHOUT FEVER AND WAS CLOSELY MONITORED. BLOOD CULTURES HAD NO GROWTH AFTER 4 DAYS. PHARMACY WAS DOSING VANCOMYCIN.