2012年12月22日 星期六

一級召修 Medtronic SynchroMed II (EL)mplantable Drug Infusion Pump

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Medtronic SynchroMed II Implantable Drug Infusion Pump 衛署醫器輸字第023865號 美敦力醫療產品股份有限公司 



Medtronic SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps – Feed Through Failure

Recall Class: Class I
Date Recall Initiated: June 3, 2013
Products: SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps
  • SynchroMed II, Model 8637 (20 ml or 40 ml reservoir size)
  • SynchroMed EL Programmable Pumps, Models 8626, 8626L, 8627, 8627L (10 ml or 18 ml reservoir size)
This recall does not affect Medtronic external insulin pumps for diabetes.
These recalled products were manufactured from May 1998 through June, 2013 and distributed from April 1999 through June 2013.
Use: The SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps (SynchroMed Implantable Infusion Pumps) contain and administer prescribed drugs to a specific site inside the patient’s body. Currently, the approved drugs for use with the SynchroMed Infusion Pump are Infumorph, Lioresal, Prialt (Ziconotide), Floxuridine, Methotrexate and Gablofen. The SynchroMed pumps are used to treat primary or metastatic cancer, chronic pain, and severe spasticity.
The implantable components of the SynchroMed II infusion system include the pump, catheter, and catheter accessories.

Recalling Firm:Medtronic, Inc. Neuromodulation
7000 Central Ave NE
Minneapolis, Minnesota 55432-3568

Manufacturer:Medtronic Puerto Rico Operations Co.
50 Road 31 km 24.4 Ceiba Norte Ind Park
Juncos, Puerto Rico 00777

Reason for Recall: There is a potential for electrical shorting, internal to the SynchroMed infusion pump. An electrical short circuit in a feedthrough may present as a motor stall or low battery reset/alarm and may lead to a loss of or reduction in therapy. This may result in the return of underlying symptoms and/or withdrawal symptoms. Use of this recalled product may result in serious adverse health consequences, including death.

Public Contact: For questions about this recall, contact Medtronic Neuromodulation Technical Services at 1-800-707-0933 Monday through Friday, 7 AM through 6 PM Central Standard Time.

FDA District: Minneapolis District Office
FDA Comments:
Patients: Maintain regular follow-up appointments with your physicians. However, if you experience a change or return of symptoms or hear a device alarm, contact your physician immediately.
Physicians: No action is required beyond the recommendations provided in the Urgent Medical Device Correction letter.
On June 3, 2013, Medtronic sent an "Urgent: Medical Device Correction1"disclaimer icon2 letter dated May 2013 to all affected customers. The letter described the issue of a pump’s potentially shorting, how to identify if a pump is affected, and provided ongoing patient management recommendations.
The firm is asking health care providers to return any explanted SynchroMed II implantable infusion pump to Medtronic Returned Products Analysis.
These actions are not expected to cause a device shortage.
Customers can contact their Medtronic field representative or Medtronic Neuromodulation Technical Services at 1-800-707-0933 Monday through Friday, 7 AM through 6 PM Central Standard Time.
Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death.
Health care professionals and consumers may report adverse reactions or quality problems they experienced using these products to MedWatch: The FDA Safety Information and Adverse Event Reporting Program3 either online, by regular mail or by FAX.
-

Additional Links:



===================================================================
Recall Class: Class I

Date Recall Initiated: November 9, 2012

Products: Medtronic SynchroMed II Implantable Drug Infusion Pump and SynchroMed EL Implantable Drug Infusion Pump
Model numbers:
  • SynchroMed II, models 8637-40 and 8637-20 (The SynchroMed II Pump is supplied in 20 ml or 40 ml reservoir sizes.)
  • SynchroMed EL, models 8626-10, 8626L-10, 8626-18, 8626L-18, 8627-10, 8627L-10, 8627-18, 8627L-18
These infusion pumps were manufactured from May 1998 through November 2012 and distributed from April 1999 through November 2012.

Use:
The SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps (SynchroMed Infusion Pumps) contain and administer prescribed drugs or fluids to a specific site inside the patient’s body. Currently, the approved drugs for use with the SynchroMed Infusion Pump are Infumorp, Lioresal, Prialt (Ziconotide), Floxuridine, Methotrexate and Gablofen. More information related to the drugs approved for use with the SynchroMed Infusion Pump can be found by reviewing the Medtronic Summary of Approved Drugs, which can be found by accessing the link under the Additional Information section below.

Recalling Firm: Medtronic Neuromodulation 7000 Central Ave NE Minneapolis, Minnesota 55432-3568

Reason for Recall: Medtronic recently notified healthcare professionals that using unapproved drugs with the SynchroMed Infusion Pump may negatively impact the pump’s performance. Based on data from the firm’s Implantable Systems Performance Registry, the overall failure rate of the SynchroMed II pump at 78 months post implant is 2.4% when used to dispense approved drugs, and 7.0% when used to dispense unapproved drugs. The use of unapproved drugs can lead to intermittent or permanent pump motor stall and cessation of drug infusion. A cessation of drug infusion may cause serious adverse health consequences, including death. The firm reminded healthcare professionals that the SynchroMed pump can experience motor stalls when used with either approved or unapproved drugs, however pump motor stalls have been reported at a significantly lower rate when approved drugs are exclusively used.

The firm's Medical Device Safety Notification1 includes detailed information about this issue. In addition to the Healthcare Professional Letter, the following important enclosures were provided:
  • A white paper documenting the Increased Risk of Motor Stall and Loss of or Change in Therapy when Unapproved Drug Formulations are used with the SynchroMed Pump: and
  • A summary of the drugs that are approved to be used with the SynchroMed.
Medtronic also reiterated that it continues to investigate motor gear corrosion, which has been identified as a primary contributor to permanent motor stall in the SynchroMed Infusion Pump.

Public Contact: For any questions, contact Medtronic Neuromodulation Technical Services at 1-800-707-0933 weekdays 7am - 6pm Central Standard Time.

FDA District: Minneapolis District Office

FDA Comments:
Medtronic sent an Urgent Medical Device Safety Notification dated November 2012 to healthcare professionals beginning on November 9, 2012. The letter described the issue and recommendations; and physicians were asked to return a response form.

Medtronic recommendations:
To minimize the potential for motor stall, the firm recommended that healthcare professionals only use the approved drugs that are identified in the SynchroMed Infusion Pump labeling or drugs approved by FDA that are labeled for use with the SynchroMed II pump.
DO NOT USE compounded drugs, unapproved concentrations, or unapproved formulations with the SynchroMed Infusion Pump.

  • Continue to monitor patients closely for the possible return of baseline symptoms. A return of baseline symptoms could potentially indicate pump damage.
  • Reinforce with patients and caregivers information on the signs and symptoms of withdrawal due to therapy cessation, and the importance of contacting their healthcare professionals immediately if these signs and symptoms appear.
  • The SynchroMed II pump is designed with a critical alarm for pump motor stall. For patients implanted with a SynchroMed II pump, you can change the critical alarm interval frequency to sound every 10 minutes.
    • Remind patients, their caregivers, and your appropriate staff members to be alert for pump alarms.
    • At implant or follow-up visits, perform an alarm test to provide an opportunity for patients and caregivers to hear and differentiate between the critical and non-critical pump alarms.
    • For patients with a Personal Therapy Manager (PTM), the PTM will show alarm code 8476 when a bolus is attempted if there is an active alarm.
  • Retrieve logs when interrogating the SynchroMed II pump in order to check for motor stall events. Note that a temporary motor stall with recovery is expected behavior when the pump is exposed to a strong magnetic field such as during an MRI. Medtronic Technical Services can be contacted for further assistance evaluating motor stall events on logs.
  • Report any malfunction or adverse event related to a device to Medtronic Neuromodulation Technical Services and to FDA's MedWatch Program (see link below)
Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death.
Health care professionals and consumers may report adverse reactions or quality problems they experienced using these products to MedWatch: The FDA Safety Information and Adverse Event Reporting Program2 either online, by regular mail or by FAX.

Additional Information:

2012年12月1日 星期六

2013 Top 10 Health Technology Hazards List

(http://bme.freebbs.tw 醫學工程論壇 同步發表) 修護經驗

2013 Top 10Health Technology Hazards List

2011~2013歷年比較表




2013

2012

2011

1

Alarm hazards 

各種不適當警報造成的危害

Alarm hazards
各種不適當警報造成的危害

Radiation Overdose and Other Dose Errors during Radiation Therapy
放射治療的輻射劑量過量和其他劑量錯誤

2

Medication administration errors using infusion pumps
點滴幫浦給藥量錯誤

Exposure hazards from radiation therapy and CT
放射治療及電腦斷層輻射曝露危害

Alarm Hazards
各種不適當警報造成的危害

3

Unnecessary radiation exposures and radiation burns during diagnostic radiology procedures

非必要輻射曝露及檢查過程中輻射灼傷

Medication administration errors using infusion pumps
點滴幫浦給藥量錯誤

Cross-Contamination from Flexible Endoscopes
軟式內視鏡的交叉污染

4

Patient/data mismatches in EHRs and other health IT (HIT) systems

電子病歷及其他健康資訊資料錯誤

Cross-contamination from flexible endoscopes
軟式內視鏡的交叉污染

The High Radiation Dose of CT Scans
電腦斷層的高輻射劑量

5

Interoperability failures with medical devices and health  IT systems

醫儀與資訊系統連線管理疏忽

Inattention to change management for medical device connectivity
醫儀與資訊系統連線管理疏忽

Data Loss, System Incompatibilities, and Other Health IT Complications
電腦設備與系統的異常

6

Air embolism hazards

空氣栓塞危害

Enteral feeding misconnections
餵食管的錯誤連接

Luer Misconnections
接頭誤接

7

Inattention to the needs of pediatric patients when using "adult" techniques

用成人治療技術未注意小兒病患的差別需求

Surgical fires
手術室火災

Oversedation during Use of PCA Infusion Pumps
自控式止痛器導致的過度鎮靜

8

Inadequate reprocessing of endoscopic devices and surgical instruments

軟式內視鏡及手術器械的交叉污染

Needlesticks and other sharps injuries
針頭或其他銳器傷害

Needlesticks and Other Sharps Injuries
針扎與其他銳器造成的傷害

9

Caregiver distractions from smartphones and  other mobile devices

智慧型手機或行動裝置造成醫護人員分心

Anesthesia hazards due to incomplete pre-use inspection
檢查疏失造成的麻醉意外

Surgical Fires
手術室火災

10

Surgical Fires
手術室火災

Poor usability of home-use medical devices
家用醫療器材可用性不佳造成的意外

Defibrillator Failures in Emergency Resuscitation Attempts
除顫器於急救復甦時失效

What’s New on This Year’s List?

In the current healthcare environment, the interplay between complexity and either effectiveness or the potential for harm is perhaps most evident in the realm of healthcare information technology, or health IT. Thus, it shouldn’t be surprising that 3 of the 10 topics on this year’s list are associated with the still-maturing health IT field.

Health IT encompasses information systems such as electronic health records (EHRs), the hardware and software that support human interactions with such systems (e.g., laptops, tablet computers,smartphones), and the interfaces that allow interactions between medical devices and these and other systems.

While many health IT implementations offer great promise for improving patient care, it must be recognized that these complex technologies also can create new paths to failure.


As the Institute of Medicine points out in its 2012 report Health IT and Patient Safety,*However, the report cautions that Designed and applied inappropriately,health IT can add an additional layer of complexity to the already complex delivery of health care, which can lead to unintended adverse consequences, for example dosing errors, failure to detect fatal illnesses, and delayed treatment due to poor human–computer interactions or loss of data.


It is widely believed that health IT, when designed, implemented, and used appropriately, can be a positive enabler to transform the way care is delivered.


The complexity of these technologies, their potential to introduce new failure modes, and the possibility that such failures will affect many patients before being noticed—combined with the increased usage that will likely result from the U.S. government's incentivizingthe implementationand meaningful use of effective health IT—leads us to encourage healthcare facilities to pay particular attention to health IT when prioritizing their safety initiatives for 2013.

2012年11月29日 星期四

特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法

(http://bme.freebbs.tw 醫學工程論壇 同步發表)

主旨:特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法,第十條,第二條,附表修正條文,業經本署於中華民國101年11月23日以衛署醫字第1010267627號令修正發布施行,請查照並轉知所屬。

說明:檢附"特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法"第十條,第二條附表修正條文及發布令掃描檔各一份。



附件掃描檔.pdf

2012年11月26日 星期一

醫療儀器驗收管理

1) 數量點験:配合資材部門及廠商在使用單位現場開箱點驗新購醫儀,如此可避免廠商來院辦理驗收時疲於奔命於各驗收單位的情形;若廠不及來院時可由3個單位會同開箱點驗,可避免因廠商不及來院而延誤使用單位使用情形;由於3個單位會同開箱,對於不符採購的點驗結果更具公信力。

2) 驗收基準:驗收基準由幾個項目組成
  (1) 規格驗收單:
  •  購買合約書:依據購買合約中所載明的標的物的規格內容加以核對測試。
  • 手冊及文件:使用手冊及維修手冊、零件清單(Parts List)
  • 漏電安全測試:以AAMI的漏電標準必須在5uA以下
  • 安規核對:最基本的台灣衛生署所規定的醫療器材證證(QSD)、ISO13485及IEC60601
  • PC-base中的PC硬體規格、軟體版權、備份還原方式要特別注意
 
 (2) 試用報告單:驗收基準由幾個項目組成對於所試用的醫儀設備,一般在1個月試用期到時,應請使用單位填具試用報告單,對於試用無異議者勾選【同意驗收】代表結案,對於試用有異議者則請詳填異議情形以利後續處理。試用報告可由幾個項目組成:
  • 使用前:準備簡便性、開機正常否…等
  • 使用時:操作順暢性、使用簡便性、與現有設備配合情形、緊急中斷、停電操作…等
  • 使用後:關機正常否、清潔保養方法…等 
 (3)保固書:一般醫儀保固大都以二年為期,並以驗收完成隔日為保固起始日。並在驗收完成後,影印回傳給廠商留存。

2012年9月14日 星期五

Toshiba KXO-12R X 光機故障無法攝影

(http://bme.freebbs.tw 醫學工程論壇同步發表)
名稱: Toshiba KXO-12R X光機故障無法攝影  2台
故障情形:一台可Ready無法攝影(Exposure) ,一台冒煙
故障原因:一台電路板斷線 ;一台POWER板MOSFET2SK526擊穿,限流電阻330 Ohm/5W燒毀

真的是巧合吧,剛好前後連續二台同型的12R X光機故障,雖然是很頭痛,但也幸運的是,不是同一塊電路板的問題,所以可以湊成一台先擋著使用,爭取維修時間;在醫院要自己維修,有備品所能換來的時間真的是自行維修關鍵之一。

先處理第一塊板子,這片板子是控制板,目前是可以Ready但無法攝影(Exposure),依經驗來看,應該不會太麻煩,可能是邏輯閘IC的問題,Toshiba的工程師也這樣認為,真的也要感謝他們的協助,因為12R算是老機器了,線路圖早就因為搬家不知道搬到哪去了,謝謝Toshiba的友情贊助提供二片板子的線路圖,才方便後續的查修。

同事也覺得依他以往的經驗,應該不會太難處理,只是要時間啦,畢竟在板子上一點一點的量電壓確認High,Low,很費功的,但也這是查修的樂趣,特別是查到疑似故障點處理後,動作正常時,真的是會令人感動呢。
這次的問題,很出乎同事的意料之外,因為Hand switch上應該有15V,結果沒有,往前一級就有15V,他還喃喃自語說,真的假的,就這麼簡單啊,多層電路板上的電銅泊可能斷線,外表看不出來,造成15V過不去,補條線吧!處理後,就聽得到"嗶"的Exposure聲,收工,呵....。


第二片板子就較傷腦筋了,因為冒煙,帶回來看,很明顯的限流電阻己經變黑碳了,週遭的電容也都薰黑了,不知道災情會到哪去,剛好現在有實習生,請中原的黃同學先拆下限流電阻,這時就算是發揮實習的成效了,順利拆下了電阻,好大的一顆喔,烏漆麻黑的,也看不出來,本來對照另一顆以為是33K,就到零件盒找到了一顆33K/5W的先裝上去代用,還好,Toshiba的線路來了,一對之下,原來是330而己,還好,不過330 ohm/5W沒這規格,又到網拍買了5個回來,有網拍還真方便,不怕被當凱子,呵...


貨到,請實習的黃同學再發揮焊功。Q板子去了,結果上機,剛開始OK,一陣後,出現Overload,應該還有問題,同事、我跟同學,就對著線路圖,慢慢量測過去了,這次幸運的是我們有一台正常的,可以對照正常的電壓值及電路圖。

對實習的同學來說,這次是很好的Q板子經驗,完全是用電表一段一段的量下去;結果最後斷定應該是MOSFET(2SK526)打穿了,量不到22V,136V電壓灌過去,造成前級的330 ohm/5W燒毀,到此算是可以先休兵,等買到MOSFET及限流電阻來再繼續。

2SK526是耐流10A,己經停產,後續代替是2SK2417(7.5A),還是很難買,網路功能大...還是有人有這個526的MOSFET,只是要調貨,可能是庫存貨吧。

到了,換上,上機測試OK,不過還是得再燒機一陣子看看。

2012年9月12日 星期三

血液透析原理(洗賢機的原理)


2012年8月14日 星期二

Joson-Care ES-05HD電動床無法動作

(http://bme.freebbs.tw 醫學工程論壇同步發表)
名稱: Joson-Care ES-05HD電動床無法動作
故障情形:控制電路板零件味故障更換
故障原因:電流迴路設計需要加強,導致TL494CN燒焦、 ULN2003APG功能故障、其中一顆繼電器(Relay)功能故障


這次是由中原的實習同學試著記錄後po上來的經驗,提供有同型設備的黟伴參考,非常感謝中原的黃同學

之前換這型的電動床,都是直接帶板子上去換,換下來的故障板,就擺著,一直沒電動床可以試,這次剛好把電動床推回辦公室,一併把之前換下來的障板,一片片的測試,修好了3片,問題都差不多,都是這幾個IC燒掉的問題,看來Jssoncare的耐電流的設計需要再加強囉

首先,電動床這塊控制電路板,由於電動床的控制頭部最常被使用到,之前已將這顆常常被燒壞的10安培(耐電流)繼電器,升等成一顆耐16安培的繼電器了。如圖


由於有時誤按到LOCK功能鍵,導致明明沒有故障,醫護人員卻叫修,因此把電動床兩個控制LOCK功能的腳座拔掉。如圖


以下兩張圖就是這塊控制電路板當中最常故障的兩顆IC,TL494CN與ULN2003APG。如圖


修好後的電路工作正常。如圖

2012年8月10日 星期五

DR攝影系統條碼機(Barcide reader)無法讀取

(http://bme.freebbs.tw 醫學工程論壇同步發表)
名稱: DR攝影系統條碼機(Barcide reader)無法讀取
故障情形:條碼機(Barcide reader)故障更換
故障原因:更換後介面不合(USB,PS2)



這次的系統處理,也算是偏IT面的處理,特別是現在很多設備都使用條碼機(Barcide reader)來讀取診單上的資訊,所以條碼機(Barcide reader)故障時,真的會造成使用單位的困擾。

條碼機(Barcide reader)其實很耐操,基本上設計是跟鍵盤(Keyboard)同一種介面及傳輸方式,所以早期的條碼機(Barcide reader)都是以PS2介面跟鍵盤(Keyboard)並接就可以使用了,不需要特別的驅動程式(Driver)。

但現在,USB介面普及了,所以就慢慢都改為USB了,因為一般win98後都有內建USB的介面驅動,所以在win98後使用USB的條碼機(Barcide reader),應該都沒什麼太大的問題。

偏偏就是6年前的DR用的是Windows NT(widnows 2000的前身),NT是不支援USB的,而且也沒法外掛再加上USB的Driver,所以雖然有USB硬體,但軟體是沒法讀取USB的資料內容。
這可讓我們吃足了苦頭,剛開始沒注意到這個OS上的差異,拿了許多的條碼機(Barcide reader)去試,都看到燈亮了,掃瞄也會有聲響,就是沒法在螢幕上看到資料,最後,注意到原來的線是PS2的線,才想到了OS的差異,趕緊連絡條碼機(Barcide reader)廠商,他們也沒這種經驗,不過至少還有ps2的專用線,很大方,還先寄來試用,不合可以退,在颱風天的前夕真的感覺到很溫馨呢。
換了ps2的線,記得條碼機(Barcide reader)也是要再設定成ps2的模式,一般在條碼機(Barcide reader)的說明書都會有設定控制碼,很簡單,嗶它一下就OK了。哈....
記得如果您家的設備是NT base,記得USB是不支援的,別浪費力氣了。