HysteroLux Fluid Management System (2020-11-23) — recall 61901
Health Canada — Medical Devices · Canada · 2020-12-11 · Type II
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Reported risk: WOM has received complaints from customers in the United States that the display of inflow volume on the HysteroLux Fluid Management System can reach its limit of 32,450 mL during long procedures. In these cases, the display does not indicate the actual inflow volume. In cases where an unusually high amount of fluid is used for distension of the patient's uterus, the calculation of the inflow and outflow volumes reaches its limit and the pump control unit display will freeze at the maximum value. There is a risk of distension fluid reaching the circulatory system of the patient's soft tissue. Our investigation has identified a software anomaly as the cause for this display freeze. The reason for this is that at 32,450 mL an internal software calculation threshold is being reached. As the outflow measurement will continue, the result is that the deficit accumulated up to this point will start counting backwards until 0 mL is reached.
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