Questionnaire for market observation
SFN®(non coring) port needle
Costumer feedback form - patient
Dear Sir or Madam,
Against the background above, we are dependent on your support within the framework of the practical implementation of the EU Regulation 2017/745 enacted by the European Parliament and the Council.
Feedback by patients and former patients who are or have been into contact with our products and can thus adequately evaluate them is particularly helpful to us.
The evaluation of your answers is anonymous and no conclusions about individual patients are included in the corresponding evaluation.
The questionnaire is divided into the following topics:
I. Information about the patient
II. Product information
III. Information about the treatment
IV. Information about the product SFN® port needles
V. General information
We kindly ask you to take a few moments to answer the questionnaire. The questionnaire will take about 5-10 minutes to complete.
Your answers will help us to improve medical products in the future, to make them even safer and to make them available in the usual form.
Thank you very much for your support!
The team of PakuMed gmbh
PakuMed medical products gmbh
Im Löwental 79
Phone: +49 201 – 43 70 97 – 0
SFN 0750 G
SFN 0930 B
SFN 0930 G
SFN 0720 S
SFN 0916 S
SFN 0920 S
SFN 0925 S
SFN 0930 S
SFN 1120 S
SFN 1125 S
SFN 1320 S
SFN 1325 S
SFN 1535 B
SFN 1835 B
Are you receiving active treatment at this time?
In which country are / were you treated?
Are you /were you being treated as an inpatient or outpatient?
How long does a therapy session usually last?
< 1 hour
between 1 - 2 hours
between 2 - 3 hours
> 3 hours
Contact person/ attending physician
Department / specialisation / focus
Is the therapy usually applied with a PakuMed needle?
Only to be filled in if "Other" is selected
How long does a needle/cannula usually stay in place when using the port catheter system?
Only for the therapy session
Only to be filled in if "Other period" is selected
Are you familiar with the safety mechanism of the needle?
No own application
Is a medical standard of hygiene maintained for the puncture?
Satisfaction (0 = Not at all satisfied, 4 = very satisfied)
How do you feel about the puncture?
How would you rate the user-friendliness?