K Number
K153605

Validate with FDA (Live)

Manufacturer
Date Cleared
2016-02-11

(56 days)

Product Code
Regulation Number
880.5725
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The iv Watch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand.

The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The iv Watch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.

Device Description

The ivWatch Model 400 is a medical device that provides continuous, noninvasive monitoring of human tissue adjacent to peripheral intravenous (PIV) insertion sites on the forearm and dorsal aspect of the hand to aid in the early detection of infiltration and extravasation events. The ivWatch Model 400 consists of the ivWatch Patient Monitor (IPM), a reusable optical sensor cable and a single-use sensor receptacle.

The ivWatch Model 400 uses visible and near-infrared light to measure changes in the optical properties of the tissue near a PIV insertion site. The IPM contains an optical system that generates visible and near-infrared light signals that are sent through the optical sensor cable to the patient's skin. Simultaneously, the IPM measures the light reflected back through the optical sensor cable from the patient's skin. Measured changes between the emitted and reflected signal are processed by proprietary ivWatch signal processing algorithms to determine if an infiltration event may have occurred. If changes in the optical properties of the tissue near the peripheral IV insertion site are consistent with an infusate pooling in the subcutaneous tissue, the IPM emits audible and visual notifications intended to prompt the clinician to inspect the peripheral IV site for a possible infiltration event.

AI/ML Overview

The ivWatch Model 400 is an adjunctive device to aid in the early detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates in patients 18 years or older with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand. The device was submitted for a 510(k) premarket notification (K153605).

Here's an analysis of the acceptance criteria and study information provided in the document:

1. Table of Acceptance Criteria and Reported Device Performance

The device under review is an updated version of the ivWatch Model 400 (K153605), with modifications only to the sensor cable sheathing. The performance data presented focuses on verifying that these modifications do not negatively impact the device's safety and effectiveness compared to the predicate device (K142374). Therefore, the acceptance criteria and results specifically address biocompatibility and reprocessing, as clinical efficacy was not re-evaluated for this submission.

Performance CharacteristicAcceptance CriteriaResult
Biocompatibility Testing
Sensitization (on sheathing of sensor cable)Per ISO 10993-10:2010, Non-sensitizerPass
Irritation (on sheathing of sensor cable)Per ISO 10993-10:2010, Non-irritantPass
Cytotoxicity (on sheathing of sensor cable)Per ISO 10993-5:2009, Non-toxicPass
Reprocessing Validation
Low Level Disinfection (on sensor cable)Per AAMI TIR12 -2010, AAMI TIR30-2011 and Reprocessing Medical Devices in Health Care Settings: Validation Methods and LabelingPass
Cleaning (on sensor cable)Per AAMI TIR12 -2010, AAMI TIR30-2011 and Reprocessing Medical Devices in Health Care Settings: Validation Methods and LabelingPass

2. Sample Size Used for the Test Set and Data Provenance

The document does not detail specific sample sizes for the individual biocompatibility and reprocessing tests beyond indicating that the tests were performed. It broadly states that the testing was performed on the "sheathing of the sensor cable" and "the sensor cable."

Given the nature of the tests (biocompatibility and reprocessing validation), the "test set" would typically refer to the samples of the modified sensor cable sheathing and sensor cable that underwent the evaluations. The provenance of this data is from tests conducted by ivWatch, LLC for regulatory submission. The document does not specify country of origin for the data or whether it was retrospective or prospective, but such testing is typically prospective, conducted specifically for the submission.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

For the biocompatibility and reprocessing tests, "ground truth" is established by adherence to recognized international standards and guidelines (ISO 10993 series and AAMI guidance documents). The "experts" involved would be the certified laboratories and personnel performing these tests, who are qualified to interpret the standards and conduct the specific assays (e.g., cell culture for cytotoxicity, animal models for sensitization/irritation, microbiology for disinfection). The document does not specify the number or specific qualifications of these experts beyond referencing the ISO and AAMI standards.

4. Adjudication Method for the Test Set

Adjudication methods like 2+1 or 3+1 (common in image review studies) are not applicable to the type of non-clinical "test sets" described (biocompatibility and reprocessing validation). The results are objectively determined based on the outcomes of standardized scientific assays and compared against predefined pass/fail criteria outlined in the relevant standards.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No MRMC comparative effectiveness study was done for this specific submission (K153605). The document explicitly states, "Clinical testing was not required for this submission." This indicates that the safety and effectiveness of the device's core functionality (detection of infiltrations) was established in a prior submission (K142374), and the current submission only addresses modifications that do not impact that core functionality or clinical performance. Therefore, there is no effect size reported for human readers improving with or without AI assistance, as AI functionality for interpretive purposes is not central to this device's regulatory review.

6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study

No standalone study presenting algorithm-only performance metrics (e.g., sensitivity, specificity for infiltration detection) was performed or discussed in this submission. Similar to the MRMC study, this type of performance data would have been part of the original K142374 submission that established the device's fundamental function. The current submission focuses on material and reprocessing changes.

7. Type of Ground Truth Used

For the biocompatibility tests (sensitization, irritation, cytotoxicity), the "ground truth" is determined by the biological response observed in standardized in vitro or in vivo tests, as interpreted against the acceptance criteria defined by the ISO 10993 standards.

For the reprocessing validation (low-level disinfection and cleaning), the "ground truth" is established by demonstrating a predefined reduction in microbial load or removal of organic soil from the device, verified through validated laboratory methods according to AAMI guidance.

8. Sample Size for the Training Set

The concept of a "training set" is generally applicable to machine learning algorithms. While the ivWatch Model 400 uses "proprietary ivWatch signal processing algorithms," the document does not discuss the algorithms' development or any associated training sets for this particular submission. The focus is on the physical components of the device. Any algorithm training would have occurred during the development of the original predicate device (K142374).

9. How the Ground Truth for the Training Set Was Established

As no training set is discussed in this specific 510(k) summary, the method for establishing its ground truth is not provided. For such a device, if an algorithm were indeed trained, the ground truth for infiltration detection would likely involve direct clinical observation by healthcare professionals, potentially confirmed by imaging or other objective measures of fluid extravasation, collected prospectively or retrospectively. However, this level of detail is absent from the provided document.

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Image /page/0/Picture/1 description: The image is a logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around a symbol. The symbol is a stylized representation of a human figure, with three profiles overlapping to create a sense of depth and connection.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

February 11, 2016

ivWatch, LLC Ms. Jaclyn Lautz Director of Regulatory Affairs and Quality Assurance 469 Mclaws Circle Williamsburg, Virginia 23185

Re: K153605 Trade/Device Name: ivWatch Model 400 Regulation Number: 21 CFR 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: PMS Dated: January 12, 2016 Received: January 14, 2016

Dear Ms. Lautz:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Tina Kiang
-s

for Erin I. Keith, M.S. Director Division of Anesthesiology. General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K153605

Device Name ivWatch Model 400

Indications for Use (Describe)

The iv Watch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand.

The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The iv Watch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.

Type of Use (Select one or both, as applicable)
-------------------------------------------------

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/0 description: The image shows the logo for IVWatch. The logo consists of a black teardrop shape with the letters "iv" in white inside the teardrop. To the right of the teardrop is the word "Watch" in a stylized font. The logo is simple and modern, and it is likely used to represent a company or product related to intravenous therapy or monitoring.

ivWatch, LLC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

7 SPECIAL 510(K) SUMMARY

7.1 Administrative

Submitter NameivWatch, LLC
Applicant Address469 McLaws CircleWilliamsburg, VA 23185
Phone855-489-2824
Fax757-645-4760
Primary ContactJaclyn Lautz, Director ofRegulatory Affairs and QualityAssurance
Primary Contact Emailjaclyn.lautz@ivwatch.com
Primary Contact Phone855-489-2824 x7023
Date PreparedJanuary 12, 2016

7.2 Device

Trade NameivWatch Model 400
ManufacturerivWatch, LLC
510(k) NumberK153605
Device ClassII
Classification NameInfusion Pump
Regulation Number21 CFR 880.5725
Product CodePMS (Peripheral Intravenous(PIV) Infiltration Monitor)

7.3 Predicate Device

Trade NameivWatch Model 400
ManufacturerivWatch, LLC
510(k) NumberK142374
Device ClassII
Classification NameInfusion Pump
Regulation Number21 CFR 880.5725
Product CodeMRZ (Accessories, Pump,Infusion)

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Image /page/4/Picture/0 description: The image shows the logo for IV Watch. The logo consists of a stylized black teardrop shape with a grid pattern in the upper left corner. The text "ivWatch" is written in a modern, sans-serif font to the right of the teardrop shape. The "i" and "v" are connected, and the "W" is stylized with a curved line.

ivWatch IIC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

7.4 Device Description

The ivWatch Model 400 is a medical device that provides continuous, noninvasive monitoring of human tissue adjacent to peripheral intravenous (PIV) insertion sites on the forearm and dorsal aspect of the hand to aid in the early detection of infiltration and extravasation events. The ivWatch Model 400 consists of the ivWatch Patient Monitor (IPM), a reusable optical sensor cable and a single-use sensor receptacle.

The ivWatch Model 400 uses visible and near-infrared light to measure changes in the optical properties of the tissue near a PIV insertion site. The IPM contains an optical system that generates visible and near-infrared light signals that are sent through the optical sensor cable to the patient's skin. Simultaneously, the IPM measures the light reflected back through the optical sensor cable from the patient's skin. Measured changes between the emitted and reflected signal are processed by proprietary ivWatch signal processing algorithms to determine if an infiltration event may have occurred. If changes in the optical properties of the tissue near the peripheral IV insertion site are consistent with an infusate pooling in the subcutaneous tissue, the IPM emits audible and visual notifications intended to prompt the clinician to inspect the peripheral IV site for a possible infiltration event.

Indications For Use 7.5

The indications for use are identical to the predicate device.

The ivWatch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand. The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The ivWatch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the ivWatch Model 400.

7.6 Comparison of Modified Device with the Predicate Device

The subject device has the same technological characteristics and intended use as compared to the predicate device (K142374). The ivWatch Model 400 consists of the ivWatch patient monitor, a single-use sensor receptacle and a reusable optical sensor cable. There have been no changes to the ivWatch patient monitor and the single-use sensor receptacle of the subject device compared to the predicate device submission. The sensor cable of the subject device is the only component of the ivWatch Model 400 that has been modified. Specifically, the sensor cable sheathing, which is the outer protective layer encasing the flexible glass fibers, has been modification of the subject device's sheathing includes removing an additive and changing the colorant.

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Image /page/5/Picture/0 description: The image shows the logo for "ivWatch". The logo consists of a stylized water droplet shape on the left, with the letters "iv" inside the droplet. To the right of the droplet, the word "Watch" is written in a modern, sans-serif font. There is a small trademark symbol after the word "Watch".

ivWatch IIC 469 McLaws Circle Williamsburg, VA 23185

ItemPredicate Device - ivWatchModel 400K142374Subject Device – ivWatchModel 400K153605
MonitorivWatch Patient MonitorivWatch Patient Monitor
Sterile, disposablepatient-contactingcomponentivWatch Sensor ReceptacleivWatch Sensor Receptacle
SensorCableFormulationPellethane 80AEBiosafe2.7% PropellPellethane 80AE2.7% Propell
ColorantPantone 2975CPantone 646C
ExtrusionMethodCo-extrusionSingle extrusion

Performance Data 7.7

ivWatch has performed the following non-clinical/design verification testing based on the risk analysis conducted. The 510(k) submission included a summary of these design control activities to assure that the risks were adequately mitigated. The risks identified included biocompatibility and reprocessing. The mitigation for biocompatibility risks was to repeat the testing that was previously performed on the sensor cable sheathing of the predicate device per ISO 10993-1: Biological evaluation of medical devices, Part 1: Evaluation and testing. The reprocessing risks were mitigated by repeating the low-level disinfection validation and cleaning validation that was performed on the sensor cable of the predicate. The results of these tests demonstrate that the sensor cable modification of the ivWatch Model 400 is substantially equivalent to the sensor cable of the predicate device based on predetermined acceptance criteria. Clinical testing was not required for this submission.

Performance CharacteristicAcceptance CriteriaResult
BiocompatibilityTestingPerformed onthe sheathingof the sensorcableSensitizationPer ISO 10993-10:2010, Non-sensitizerPass
IrritationPer ISO 10993-10:2010, Non-irritantPass
CytotoxicityPer ISO 10993-5:2009, Non-toxicPass
ReprocessingValidationPerformed onthe sensorLow LevelDisinfectionPer AAMI TIR12 -2010, AAMITIR30-2011 and ReprocessingMedical Devices in HealthCare Settings: ValidationPass
CleaningPass

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Image /page/6/Picture/0 description: The image shows the logo for "ivWatch". The logo consists of a stylized black teardrop shape with three small white squares inside, followed by the text "ivWatch" in a clean, sans-serif font. A vertical black line is present on the right side of the logo.

ivWatch, LLC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

cable

Methods and Labeling

7.8 Conclusions

The risks associated with the modified ivWatch Model 400 have been identified and the design control activities demonstrate adequate risk mitigation. The modified ivWatch Model 400 is substantially equivalent to the predicate device.

§ 880.5725 Infusion pump.

(a)
Identification. An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.(b)
Classification. Class II (performance standards).