OXIMETER PRE-AMP CABLE
K965172 · Epic Medical Equipment Services, Inc. · DQA · Jul 16, 1997 · Cardiovascular
Device Facts
| Record ID | K965172 |
| Device Name | OXIMETER PRE-AMP CABLE |
| Applicant | Epic Medical Equipment Services, Inc. |
| Product Code | DQA · Cardiovascular |
| Decision Date | Jul 16, 1997 |
| Decision | SESE |
| Submission Type | Traditional |
| Regulation | 21 CFR 870.2700 |
| Device Class | Class 2 |
Intended Use
Replacement for Nellcor® Patient Module; to connect oximeter sensors to oximeter monitor. For use with Nellcor® N200® and N100® 5 button oximeters only.
Device Story
Oximeter Pre-AMP Cable functions as interface component; connects oximeter sensors to Nellcor N200 and N100 oximeter monitors. Device serves as replacement for original Nellcor Patient Module. Operates as passive electrical conduit for physiological signals between sensor and monitor. Used in clinical or home settings where Nellcor oximeters are deployed. Facilitates continuous pulse oximetry monitoring by ensuring signal integrity between sensor and host monitor.
Clinical Evidence
No clinical data provided; bench testing only.
Technological Characteristics
Passive electrical cable assembly; designed for compatibility with Nellcor N200 and N100 oximeter interfaces. No active electronic components or software algorithms.
Indications for Use
Indicated for use as a replacement patient module cable to connect oximeter sensors to Nellcor® N200® and N100® 5-button oximeter monitors.
Regulatory Classification
Identification
An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.
Reference Devices
- Nellcor N200 oximeter
- Nellcor N100 5 button oximeter
Related Devices
- K192404 — Patient Monitoring Cable (SpO2 Extension Cable) · Shenzhen Coreray Technology, Ltd. · Jun 22, 2020
- K052544 — PULSE OXIMETER ADAPTER CABLES · American I.V. Products, Inc. · Sep 29, 2006
- K222370 — SpO2 Extension Cable · Beijing Rongrui-Century Science & Technology Co., Ltd. · Apr 2, 2023
- K242986 — SpO2 Extension Cable · Beijing Rongrui-Century Science & Technology Co., Ltd. · May 2, 2025
- K033349 — AC-1 SP02 ADAPTOR CABLE, MODEL AC-1 · Masimo Corp. · Jan 28, 2004
Submission Summary (Full Text)
{0}
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Food and Drug Administration
9200 Corporate Boulevard
Rockville MD 20850
Mr. Jeffrey Secunda
VP Product Development & Regulatory Affairs
Epic Medical Equipment Services, Inc.
4643 Westgrove Drive
Dallas, Texas 75248
JUL 16 1997
Re: K965172
Oximeter Pre-AMP Cable
Regulatory Class: II (Two)
Product Code: 74 DQA
Dated: April 16, 1997
Received: April 17, 1997
Dear Mr. Secunda:
We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). 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.
If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.
{1}
Page 2 - Mr. Jeffrey Secunda
This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.
If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for *in vitro* diagnostic devices), please contact the Office of Compliance at (301) 594-4648. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html."
Sincerely yours,

Thomas J. Callahan, Ph.D.
Director
Division of Cardiovascular, Respiratory, and Neurological Devices
Office of Device Evaluation
Center for Devices and Radiological Health
Enclosure
{2}
Page 1 of 1
510(k) K965172
DEVICE NAME:
OXIMETER PRE-AMP CABLE
## INDICATIONS FOR USE:
Replacement for Nellcor® Patient Module;
to connect oximeter sensors to oximeter monitor.
For use with Nellcor® N200® and N100® 5 button oximeters only.
(PLEASE DO NOT WRITE BELOW THIS LINE—CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)
Prescription Use ☐
OR
Over-the-Counter Use ☑
(Per 21 CFR 801.109)
(Optional Format 1-2-96)
Lark Madon 7-14-97
(Dissident Date)
Dresser: 100000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
510(k) Number K965172