K Number
K020251
Device Name
PARAGON INFUSION SYSTEM
Manufacturer
Date Cleared
2002-02-15

(22 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
- 1. The Paragon Infusion System is intended for continuous and/or intermittent infusion of medications for general infusion use, including antibiotic delivery, chemotherapy and pain medications for general, subcutaneous, intramuscular and epidural. - 2. The Paragon Infusion System is also intended for continuous and/or intermittent infusion of medication (such as local anesthetics or narcotics) to surgical wound sites for postoperative pain relief via percutaneous or indwelling catheter.
Device Description
The Paragon Infusion System consists of a reusable mechanical infusion pump and various types of single use administration sets. This special 510(k) proposes a new line of administration sets that incorporates a variable flow rate mechanism.
More Information

No
The document describes a mechanical infusion pump and administration sets with a variable flow rate mechanism, with no mention of AI or ML.

Yes
The device is described as an infusion system intended for the continuous and/or intermittent infusion of medications, including antibiotics, chemotherapy, and pain medications, as well as local anesthetics or narcotics for postoperative pain relief. The administration of these medications for treatment and pain management clearly falls under therapeutic use.

No

Explanation: The device is described as an "infusion pump" intended for "continuous and/or intermittent infusion of medications." Its purpose is to deliver medications, not to diagnose conditions.

No

The device description explicitly states that the system consists of a reusable mechanical infusion pump and administration sets, indicating hardware components are involved.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly describes the device as an "infusion system" for delivering medications directly into the body (general, subcutaneous, intramuscular, epidural, and surgical wound sites). This is a therapeutic function, not a diagnostic one.
  • Device Description: The description confirms it's a "mechanical infusion pump and various types of single use administration sets." This aligns with a device used for delivering substances, not for testing samples outside the body.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens (like blood, urine, tissue) in vitro (outside the body) to provide information for diagnosis, monitoring, or screening.

IVD devices are used to perform tests on samples taken from the body to help diagnose or monitor medical conditions. This device's function is to administer substances into the body.

N/A

Intended Use / Indications for Use

    1. The Paragon Infusion System is intended for continuous andor intermittern infrasion of medications for general infusion use, including antibiotic delivery, chemotherapy and pain medications for general infusion use, induding antibiotic delliery, entributions for general, subcutaneous, intramuscular and epidural.
    1. The Paragon Infusion System is also intended for continuous and/or internities for postoperative medication (such as local anesthetics or narcotics) to surgical wound sites for postoperative medication (such as local anesthetics or narcolics) to suglour wound the first and painter or percutaneous.

Product codes

FPA, FRN

Device Description

The Paragon Infusion System consists of a reusable mechanical infusion pump and various types of single use administration sets. This special 510(k) proposes a new line of administration sets that incorporates a variable flow rate mechanism.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K923875, K984146, K984063, K984638

Reference Device(s)

K960318, K890489

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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).

0

1)20251

FEB 1 5 2002

SPECIAL 510(K) - SUMMARY OF SAFETY AND EFFECTIVENESS

January 23, 2002

Submitter:

I-Flow Corporation 20202 Windrow Drive Lake Forest, CA 92630

Contact:

Shane Noehre Manager of Regulatory Affairs I-Flow Corporation

Paragon Infusion System

Trade Name:

Infusion Pump and Administration Set Common Name:

Pump, Infusion Classification Name:

Existing Device:

Device Description:

The Paragon Infusion System consists of a reusable mechanical infusion pump and various types of single use administration sets. This special 510(k) proposes a new line of administration sets that incorporates a variable flow rate mechanism.

Paragon Infusion System (K923875, K984146, K984063, K984638)

Technology Comparison:

The Paragon Infusion System with Variable Flow Rate utilizes the same technology for regulating flow rate (i.e. flow control tubing) and similar devices with variable flow rate components exist in the market (Novacon DIB-Infusor-RA - K960318 and Baxter Flow Regulator -K890489).

Conclusion: The Paragon Infusion System is substantially equivalent to the existing Paragon Infusion System and other variable flow rate devices currently being legally marketed.

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/1/Picture/1 description: The image is a black and white logo. The logo is circular in shape and contains an image of a bird with three wing-like lines. The bird is facing to the right. The text "HEALTH & HUMAN SERVICES - USA" is arranged around the top half of the circle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 1 5 2002

Mr. Shane Noehre Manager of Regulatory Affairs I-Flow Corporation 20202 Windrow Drive Lake Forest, California 92630

Re: K020251

Trade/Device Name: Paragon Infusion System Regulation Number: 880.5440 and 880.5725 Regulation Name: Infusion Pump and Administration Set Regulatory Class: II Product Code: FPA and FRN Dated: January 23, 2002 Received: January 24, 2002

Dear Mr. Noehre:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave rowed your 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting (1 w 1), it is a 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.

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.

2

Page 2 - Mr. Noehre

You must comply with all the Act's requirements, including, but not limited to: registration increative You must comply with an the Act S requirements, and 801); good manufacturing practice and listing (21 CFR Part 807); labeling (21 CFR Part 800); Books (21 CFR Pat 820); and if
requirements as set forth in the quality systems (QS) regulation (21 -542 of the Ac requirements as set forth in the quality systems (Sections (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section This letter will allow you to begin marketing your several aequivalence of your device to
510(k) premarket notification. The FDA finding of server device and thus 510(k) premarket nouncation. The I Dr I minute of securities in for your device and thus, a regally managevice to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 If you desire specific advice for your active on vitro diagnostic devices), please contact the promotion and additionally 21 CFR Part 809.10 tor in Vito ungliocally, for questions on the promotion and
Office of Compliance at (301) 594-4618 . Additionally, for questions on the pr Office of Compliance at (301) 594-4016 : Tradition of Compliance at (301) 594-4639.
advertising of your device, please contact the Office of Compliance at a respectical advertising of your avvises posses inteled, "Misbranding by reference to premarket Also, please note the regulation on active general information on your responsibilities under
notification" (21CFR Part 807.97). Other general informational and notification" (ZICFK Fall 807.97). Outlor get Small Manufacturers, International and the Act may be obtained from the Drivision of 800 638-2041 or (301) 443-6597 or at its
Consumer Assistance at its toll-free number (800) 443-6597 or at its m Consumer Assistance at his ton free hances (on)/dsma/dsmamain.html

Sincerely yours

Timothy A. Ulatowski

A. Ulatowski Timothy Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Ver/ 3 - 4/24/96

Applicant:

I-Flow Corporation

510(k) Number (if known):

Device Name:

Paragon Infusion System

Indications For Use:

    1. The Paragon Infusion System is intended for continuous andor intermittern infrasion of
      ten interest and informating increason, including antibiotic delivery, chemotherapy The Paragon Infusion System is intended to continuous antibiotic delivery, chemotherapy and pain
      medications for general infusion use, including antibiotic delivery, chematic medications for general infusion use, induding antibiotic delliery, entributions for general, subcutaneous, intramuscular and epidural.
  • intramuscular arts epidian.
    The Paragon Infusion System is also intended for continuous and/or internities for postoperative The Paragon Infusion System is also intention wound sites for postoperative
    medication (such as local anesthetics or narcotics) to surgical wound sites for postoperative medication (such as local anesthetics or narcolics) to suglour wound the first and painter or percutaneous.

Atan Ciceut

(Division Sign-Off) vision of Dental, Infection Control, ് General Hospital Devic ്ര(k) Number -

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE) (Per 21 CFR 801.109)

(Optional Format 1-2-96)