K Number
K030739
Device Name
INFUSION DYNAMICS (ID) POWER INFUSER, MODEL M100B-3A WITH BLOOD CARTRIDGE
Date Cleared
2004-01-14

(310 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The ID Power Infuser® Model M100B-3A is intended to support primary intravenous fluid resuscitation therapy to rapidly restore intravascular volume and blood pressure in patients with Clinical Shock, hypovolemic shock, and septic shock. The device is intended for use by medical, paramedical, and EMT personnel in the field and in pre-hospital and hospital environments. When used with the Crystalloid/Colloid Cartridge (K992044), the ID Power Infuser® Model M100B-3A is intended to deliver crystalloid and colloid fluids. The ID Power Infuser® Model M100B-3A is not intended to support the infusion of blood or blood products. When used with the Blood Cartridge, the ID Power Infuser® Model M100B-3A is intended to deliver resuscitative fluids, whole blood and packed red blood cells. The ID Power Infuser® Model M100B-3A is not intended to support the delivery of any pharmaceutical or other medications.
Device Description
Not Found
More Information

Not Found

No
The provided text describes a fluid infuser and its intended use, but there is no mention of AI, ML, or related concepts.

Yes
The device is intended to support primary intravenous fluid resuscitation therapy to rapidly restore intravascular volume and blood pressure in patients with clinical shock, which is a therapeutic intervention.

No

The device is intended to support intravenous fluid resuscitation therapy to restore intravascular volume and blood pressure, not to diagnose medical conditions.

No

The device description is not found, but the intended use clearly describes a physical device ("ID Power Infuser® Model M100B-3A") that delivers fluids, indicating it is a hardware device, not software-only. It also mentions cartridges (K992044) which are physical components.

Based on the provided information, the ID Power Infuser® Model M100B-3A is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • IVD devices are used to examine specimens derived from the human body (like blood, urine, or tissue) to provide information for diagnosis, monitoring, or screening.
  • The ID Power Infuser® Model M100B-3A is a device intended to deliver fluids (crystalloids, colloids, whole blood, packed red blood cells) directly into a patient's bloodstream. Its purpose is to support fluid resuscitation therapy, not to analyze biological samples.

The intended use clearly describes a device for administering fluids to a patient, which is a therapeutic intervention, not an in vitro diagnostic test.

N/A

Intended Use / Indications for Use

The ID Power Infuser® Model M100B-3A is intended to support primary intravenous fluid resuscitation therapy to rapidly restore intravascular volume and blood pressure in patients with Critical Shock, hypotensive shock, and septic shock.

The device is intended for use by medical, paramedical, and EMT personnel in the field and in pre-hospital and hospital environments.

When used with the Crystalloid/Colloid Cartridge (K992044), the ID Power Infuser® Model M100B-3A is intended to deliver crystalloid and colloid solutions. It is not intended to support the infusion of blood or blood products.

When used with the Blood Cartridge, the ID Power Infuser® Model M100B-3A is intended to deliver resuscitative fluids, whole blood and packed red blood cells.

The ID Power Infuser® Model M100B-3A is not intended to support the delivery of any pharmaceutical or other medications.

Product codes

FRN

Device Description

Not Found

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

medical, paramedical, and EMT personnel in the field and in pre-hospital and hospital environments.

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): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

Not Found

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

K992044

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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§ 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

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three stripes extending from its back, symbolizing protection and service. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN 1 4 2004

Infusion Dynamics, Incorporated Mr. Thomas Becze Director, Consulting Services Science Applications International Corporation 5340 Spectrum Drive, Suite N Frederick, Maryland 21703

Re: K030739

Trade/Device Name: Infusion Dynamics (ID) Power Infuser® Model M100B-3A with Blood Cartridge Regulation Number: 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: FRN Dated: October 27, 2003 Received: October 29, 2003

Dear Mr. Becze:

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 controls provided be a 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 (111) 1) and 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.

1

Page 2 - Mr. Becze

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. or the Act of ally I ederal the Act a requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if requirements as bet roring product radiation control provisions (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 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), 11 you decire speember at (301) 594-4618. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely your,

Chiu Lin, Ph.D.

Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications For Use Statement

510(k) Number (if known): K030739

Device Name: ID Power Infuser® Model M100B-3A

Indications For Use:

The ID Power Infuser® Model M100B-3A is intended to support primary intravenous The ID Power Infuser® Model MT600 of to intenescular volume and blood pressure in
fluid resuscitation therapy to rapidly restore intravascular volume and blood pressure in fillid resuscitation therapy to rapidly routers in the poperfusion states as a result of patients with Cilifical Shock, hypotonenic shock, and septic shock, and septic shock.

The device is intended for use by medical, paramedical, and EMT personnel in the field and in pre-hospital and hospital environments.

When used with the Crystalloid/Colloid Cartridge (K992044), the lD Power When used with the Oryetalloid to deliver crystalloid and colloid musel® Model MTOOD of to interior is not intended to support the infusion of blood or blood products.

When used with the Blood Cartridge, the ID Power Infuser® Model M100B-3A is When used with the Drood Cartings, it resuscitative fluids, whole blood and packed red blood cells.

The ID Power Infuser® Model M100B-3A is not intended to support the delivery of any pharmaceutical or other medications.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)

Pattana Cucenote

(Division Sign-Off) Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K030739