K Number
K033054
Date Cleared
2003-12-16

(78 days)

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

Harvard 1: The Harvard 1 is designed to provide, intravenous, intra-arterial, or epidural delivery of drugs, blood or blood products or other parenteral fluids when administered by a health care professionals such as physicians and nurses. The Harvard 1 is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Harvard 1 with PCA: Harvard 1 with PCA is designed provide patient controlled analgesia, intravenous, intra-arterial, or epidural delivery of drugs, blood or blood products, or other parenteral fluids when administered by a health care professionals such as physicians and nurses. The Harvard 1 with PCA is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Device Description

The Harvard Pump is intended for the delivery of parenteral fluids. It accommodates syringe sizes from 1 through 60 ml from multiple manufacturers. Its user interface consists of an active matrix color LCD display with two rotary knobs for controling pump operation. The rotary Data Entry knob provides scrolling and selection of data and memu items as well as state selection. The knob is turned to scroll, and pressed for selection. The rotary Function knob controls the state (Purge, Setup, Stop, Run and Bolus) of the pump. The pump has several microprocessors, one master which controls operation of the device, one pump processor which controls the operation of the motor and sensors specific to the syringe drive mechanism, and one supervisor which monitors the status of the system. The pump has sensors which permit its microprocessors to determine the syringe size loaded, determine if the syringe plunger is securely captured by the pusher block assembly, measure occlusion force and calculate the proper rate and distance the plunger of the syringe must travel to cause an infusion of fluid at a given rate and volume. The pump provides for bidirectional remote communications via an RS232 serial port. The Harvard 1 with PCA extends the Harvard 1 functionality to include Patient Controled Analgesia capability through the addition of an optional PCA pendent and PCA cover and lock assembly. PCA capability allows the patient to request delivery of a dose of pain medication from a regimen prescribed by the physician. The pump may be used with The Harvard Library, an optional computer program which runs on MS Windows based personal computers. The Harvard Library is capable of downloading and uploading drug information in the form of a drug library to and from the pump. After downloading, the drug library is resident in flash memory within the pump, enabling the pump to provide drug specific defaults for drug concentrations, pumping rates, bolus amounts, and bolus times. Barcode versions of the pump provide a laser scanning barcode reader is used to scan a label placed on the syringe which selects a drug from the pump's resident drug library. This allows the pump to retrieve from its internal memory the drug's specific parameters such as concentration, infusion rate etc. In an effort to minimize user input errors.

AI/ML Overview

The provided text describes a 510(k) premarket notification for the Harvard 1 Syringe Pump and Harvard 1 with PCA Syringe Pump, not an AI/ML powered medical device. Therefore, a direct response to many of the requested criteria (such as MRMC studies, training set details, expert qualifications for ground truth) is not applicable or cannot be extracted from the document.

However, I can extract information related to performance testing and acceptance criteria as much as possible for a traditional medical device like a syringe pump.

Here's a breakdown of the available information:

1. Table of Acceptance Criteria and Reported Device Performance

Acceptance Criteria / Performance MetricReported Device Performance
Gravimetric Rate AccuracyMean error within specified range
Occlusion System TestingMean error within specified range

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

The document mentions "Performance testing using prototype pumps". It does not specify a numerical sample size for the test set.

  • Data Provenance: Not explicitly stated, but the testing was conducted on "prototype pumps" developed by Harvard Clinical Technology Inc. This implies internal testing.
  • Retrospective/Prospective: Implied prospective, as it was "performance testing" of prototypes.

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

Not applicable. For a syringe pump, performance is typically measured against established physical and engineering standards, not through expert consensus on qualitative data.

4. Adjudication Method for the Test Set

Not applicable. Performance testing for a syringe pump relies on objective measurements against engineering standards, not an adjudication process.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size

Not applicable. This is not an AI/ML powered device, and therefore, MRMC studies are not relevant.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done

The device is a physical syringe pump. Its performance is inherently "standalone" in terms of its mechanical and electronic functions. The performance measurements mentioned (gravimetric rate accuracy, occlusion system) relate to the device's intrinsic operation.

7. The Type of Ground Truth Used

The ground truth for the performance testing cited (Gravimetric Rate Accuracy and Occlusion System) would be based on:

  • Physical and Engineering Standards: Specifically, the document references "IEC-601-2-24 - Particular requirement for safety of infusion pump," indicating that the device performance was measured against the requirements of this international standard.

8. The Sample Size for the Training Set

Not applicable. This is not an AI/ML powered device, so there is no "training set."

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

Not applicable. No training set for an AI/ML model is involved.

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K033054

36

DEC 1 6 2003

510(K) SUMMARY

Harvard Clinical Technology Inc. 22 Pleasant Street South Natick MA 01760

Contact Person:

Eric J. Flachbart Vice President, Research and Development Harvard Clinical Technology, Inc. 22 Pleasant Street South Natick, MA 01760 (508)-655-2000 (508)-655-2211 Fax eflachbart@harvardclinical.com

Date Prepared: July 23, 2003

Trade Name: Harvard 1 Syringe Pump, Harvard 1 with PCA Pump Common Name: Syringe Infusion Pump Classification Name: Infusion Pump

Predicate Devices

Harvard 2 Syringe Pump, Medex Protégé, B. Braun Horizon with Dose Scan, Baxter PCA-II

Intended Use

Harvard 1

The Harvard 1 is designed to provide, intra-arterial, or epidural delivery of drugs, blood or blood products or other parenteral fluids when administered by a health care professionals such as physicians and nurses.

The Harvard 1 is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Harvard 1 with PCA

Harvard with PCA to provide patient controlled analgesia, intra-arterial, or epidural delivery of drugs, blood or blood products, or other parenteral fluids when administered by a health care professionals such as physicians and nurses.

The Harvard 1 with PCA is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Harvard 1 / Harvard 1 with PCA Premarket Notification - 23 July, 2003

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Device Description:

The Harvard Pump is intended for the delivery of parenteral fluids. It accommodates syringe sizes from 1 through 60 ml from multiple manufacturers.

Its user interface consists of an active matrix color LCD display with two rotary knobs for controling pump operation. The rotary Data Entry knob provides scrolling and selection of data and memu items as well as state selection. The knob is turned to scroll, and pressed for selection. The rotary Function knob controls the state (Purge, Setup, Stop, Run and Bolus) of the pump.

The pump has several microprocessors, one master which controls operation of the device, one pump processor which controls the operation of the motor and sensors specific to the syringe drive mechanism, and one supervisor which monitors the status of the system.

The pump has sensors which permit its microprocessors to determine the syringe size loaded, determine if the syringe plunger is securely captured by the pusher block assembly, measure occlusion force and calculate the proper rate and distance the plunger of the syringe must travel to cause an infusion of fluid at a given rate and volume.

The pump provides for bidirectional remote communications via an RS232 serial port.

The Harvard 1 with PCA extends the Harvard 1 functionality to include Patient Controled Analgesia capability through the addition of an optional PCA pendent and PCA cover and lock assembly. PCA capability allows the patient to request delivery of a dose of pain medication from a regimen prescribed by the physician.

The pump may be used with The Harvard Library, an optional computer program which runs on MS Windows based personal computers. The Harvard Library is capable of downloading and uploading drug information in the form of a drug library to and from the pump. After downloading, the drug library is resident in flash memory within the pump, enabling the pump to provide drug specific defaults for drug concentrations, pumping rates, bolus amounts, and bolus times.

Barcode versions of the pump provide a laser scanning barcode reader is used to scan a label placed on the syringe which selects a drug from the pump's resident drug library. This allows the pump to retrieve from its internal memory the drug's specific parameters such as concentration, infusion rate etc. In an effort to minimize user input errors.

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Warnings / StatusPurgePurgePurgePurgePurgeStopInfusion near endHold time exceeded
SetupSetupSetupSetupSetupInfusion endLow battery
StopStopStopStopStopHi-pressure-OcclusionLow flow from
RunRunRunRunRunSystem Malfunction
BolusBolusBolusBolusBolusSyringe not capture
AC PowerAC PowerAC PowerAC PowerAC PowerPlunger disengaged
Battery ChargingBattery ChargingBattery ChargingBattery ChargingBattery ChargingLow Battery
RemoteRemoteRemoteRemoteRemote
Syringe will be emptyin 15 minutesSyringe will be emptyin 15 minutesSyringe will be emptyin 15 minutesSyringe will be emptyin 15 minutesSyringe will be emptyin 15 minutes
Battery will be depletedin 30 minutesBattery will be depletedin 30 minutesLow Battery

.

Harvard 1 / Harvard 1 with PCA Premarket Notification - 23 July, 2003

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Harvard 1Harvard with PCAHarvard 2Baxter PCA IIProtégé 3010B. BraunHorizon Lite
AlarmsOcclusionBattery will be depletedin 5 minutesSyringe plunger notcapturedSyringe barrelPusher movedSyringe EmptySystem FaultSystem Fault - BatteryDepletedOcclusionBattery will be depletedin 5 minutesSyringe plunger notcaptured1 hour limit reachedSyringe barrelPusher movedSyringe EmptySystem FaultSystem Fault - BatteryDepletedOcclusionBattery will be depletedin 5 minutesSyringe plunger notcapturedSyringe barrelPusher movedSyringe EmptySystem FaultSystem Fault - BatteryDepletedOcclusionDoor openDoor unlocked1 hour limit reachedSyringe plunger notcapturedSyringe emptyBattery depletedSystem FaultInfusion endHi-pressure-OcclusionSystem MalfunctionSyringe not capturePlunger disengagedLow BatteryAir-in-lineContainer emptyDoor openDownstream occlusioncontainerSystem errorUpstream occlusionSet improperly loaded
InputsConcentrationRateBolus amountBolus timeSyringe manufacturerSyringe size3Patient weightDose amountDose timeNumber of dosesDose intervalConcentrationRateBolus amountBolus timeSyringe manufacturerSyringe sizePatient weightDose amountDose timeNumber of dosesDose intervalPCA dose1 hour limitConcentrationRateBolus amountBolus timeSyringe manufacturerSyringe sizePatient weightDose amountDose timeNumber of dosesDose intervalConcentrationBasal RateBolus AmountPCA Amount1 Hour limitPCA Delay timeNumber of PCA doesDose intervalConcentrationRateBolus amountBolus timeSyringe manufacturerSyringe sizePatient weightDose amountDose timeNumber of dosesDose intervalConcentrationRateBolus amountBolus timePatient weightDose amountDose timeNumber of dosesDose interval
SerialCommunicationsBidirectionalBidirectionalBidirectionalNoneBidirectionalUnknown
Barcode ReaderOptional laser scanningreaderOptional laser scanningreaderNoneNoneNoneLaser scanning reader
MRICompatibilityYesYesNoNoYesNo

3 Detected by syringe size mechanism and confirmed by user.
Harvard 1 / Harvard 1 with PCA Premarket Notification - 23 July, 2003

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Performance testing using prototype pumps which functionally reflect the final design configuration was performed to substantial
equivalence claims.

Cravimetric Rate Accuracy and occlusion system
cesting per IRC-601-2-24 - Particular requirement
cesting per IEC-601-2-24 - Particular requirement
for safety of infusion pump


slusion test results indicate a mean error within
specified range of the device.

arvard 1 / Harvard 1 with PCA Premarket Notification - 23 July, 200

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Image /page/5/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 lines forming its body and wings. The eagle is enclosed in a circle, and the text "DEPARTMENT OF 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

DEC 1 6 2003

Harvard Clinical Technology Ms. Susan Gill Responsible Third Party Official Underwriters Laboratories, Incorporated 12 Laboratory Drive Research Triangle Park, North Carolina

Re: K033054

Trade/Device Name: Harvard 1 Syringe Pump/ Harvard 1 with PCA Syringe Pump Regulation Number: 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: MEA, FRN Dated: December 1, 2003 Received: December 2, 2003

Dear Ms. Gill:

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.

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 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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic 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), please contact the Office of Compliance 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 vours,

Carl
Chiu Lin, Ph.D.

hiu 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

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INDICATIONS FOR USE

Harvard Clinical Technology, Inc

510(k) Number (if known): Device Name:

Ko33054 Harvard 1 Harvard 1 with PCA Syringe Pumps

Indications For Use:

Harvard 1

The Harvard 1 is designed to provide, intravenous, intra-arterial, or epidural delivery of drugs, blood or blood products or other parenteral fluids when administered by a health care professionals such as physicians and nurses.

The Harvard 1 is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Harvard 1 with PCA

Harvard 1 with PCA is designed provide patient controlled analgesia, intravenous, intra-arterial, or epidural delivery of drugs, blood or blood products, or other parenteral fluids when administered by a health care professionals such as physicians and nurses.

The Harvard 1 with PCA is compatible for use inside the MRI room when mounted outside the 150 gauss line with MRI systems of 1.5 tesla or less.

Patrizio Curante

Division Sign-Off) (Division Sign-Olf)
Division of Anesthesiology, General Hospit Infection Control, Dental De

Infection Control:
510(k) Number: K033054

510(k) Number.

Prescription Use
(Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF

NEEDED)

§ 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).