K Number
K040456
Device Name
FLEBOSET MULTIPLE
Date Cleared
2004-03-09

(15 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
FLEBOSET MULTIPLE is an ancillary device used as fluid pathway through which substances from 6 glass source flasks containing the same solution may be continuously delivered for: - (a) Pharmacy compounding, when used in conjunction with the GRI-FILL 2.0 pharmacy compounding device and associated transfer sets, and - (b) I.V. administration, when used in conjunction with a gravity or pump infusion set to channel the solution from the source containers to the infusion set. The device should not be used with lipids. This device is intended to be used by trained health-care personnel. It is restricted to sale by or on order of a physician.
Device Description
FLEBOSET MULTIPLE is a fluid transfer tubing set used to enable continuous (uninterrupted) delivery of drug solutions from 6 glass source containers. It is used in pharmacy compounding or for I.V. fluid transfer to minimize tubing manipulation when working with small volume source containers. The device is made up of 6 spikes connected in series with flexible tubing segments, each segment with an individual clamp. The set terminal, for connection to pharmacy compounding device sets or the administration sets (gravity or pump) consists of a spikeable twist-off valve connector.
More Information

No
The device description and intended use focus solely on fluid transfer tubing and mechanical components. There is no mention of software, algorithms, or any capabilities that would suggest AI/ML. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

No.
The device description clearly states it is a "fluid transfer tubing set" and an "ancillary device" for channeling solutions, not a device that directly treats a condition or disease.

No

Explanation: The device is described as an ancillary device for fluid pathway and transfer tubing set for pharmacy compounding and I.V. administration. It facilitates the delivery of substances but does not perform any diagnostic function such as identifying, assessing, or measuring a medical condition or disease.

No

The device description clearly states it is a "fluid transfer tubing set" made up of "spikes connected in series with flexible tubing segments," which are physical hardware components.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is used as a fluid pathway for delivering substances from source flasks for pharmacy compounding and I.V. administration. These are procedures performed on or for a patient, not on a sample taken from a patient for diagnostic purposes.
  • Device Description: The description details a fluid transfer tubing set for delivering drug solutions. This aligns with the intended use and does not involve any components or functions related to analyzing biological samples.
  • Lack of Diagnostic Elements: There is no mention of the device being used to analyze biological samples (blood, urine, tissue, etc.) or to provide information for the diagnosis, monitoring, or treatment of a disease or condition based on such analysis.
  • Predicate Devices: The listed predicate devices (transfer sets and a compounder transfer set) are also not IVDs. They are devices used in the preparation or administration of medications or fluids.

In summary, the FLEBOSET MULTIPLE is a medical device used for the preparation and administration of solutions, not for performing diagnostic tests on biological samples.

N/A

Intended Use / Indications for Use

FLEBOSET MULTIPLE is an ancillary device used as fluid pathway through which substances from 6 glass source flasks containing the same solution may be continuously delivered for:

  • (a) Pharmacy compounding, when used in conjunction with the GRI-FILL 2.0 pharmacy compounding device and associated transfer sets, and
  • (b) I.V. administration, when used in conjunction with a gravity or pump infusion set to channel the solution from the source containers to the infusion set.

The device should not be used with lipids.

Product codes

LHI

Device Description

FLEBOSET MULTIPLE is a fluid transfer tubing set used to enable continuous (uninterrupted) delivery of drug solutions from 6 glass source containers. It is used in pharmacy compounding or for I.V. fluid transfer to minimize tubing manipulation when working with small volume source containers. The device is made up of 6 spikes connected in series with flexible tubing segments, each segment with an individual clamp. The set terminal, for connection to pharmacy compounding device sets or the administration sets (gravity or pump) consists of a spikeable twist-off valve connector.

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

This device is intended to be used by trained health-care personnel.

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)

Functional laboratory testing performed in foreseeable operating conditions showed correct operation of the device as per its intended use.

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

Not Found

Predicate Device(s)

Automix 3+3 Compounder Transfer Set (BAXTER HEALTHCARE CORP.) K894827, Medrad Transfer Set (MEDRAD INC.) K022431, Merit Medical Contrast Management System (MERIT MEDICAL SYSTEMS, INC.) K961794

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5440 Intravascular administration set.

(a)
Identification. An intravascular administration set is a device used to administer fluids from a container to a patient's vascular system through a needle or catheter inserted into a vein. The device may include the needle or catheter, tubing, a flow regulator, a drip chamber, an infusion line filter, an I.V. set stopcock, fluid delivery tubing, connectors between parts of the set, a side tube with a cap to serve as an injection site, and a hollow spike to penetrate and connect the tubing to an I.V. bag or other infusion fluid container.(b)
Classification. Class II (special controls). The special control for pharmacy compounding systems within this classification is the FDA guidance document entitled “Class II Special Controls Guidance Document: Pharmacy Compounding Systems; Final Guidance for Industry and FDA Reviewers.” Pharmacy compounding systems classified within the intravascular administration set are exempt from the premarket notification procedures in subpart E of this part and subject to the limitations in § 880.9.

0

K040456

3/9/04

TECHNICAL EVALUATION DOCUMENTATION multiple-01 GRIFOLS SECTION 1 - FLEBOSET MULTIPLE: 510(k) SUMMARY

: 上一

DATE OF SUBMISSION:2004-02-06
SUBMITTER NAME:
SUBMITTER ADDRESS:Laboratorios Grifols, S.A.
C/ Can Guasch, 2
08150 PARETS DEL VALLES
BARCELONA
SPAIN
TELEPHONE:
FAX:
e-mail:+ 34 93 571 01 00
  • 34 93 573 09 12
    sebastian.gascon@grifols.com |
    | CONTACT: | Sebastián Gascón
    Technical Director |
    | DEVICE TRADE NAME:
    COMMON NAME: | FLEBOSET MULTIPLE
    I.V. FLUID TRANSFER SETS
    FLUID DELIVERY TUBING |
    | CLASSIFICATION NAME: | SET, I.V. FLUID TRANSFER (21 CFR 880.5440, LHI)
    TUBING. FLUID DELIVERY (21 CFR 880.5440, FPK) |
    | PREDICATE DEVICE: | Automix 3+3 Compounder Transfer Set (BAXTER
    HEALTHCARE CORP.)
    Medrad Transfer Set (MEDRAD INC.)
    Merit Medical Contrast Management
    System
    (MERIT MEDICAL SYSTEMS, INC.) |
    | DEVICE DESCRIPTION: | FLEBOSET MULTIPLE is a fluid transfer tubing set
    used to enable continuous (uninterrupted) delivery
    of drug solutions from 6 glass source containers. It
    is used in pharmacy compounding or for I.V. fluid
    transfer to minimize tubing manipulation when
    working with small volume source containers. The
    device is made up of 6 spikes connected in series
    with flexible tubing segments, each segment with an
    individual clamp. The set terminal, for connection to
    pharmacy compounding device sets or
    the
    administration sets (gravity or pump) consists of a
    spikeable twist-off valve connector. |

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ાવ 1


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Image /page/1/Picture/0 description: The image is a document header with the word GRIFOLS on the left side. The header also contains the words TECHNICAL EVALUATION DOCUMENTATION. The document number is TED-FLEBOSET MULTIPLE-01. The section is titled SECTION 1 - FLEBOSET MULTIPLE: 510(k) SUMMARY.

INTENDED USE:

FLEBOSET MULTIPLE is an ancillary device used as fluid pathway through which substances from 6 glass source flasks containing the same solution may be continuously delivered for.

Pharmacy compounding, (a) when used in conjunction with the GRI-FILL 2.0 pharmacy compounding device and associated transfer sets, and

I.V. administration, when used in conjunction with (b) a gravity or pump infusion set to channel the solution from the source containers to the infusion set. The device should not be used with lipids.

SUMMARY OF COMPARISON WITH PREDICATE DEVICE:

In the establishment of substantial equivalence, FLEBOSET MULTIPLE is compared with other fluid delivery tubing used in pharmacy compounding and I.V. administration. The following table summarizes the similarities of the principal technological characteristics and features of both predicate and new devices.

PREDICATES
#Characteristic /
FeatureFLEBOSET
MULTIPLEBAXTER
Automix 3+3
(transfer set
presented
together with
compounder)
K894827MEDRAD
Transfer Set
K022431MERIT MEDICAL
Transfer Sets
K961794
1.Intended use / ClaimsFLEBOSET MULTIPLE is
an ancillary device used
as fluid pathway through
which substances from 6
glass
source
flasks
containing
the
same
solution
may
be
continuously delivered for.
(a) Pharmacy compoun-
ding, when
used
in
conjunction with the GRI-
FILL
2.0 pharmacy
compounding device and
associated transfer sets,
and (b) I.V. administration,
when used in conjunction
with a gravity or pump
infusion set to channel the
solution from the source
containers to the infusionPositive
displacement
fluid
compounding
system employing the
3+3
compounder,
TRANSFER
SETS,
empty
Viaflex
or
Travamulsion containers
with
connectors and
multitask
computer
software to provide
compounding of a wide
variety of fluidsThe Medrad Transfer
Set is medical
disposable device used
to transfer intravascular
contrast media and
saline from a spikeable
container to a power
injector syringe. The
device components
consist of a vented
spike, connector tube, a
means of manually
stopping flow, female
luer, and individually
packaged sterile caps.Contrast media delivery
systems used to transfer
I.V. contrast media from
a spikeable container to
a syringe.

કી

2

230SET MULTIPLE: 510(k) S

| # | Characteristic /
Feature | FLEBOSET
MULTIPLE | PREDICATES | | |
|----|-----------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------|
| | | | BAXTER
Automix 3+3
(transfer set
presented
together with
compounder)
K894827 | MEDRAD
Transfer Set
K022431 | MERIT MEDICAL
Transfer Sets
K961794 |
| | | set. The device should not
be used with lipids. | | | |
| 2. | Technological
features:
-Sterilization
-Contact with patient | Ethylene Oxide
NO- Intended for use
with the pharmacy
compounding device or
INDIRECT - May be used
on-line with patient,
upstream of the gravity or
pump administration sets. | Radiation
NO - Intended for use
with the pharmacy
compounding device. | Ethylene Oxide
NO- Must be removed
from the syringe before
the syringe can be
connected to the
patient. | Ethylene Oxide
INDIRECT - May be
used on-line with the
patient through a
syringe with stopcock or
a manifold port. |
| | -Source solutions | 6 | 3 or 6. | 2 | 1 |
| 3. | Principle Materials | PVC with DEHP plasticizer | PVC with DEHP
plasticizer | PVC | Flexible plastic |
| 4. | Sterility | Sterile | Sterile | Sterile | Sterile |

From the above table, it can be established that the new device and the predicate devices are very similar.

SUMMARY DISCUSSION OF NON-CLINICAL DATA:

All materials used in the construction of FLEBOSET MULTIPLE have been subject to chemical and biological testing in accordance with the applicable requirements taking account of its intended use.

Functional laboratory testing performed in foreseeable operating conditions showed correct operation of the device as per its intended use.

CONCLUSIONS:

We believe the intended use, the indications for use, the functionality and the operation of FLEBOSET MULTIPLE and the predicate devices for fluid transfer both in pharmacy compounding and for 1.V. administration are essentially the same. Hence, substantial equivalence of FLEBOSET MULTIPLE with the legally marketed devices may be established.

: :

ਟੀ 3

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Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of a human figure, represented by three overlapping profiles, with flowing lines suggesting movement or energy. The profiles are arranged to resemble a bird in flight. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged in a circular pattern around the figure.

MAR - 9 2004

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Laboratorios Grifols, S.A. C/O Ms. Susan Gill Responsible Third Party Official Underwriters Laboratories, Incorporated 12 Laboratory Drive P.O. Box 13995 Research Triangle Park, North Carolina 27709-3995

Re: K040456

Trade/Device Name: Fleboset Multiple Regulation Number: 880.5440 Regulation Name: Set, Intravenous Fluid Transfer Regulatory Class: II Product Code: LHI Dated: February 20, 2004 Received: February 23, 2004

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 offecting 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.

4

Page 2 -Ms. Gill

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 yours.

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

5

ECHNICAL EVALUATION DOCUMENTATION ON 09 FLEBOSET MULTIPLE: INDICATIONS FO A CHE CHENE

PREMARKET NOTIFICATION INDICATIONS FOR USE STATEMENT

(as required by ODE for all 510(k) received after Jan. 1, 1996)

510(k) Number:

K040456

Device Name:

FLEBOSET MULTIPLE

Indications for Use:

FLEBOSET MULTIPLE is an ancillary device used as fluid pathway through which substances from 6 glass source flasks containing the same solution may be continuously delivered for:

  • (a) Pharmacy compounding, when used in conjunction with the GRI-FILL 2.0 pharmacy compounding device and associated transfer sets, and
  • (b) I.V. administration, when used in conjunction with a gravity or pump infusion set to channel the solution from the source containers to the infusion set.

The device should not be used with lipids.

This device is intended to be used by trained health-care personnel. It is restricted to sale by or on order of a physician.

(Do not write below this line. Continue on another page in needed)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Arne Nannestad, Interim Branch Chief
(Division Sign-Off)

Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K040456

Prescription Use X (Per 21 CFR 801.109)

OR

Over-The-Counter Use