K Number
K041042
Device Name
SPLIT SEPTUM INJECTION SITES
Date Cleared
2004-07-16

(85 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
CombiSets Hemodialysis Blood Tubing Set: The Fresenius CombSets are intended for use as the extracorporeal blood circuit during Hemodialysis, They are intended for single use only. The CombiSets are indicated for use with conventional and high flux negative pressure hemodialyzer equipment. Venous Blood Tubing Set: The Fresenius Venous Bloodline is intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Hemodialysis Venous Blood Tubing Set is indicated for use with conventional and high flux negative pressure hemodialyzer equipment. Arterial Blood Tubing Set: The Fresenius Arterial Bloodline is intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Fresenius Arterial Bloodline is intended to for use with conventional and high flux negative pressure hemodialyzer equipment.
Device Description
The Split Septum Injection Sites are designed for use during hemodialysis with either a 21 gauge metal needle or plastic needles that have a 19% priming volume. The injection site plug features a tapered split to accommodate either needle described above. This is the only change to the Fresenius Hemodialysis Blood Tubing Sets currently offered. The housing and septa are identical to that of the current standard injection site.
More Information

Not Found

No
The summary describes a minor modification to existing hemodialysis blood tubing sets, focusing on a change to the injection site design. There is no mention of AI or ML technology in the intended use, device description, or performance studies.

Yes
The device, as part of an extracorporeal blood circuit for hemodialysis, is intended to directly interact with and process blood, which constitutes a therapeutic intervention to treat kidney failure.

No

The device description clearly states its purpose as an "extracorporeal blood circuit during Hemodialysis," which is a treatment procedure, not a diagnostic one.

No

The device description clearly describes physical components (tubing sets, injection sites, septa, housing) and their intended use in a physical process (hemodialysis). There is no mention of software as the primary or sole component.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for use as the "extracorporeal blood circuit during Hemodialysis." This describes a device used outside the body to process blood, not a device used to perform tests on biological samples to diagnose or monitor conditions.
  • Device Description: The description focuses on the physical components of the blood tubing set, specifically the injection sites, and how they are used in the hemodialysis process. It doesn't mention any components or functions related to analyzing biological samples.
  • Lack of IVD Characteristics: The text does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring specific analytes (glucose, proteins, DNA, etc.)
    • Providing diagnostic or monitoring information based on sample analysis
    • Reagents or test kits

The device described is a component of the hemodialysis system, which is a life support system used to filter blood for patients with kidney failure. It facilitates the flow of blood outside the body for treatment, but it does not perform diagnostic testing on the blood itself.

N/A

Intended Use / Indications for Use

Venous Blood Tubing Set

The Fresenius Venous Bloodlines are intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Hemodialysis Venous Blood Tubing Set is indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Arterial Blood Tubing Set

The Fresenius Arterial Bloodlines are intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Fresenius Bloodlines are intended to for use with Hemodialysis arterial blood tubing sets in conventional and high flux negative pressure hemodialyzer equipment.

CombiSets Hemodialysis Blood Tubing Set

The Fresenius CombiSets are intended for use as the extracorporeal blood circuit during Hemodialysis. They are intended for single use only. The CombiSets are indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Product codes (comma separated list FDA assigned to the subject device)

KOC, 78, FJK, 78, FPA

Device Description

The Split Septum Injection Sites are designed for use during hemodialysis with either a 21 gauge metal needle or plastic needles that have a 19% priming volume. The injection site plug features a tapered split to accommodate either needle described above. This is the only change to the Fresenius Hemodialysis Blood Tubing Sets currently offered. The housing and septa are identical to that of the current standard injection site.

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)

In support of this Special 510K, Fresenius Medical North America has provided certification of compliance to 21 CFR 820.30-Design Control requirements, and a summary of the results of validation testing (performance testing) for the minor device modification.

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.

K962081, K001107, K000451, K971313, K971687, K012242

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.

Not Found

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).

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

K041042

JUL 1 6 2004

Split Septum Injection Sites "Special" 510(k) Premarket Notification

510K Summary

In accordance with the Food and Drug Administration Rule to implement provisions of the Safe Medical Devices Act of 1990 and in conformance with 21 CFR 807, this information serves as a Summary of Safety and Effectiveness for the Fresenius Combiset with Access Flow Reversing Connector.

Company: Fresenius Medical Care North America 95 Hayden Ave. Lexington, MA 02420 April 20, 2004 Date: Trade Name: Split Septum Injection Sites Common Name: Blood Tubing for Hemodialysis Classification Name and Reference: 21 CFR §876.5820 Blood Tubing Set, with or without Anti-Regurgitation Valve - Class II Device Product Code and Panel Code: KOC, 78 and FJK, 78 Predicate Device(s):

  • · Fresenius CombiSets® Hemodialysis Blood Tubing Sets; K962081, SE 11/01/96
  • · Fresenius CombiSets® Hemodialysis Blood Tubing Sets: K001107. SE 06/23/00
  • · Fresenius CombiSets® Hemodialysis Blood Tubing Sets; K000451, SE 05/09/00
  • · Fresenius Arterial Blood Tubing Sets; K971313, SE 10/27/97
  • · Fresenius Venous Blood Tubing Sets; K971687, SE 07/29/97
  • · Fresenius Single Use Arterial Bloodline Sets with Alternate Pump Segment Material, K012242, 08/16/01

Description:

The Split Septum Injection Sites are designed for use during hemodialysis with either a 21 gauge metal needle or plastic needles that have a 19% priming volume. The injection site plug features a tapered split to accommodate either needle described above. This is the only change to the Fresenius Hemodialysis Blood Tubing Sets currently offered. The housing and septa are identical to that of the current standard injection site.

Intended Use:

Venous Blood Tubing Set

The Fresenius Venous Bloodlines are intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Hemodialysis Venous Blood Tubing Set is indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Arterial Blood Tubing Set

The Fresenius Arterial Bloodlines are intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Fresenius Bloodlines are intended to for use with Hemodialysis arterial blood tubing sets in conventional and high flux negative pressure hemodialyzer equipment.

CombiSets Hemodialysis Blood Tubing Set

The Fresenius CombiSets are intended for use as the extracorporeal blood circuit during Hemodialysis. They are intended for single use only. The CombiSets are indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Safety and Performance:

The intended use, technological characteristics, design features, and materials are substantially equivalent to the predicate device. In support of this Special 510K, Fresenius Medical North America has provided certification of compliance to 21 CFR 820.30-Design Control requirements, and a summary of the results of validation testing (performance testing) for the minor device modification.

1

Image /page/1/Picture/1 description: The image shows a logo with a circular border containing text. Inside the circle is a stylized image of a bird in flight, represented by three curved lines. The text around the border is not clearly legible, but it appears to be in a circular arrangement, possibly indicating the name of an organization or agency.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 1 6 2004

Mr. Arthur Eilinsfeld Director, Regulatory Affairs Fresenius Medical Care North America 95 Hayden Avenue LEXINGTON MA 02420

Re: K041042

:

Trade/Device Name: Fresenius Split Septum Injection Sites Regulation Number: 21 CFR §876.5820 Regulation Name: Hemodialysis system and accessories Product Code: 78 FJK and KOC Regulation Number: 21 CFR §880.5440 Regulation Name: Intravascular administration set Product Code: 78 FPA Regulatory Class: II Dated: June 15, 2004 Received: June 16, 2004

Dear Mr. Eilinsfeld:

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 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.

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.

2

This letter will allow you to begin marketing your device as described in your Section SI0(k) I ms letter will and your te FDA finding of substantial equivalence of your device to a legally premately nonification. The 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 rryou desire specific as not of the following numbers, based on the regulation number at the top of the letter

8xx. 1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

Additionally, for questions on the promotion and advertising of your device, please contact the Addisonally, 1001) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general of receitos to premation of your responsibilities under the Act may be obtained from the Division of Small mioritation on your responser Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrl/dsmaldsmamain.html.

Sincerely yours,

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Image /page/3/Picture/0 description: The image shows the logo for Fresenius Medical Care. Above the company name is a symbol that looks like a funnel or an inverted pyramid. The text "Fresenius Medical Care" is written in a simple, sans-serif font and is the most prominent element in the image. The logo is clean and professional, suggesting a focus on healthcare and medical services.

Indications for Use Statement

Device Name:

Split Septum Injection Sites (a component of Fresenius Bloodlines)

Indications for Use:

CombiSets Hemodialysis Blood Tubing Set

The Fresenius CombSets are intended for use as the extracorporeal blood circuit during Hemodialysis, They are intended for single use only. The CombiSets are indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Venous Blood Tubing Set

The Fresenius Venous Bloodline is intended for use as the extracorporeal blood circuit during It is intended for single only use. The Hemodialysis Venous Blood Tubing Set is Hemodialysis. indicated for use with conventional and high flux negative pressure hemodialyzer equipment.

Arterial Blood Tubing Set

The Fresenius Arterial Bloodline is intended for use as the extracorporeal blood circuit during Hemodialysis. It is intended for single only use. The Fresenius Arterial Bloodline is intended to for use with conventional and high flux negative pressure hemodialyzer equipment.

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

000034

Fresenius Medical Care North America

510(k) Number

Corporate Headquarters: Lexington, MA 02420 (781) 402-9000 Division Sign Off oroductive and Radiological Device