K Number
K041204
Device Name
NC SP02 ADAPTER CABLE
Manufacturer
Date Cleared
2004-06-29

(53 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The NC Adapter Cable with Nellcor sensors are indicated for the continuous noninvasive monitoring of functional I its readiner of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor) for use with adult, pediation informator of Liveral In hospitals, hospitals, hospital-type facilities, mobile, and home environments.
Device Description
The NC Adapter Cable is fully compatible oximetry cable that allows the use of Nellcor Sensors with Masimo SET Radical pulse oximeter monitors. The cable represents a design change to the Masimo patient cables and the MS board. The NC Adapter Cable is similar in construction to the predicate device enabling the Nellcor Sensors to be connected to Masimo SET Radical pulse oximeters. The NC Adapter Cable is designed, and manufactured for full compatibility with Masimo SET Radical pulse oximeters using Nellcor Sensors. The NC Adapter Cable is constructed of similar materials and components of equivalent specifications as used in the predicate devices.
More Information

Not Found

No
The document describes an adapter cable for pulse oximetry sensors and does not mention any AI or ML components or functionalities.

No

The device is an adapter cable that allows different sensors to be used with a pulse oximeter, and pulse oximeters are diagnostic/monitoring devices, not therapeutic.

No

Explanation: The device is described as an "Adapter Cable" that allows the use of specific sensors with pulse oximeter monitors. Its function is "continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate," which are physiological measurements. While these measurements can inform diagnosis, the device itself is a measurement tool, not a diagnostic device that interprets the data to provide a diagnosis.

No

The device description explicitly states it is an "NC Adapter Cable," which is a physical hardware component.

Based on the provided information, the NC Adapter Cable with Nellcor sensors is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use clearly states "continuous noninvasive monitoring of functional arterial hemoglobin (SpO2) and pulse rate". This involves monitoring physiological parameters directly from the patient's body, not analyzing samples taken from the body (like blood, urine, or tissue).
  • Device Description: The device is described as an "oximetry cable" that connects sensors to a pulse oximeter monitor. This is a component used in a non-invasive monitoring system.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, reagents, or any other elements typically associated with in vitro diagnostics.

Therefore, the device falls under the category of a non-invasive patient monitoring device, not an IVD.

N/A

Intended Use / Indications for Use

The NC Adapter Cables used with Nellor Sensors are intended for the continuous nonitoring of functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor) for adult, pediatric, infant, and neonatal patients in hospitals, hospital-type facilities, mobile, and home environments.
The NC Adapter Cable with Nellcor sensors are indicated for the continuous noninvasive monitoring of functional I its readiner of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor) for use with adult, pediation informator of Liveral In hospitals, hospitals, hospital-type facilities, mobile, and home environments.

Product codes

74DSA, DQA

Device Description

The NC Adapter Cable is fully compatible oximetry cable that allows the use of Nellcor Sensors with Masimo SET Radical pulse oximeter monitors. The cable represents a design change to the Masimo patient cables and the MS board. The NC Adapter Cable is similar in construction to the predicate device enabling the Nellcor Sensors to be connected to Masimo SET Radical pulse oximeters.
The NC Adapter Cable is designed, and manufactured for full compatibility with Masimo SET Radical pulse oximeters using Nellcor Sensors. The NC Adapter Cable is constructed of similar materials and components of equivalent specifications as used in the predicate devices.

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

adult, pediatric, infant, and neonatal patients

Intended User / Care Setting

hospitals, hospital-type facilities, mobile, and home 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

Clinical studies were performed using the NC Adapter Cables used with Nellcor sensors on healthy adult volunteer subjects during no motion conditions who were subjected to a progressive induced hypoxia and measuring the arterial hemoglobin saturation value with the instruments against the arterial hemoglobin oxygen determined from arterial blood samples with a CO-Oximeter. Clinical testing of the Nellcor sensors resulted in an accuracy of less than 2% Sports in the range of 70%-100% SaO2 for adults, pediatrics and infants. The saturation accuracy of the neonatal sensors were validated on adult volunteers and 1% was added to account for the properties of fetal hemoglobin.

Key Metrics

accuracy of less than 2% Sports in the range of 70%-100% SaO2 for adults, pediatrics and infants.

Predicate Device(s)

K031330, K012891, K863784, K022889

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

JUN 29 2004

510(k) SUMMARY

Image /page/0/Picture/2 description: The image shows the logo for Masimo, followed by their address and contact information. The address is listed as 40 Parker, Irvine, CA 92618. The phone number is 949-297-7000, and the fax number is 949-297-7001.

Submitted by:

K041204

| | 2852 Kelvin Ave
Irvine, CA 92614-5826
(714) 250-9688
FAX (714) 250-9686 |
|------------------------|----------------------------------------------------------------------------------|
| Company Contact: | James J. Cronin, Vice President, Regulatory Affairs/Quality Assurance |
| Date Summary Prepared: | May 6, 2004 |

Trade NameNC Adapter Cable
Common NameCable, Transducer and Electrode
Classification Name and Product Code:Cable, Transducer and Electrode (74DSA) (870.2900)
Substantially Equivalent Devices:Masimo SET® Radical Pulse Oximeter with SatShare™ and LNOP® se
of Sensors and Cables
510(k) Number - K031330
Nellcor Oximax Pulse Oximeter System with N-595 Pulse Oximeter -
K012891
Nellcor N-200 Pulse Oximeter - K863784

Masimo Corporation

Device Description

The NC Adapter Cable is fully compatible oximetry cable that allows the use of Nellcor Sensors with Masimo SET Radical pulse oximeter monitors. The cable represents a design change to the Masimo patient cables and the MS board.

Siemens Infinity Modular Monitors - K022889

The NC Adapter Cable is similar in construction to the predicate device enabling the Nellcor Sensors to be connected to Masimo SET Radical pulse oximeters.

Intended Use

The NC Adapter Cables used with Nellor Sensors are intended for the continuous nonitoring of functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor) for adult, pediatric, infant, and neonatal patients in hospitals, hospital-type facilities, mobile, and home environments.

Technology Comparison

The NC Adapter Cables used with Nellcor Sensors are substantially equivalent in intended use, design, principles of operation, materials, and performance to predicate sensors and operate on identical principles of non-invasive optical assessment of tissue oxygenation using emitters and detectors.

033C

1

510(k) SUMMARY

The NC Adapter Cable is designed, and manufactured for full compatibility with Masimo SET Radical pulse oximeters using Nellcor Sensors. The NC Adapter Cable is constructed of similar materials and components of equivalent specifications as used in the predicate devices.

The accuracy of the NC Adapter Cables used with Nellcor Sensors is equivalent to those of the predicate devices.

Performance Testing

Environmental Testing

Applicable environmental testing per the Reviewers Guidance for Premarket Submissions - November 1993, i.c. electrical, mechanical and environmental were performed and all tests passed

Clinical Testing

Clinical studies were performed using the NC Adapter Cables used with Nellcor sensors on healthy adult volunteer subjects during no motion conditions who were subjected to a progressive induced hypoxia and measuring the arterial hemoglobin saturation value with the instruments against the arterial hemoglobin oxygen determined from arterial blood samples with a CO-Oximeter. Clinical testing of the Nellcor sensors resulted in an accuracy of less than 2% Sports in the range of 70%-100% SaO2 for adults, pediatrics and infants. The saturation accuracy of the neonatal sensors were validated on adult volunteers and 1% was added to account for the properties of fetal hemoglobin.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo is circular and features the department's name around the perimeter. In the center of the circle is an abstract symbol that resembles an eagle or bird in flight. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

JUN 2 9 2004

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. James J. Cronin Vice President, Regulatory Affairs & Quality Assurance Masimo Corporation 40 Parker Irvine, California 92618

Re: K041204

Trade/Device Name: NC Adapter Cable Regulation Number: 21 CFR 870.2700 Regulation Name: Oximeter Regulatory Class: II Product Code: DQA Dated: June 21, 2004 Received: June 22, 2004

Dear Mr. Cronin:

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.

3

Page 2 - Mr. Cronin

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) 594-4646. 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.

Ouls

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

4

Indications for Use

510(k) Number (if known):

NC Adapter Cable Device Name:

Indications For Use:

The NC Adapter Cable with Nellcor sensors are indicated for the continuous noninvasive monitoring of functional I its readiner of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor) for use with adult, pediation informator of Liveral In hospitals, hospitals, hospital-type facilities, mobile, and home environments.

Prescription Use __ X (Per 21 CFR 801 Subpart D) AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

KD41204/5001

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

Infection Control, I.P.

510(k) Number:__