K Number
K043019
Device Name
VASCULAR SOLUTIONS SCLERO-KIT
Date Cleared
2004-12-01

(28 days)

Product Code
Regulation Number
880.5570
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Vascular Solutions Sclero-Kit is indicated for delivery of sclerosing agents. Sclerosing agents may be used for treatment of small uncomplicated varieosities of the lower extremities that show simple dilation with competent valves.
Device Description
Each kit is provided sterile and contains disposable 10ml syringe, 3ml syringe with needle, butterfly needle with attached extension tubing and syringe connector.
More Information

Not Found

Not Found

No
The device description and performance studies do not mention any AI or ML components or capabilities. The device is a simple kit for delivering sclerosing agents.

No.
The device is indicated for the delivery of sclerosing agents, which are used for treatment; however, the device itself is a kit of disposable components (syringes, needles, tubing) and does not inherently provide therapy. It is an accessory to the therapeutic agent.

No
The device is described as a kit for delivering sclerosing agents to treat varicose veins, which is a therapeutic function, not a diagnostic one.

No

The device description explicitly lists physical components (syringes, needles, tubing) and mentions sterility, indicating it is a hardware-based medical device kit.

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

Here's why:

  • Intended Use: The intended use is for the "delivery of sclerosing agents" for the treatment of varicose veins. This is a therapeutic procedure performed directly on the patient's body.
  • Device Description: The components are syringes, needles, and tubing, which are used for administering substances into the body.
  • Lack of Diagnostic Function: There is no mention of the device being used to examine specimens (like blood, urine, or tissue) in vitro (outside the body) to provide information for diagnosis, monitoring, or screening.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide diagnostic information. This device is designed for direct therapeutic intervention.

N/A

Intended Use / Indications for Use

The Vascular Solutions Sclero-Kit is indicated for delivery of sclerosing agents. Sclerosing agents may be used for treatment of small uncomplicated varieosities of the lower extremities that show simple dilation with competent valves.

Product codes

FMF, FMI, FPA

Device Description

Each kit is provided sterile and contains disposable 10ml syringe, 3ml syringe with needle, butterfly needle with attached extension tubing and syringe connector.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lower extremities

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

Non-Clinical Testing: Testing conducted included assessments of the design verification of the Sclero-Kit along with biocompatibility assessments. The results of this battery of tests confirmed the suitability of the Sclero-Kit for its intended use.
Clinical Testing: No clinical evaluations of this product have been conducted.

Key Metrics

Not Found

Predicate Device(s)

needle and syringe devices.

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5570 Hypodermic single lumen needle.

(a)
Identification. A hypodermic single lumen needle is a device intended to inject fluids into, or withdraw fluids from, parts of the body below the surface of the skin. The device consists of a metal tube that is sharpened at one end and at the other end joined to a female connector (hub) designed to mate with a male connector (nozzle) of a piston syringe or an intravascular administration set.(b)
Classification. Class II (performance standards).

0

K043019

DEC - 1 2004

510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

Common/Usual Name:Injection Kit
Product Trade Name:Vascular Solutions Sclero-Kit
Classification Name:Unclassified
Product Code: FMF, FMI, FPA
Manufacturer:Vascular Solutions, Inc.
6464 Sycamore Court
Minneapolis, Minnesota 55369
Establishment Registration:2134812
Contact:Sara L. Coon
Senior Regulatory Affairs Associate
(763) 656-4300 phone
(763) 656-4200 fax
Performance Standards:No performance standards have been developed under
section 514 for this device.

Device Description:

Each kit is provided sterile and contains disposable 10ml syringe, 3ml syringe with needle, butterfly needle with attached extension tubing and syringe connector.

Intended Use:

The Vascular Solutions Sciero-Kit is indicated for delivery of sclerosing agents. Scierosing agents may be used for treatment of small uncomplicated varieosities of the lower extremities that show simple dilation with competent valves.

Summary of Non-Clinical Testing:

Testing conducted included assessments of the design verification of the Sclero-Kit along with biocompatibility assessments. The results of this battery of tests confirmed the suitability of the Sclero-Kit for its intended use.

1

Summary of Clinical Testing:

No clinical evaluations of this product have been conducted.

Predicate Devices:

The VSI Sclero-Kit is a kit of routincly used medical components that have been The VEI Delero terrilized for the convenience of the end user for use in the treatment of small uncomplicated varicosities. The kit components are equivalent to the predicate needle and syringe devices. This combination of devices is commonly combined for use in the treatment varicosities as described in the current medical textbooks and literature.

Conclusions:

The Sclero-Kit is substantially equivalent to the predicate needle and syringe devices. The testing performed confirms that the Sclero-Kit will perform as intended.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol resembling three stylized waves or lines, often interpreted as an abstract representation of the human form.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC - 1 2004

Ms. Sara L. Coon Senior Regulatory Affairs Associate Vascular Solutions, Incorporated 6464 Sycamore Court Minneapolis, Minnesota 55369

Re: K043019

Trade/Device Name: Vascular Solutions Sclero-Kit Regulation Number: 880.5570 Regulation Name: Hypodermic Single Lumen Needle Regulatory Class: II Product Code: FMI Dated: November 2, 2004 Received: November 3, 2004

Dear Ms. Coon:

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 - Ms. Coon

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 vou desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (240) 276-0115. 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.

Susen Runne
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

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Indications for Use Statement

510(k) Number:

K043019_______________________________________________________________________________________________________________________________________________________________________

l Device Name:

Vascular Solutions Scleto-Kit

Indications for Use:

The Vascular Solutions Sclero-Kit is indicated for delivery of sclerosing agents. Sclerosing a The Vascular Solutions Scietty-Att I. Incomplicated varicosities of the lower extremities that show simple dilation with competent valves.

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 IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Anton Dvorak

Page 1 of _

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

510(k) Number: K443914