K Number
K043204
Date Cleared
2005-03-30

(132 days)

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

The Sgarlato PainFree Pump is a single use, general purpose infusion device intended to provide continuous infusion of medication (such as local anesthetics or corticosteroids) directly into a target site for the purpose of pain relief. Infusion may be carried out via percutaneous, subcutaneous, and epidural routes. The PainFree Pump may be used to provide continuous infusion of a local anesthetic directly into an intraoperative site for postoperative management of pain following surgery. It is suitable for use as an ambulatory device. It is not intended for vascular drug delivery, hyperalimentation, or the delivery of blood or blood products.

Device Description

The Sgarlato PainFree pump is mechanically the same device currently legally marketed by Sgarlato Labs for continuous infusion of liquid medication into an intraoperative site for postoperative pain management. This infusion pump is one of a multiplicity of similar general purpose devices marketed to provide continuous infusion of moderate amounts of liquid medication (100-200 ml) over an extended period of time without use of electrical power. These mechanically-driven, single-use or reusable infusion pumps are therefore suitable for ambulatory use and can provide medication infusion via catheters for extended periods ranging from a few hours to several days. The PainFree pump uses a syringe-like reservoir that compresses the plunger against a self-contained spring to apply pressure to the liquid volume in the syringe. The Sgarlato device is distributed as a single-use sterile device.

AI/ML Overview

This looks like a 510(k) summary for a medical device, which typically focuses on demonstrating substantial equivalence to a predicate device rather than providing extensive details about a clinical study with detailed acceptance criteria and performance data in the way a PMA or clinical trial summary would.

Therefore, many of the requested items (sample sizes, expert qualifications, adjudication methods, MRMC studies, standalone performance, training set details) are not applicable or not provided in this type of submission.

The document describes the acceptance criteria by comparing the new device (Sgarlato PainFree pump) to two predicate devices (Paragon Infusion Kit K984146 and Sgarlato Pain Control Infusion Pump K990101) to establish substantial equivalence. The "performance" is demonstrated through this comparison, showing that its specifications are similar to or within the expected range of already cleared devices for its expanded indications.

Here's a breakdown based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The device demonstrates "performance" by being substantially equivalent to the predicate devices. The acceptance criteria are essentially met if the characteristics of the Sgarlato PainFree Pump are comparable to the Paragon Infusion Kit and the Sgarlato PCIP (Sgarlato Pain Control Infusion Pump), especially regarding the new indications.

ItemAcceptance Criteria (from Predicate Devices)Sgarlato PainFree Pump Performance (from device description)
Intended UseVariety of continuous infusion for pain management (Intraoperative for PCIP; General Infusion for Paragon)Continuous infusion of medication into a target site for pain management
Routes of AdministrationPercutaneous (PCIP); Percutaneous, subcutaneous, intramuscular, and epidural (Paragon)Percutaneous, subcutaneous, and epidural
ContraindicationsNot for IV, blood products, lipids (Paragon); Not for epidural, subcutaneous, vascular, blood products, TPN (PCIP)Not for IV, blood products, lipids, or fat emulsions
ReuseReusable pump, single-use administration sets (Paragon); Single Use (PCIP)Single Use
Fill Volumes100 ml (Paragon); 100 or 200 ml (PCIP)100 or 200 ml
Flow Rates0.5, 1, 2, 4, or 10 ml/hr (Paragon); 0.5, 1, or 2 ml/hr (PCIP)1, 2, or 4 ml/hr
Flow controlMicro-bore tubing with medication filter (both predicates)Micro-bore tubing with 5 micron medication filter
Pump MechanismSpring-scissors plate compressing PVC bag (Paragon); Spring-powered syringe plunger (PCIP)Spring-powered syringe plunger
PowerCompressed spring (both predicates)Compressed spring
Components and MaterialsConform with ISO 10993 part 1 for fluid path (both predicates)Conform with ISO 10993 part 1 for fluid path
Safety/AlarmsNone except fluid level indicator/plunger movement monitors flow (both predicates)None except plunger movement monitors flow
PackagingTyvek-sealed tray with pump, administration sets, accessories (both predicates)Tyvek-sealed tray with pump, administration sets, accessories, and catheter sets

2. Sample size used for the test set and the data provenance

Not applicable/Not provided within this 510(k) summary. This document relies on comparison to predicate devices, not a separate "test set" with patient data. The "test" is the comparison of device specifications and intended use against existing cleared devices.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

Not applicable/Not provided. This is not a study requiring expert ground truth in the traditional sense. The "ground truth" for substantial equivalence is the FDA's existing clearances for the predicate devices.

4. Adjudication method for the test set

Not applicable/Not provided. No "test set" or adjudication process described as part of this substantial equivalence determination.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This device is an infusion pump, not an AI or imaging diagnostic device.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done

Not applicable. This device is an infusion pump, not an algorithm. Its operation is purely mechanical.

7. The type of ground truth used

The "ground truth" for this 510(k) submission is the FDA's prior clearance of the predicate devices based on their established safety and effectiveness. The Sgarlato PainFree pump is deemed substantially equivalent if it shares similar technological characteristics and has the same or similar intended use, without raising new questions of safety and effectiveness, as demonstrated by the comparison table and descriptive text.

8. The sample size for the training set

Not applicable/Not provided. This is a mechanical medical device, not a machine learning algorithm requiring a training set.

9. How the ground truth for the training set was established

Not applicable/Not provided. As above, no training set is relevant for this type of device submission.

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MAR 3 0 2005

SECTION E - 510(k) Summary for the Sgarlato PainFree pump

General

The Sgarlato PainFree pump is mechanically the same device currently legally marketed by Sgarlato Labs for continuous infusion of liquid medication into an intraoperative site for postoperative pain management. Similar mechanicallydriven, infusion pumps with the same flow and reservoir capacity include percutaneous, subcutaneous, intramuscular and epidural infusion sites as alternative routes for administration of medication. Because the Sgarlato PainFree pump offers equivalent flow rates, similar reservoir volumes, and similar materials in its construction, Sqarlato laboratories believes that its use with alternative administration routes should be considered substantially equivalent to currently cleared predicate devices. Predicate Devices cited are the Paragon Infusion Kit K984146 and the Sgarlato Pain Control Infusion Pump K990101.

Similarities

This infusion pump is one of a multiplicity of similar general purpose devices marketed to provide continuous infusion of moderate amounts of liquid medication (100-200 ml) over an extended period of time without use of electrical power. These mechanically-driven, single-use or reusable infusion pumps are therefore suitable for ambulatory use and can provide medication infusion via catheters for extended periods ranging from a few hours to several days.

The Predicate Devices, the I-Flow Paragon Infusion Kit (K984146) and the Sgarlato Pain Control Infusion Pump (K990101) offer similar flow rates and reservoir capacities. They both are mechanical devices that use spring energy to provide pressurized medication. They use micro-bore flow restrictors to meter the flow from a pressure vessel to the desired at the infusion site. They both include epidural-style medication catheters for delivery of medication to the site and offer the ability to easily exchange flow restrictors in a given setting. They offer y adapters to split the reservoir volume to multiple sites in a given surgical setting. They provide convenience kits with a filling syringe, needle introducer for the catheter, and various accessories to affix the catheter to the patient, label and carry the pump, etc. Neither device is intended for use in delivering blood, blood product, lipids, or for other intravenous or TPN use.

Differences

The primary difference between the original Sqarlato Pain Control Infusion Pump K990101) and the Sgarlato PainFree pump is expansion of the sites indicated for infusion. The original device listed percutaneous infusion via a catheter to an intraoperative site. The extended indication adds subcutaneous, and epidural sites.

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The PainFree pump is intended to infuse liquid medications such as corticosteroids or other anti-inflammatory compounds of the same approximate density of local anesthetics. Compounds such as blood or lipids that may clog the medication filter included in the set are not intended to be used. The original the modion Control Infusion pump was primarily used for infusing local anesthetics.

The primary difference between the I-Flow pump and the PainFree pump is the method of pressurizing the reservoir. The I-Flow device uses a spring/scissors mechanism to apply pressure to a pliable drug bag within a hard shell. The PainFree pump uses a syringe-like reservoir that compresses the plunger against a self-contained spring to apply pressure to the liquid volume in the syringe. The Sgarlato device is distributed as a single-use sterile device. The I-Flow device may be reused and/or sterilized by the user.

Conclusion

The PainFree pump is substantially equivalent mechanically to its predecessor Pain Control Infusion Pump from Sgarlato. The PainFree pump is substantially equivalent in terms of identified infusion sites to the I-Flow Paragon device. See Table 1 for more specific information.

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Paragon Infusion Kit(K984146)Sgarlato PCIP(K896422)Sgarlato PainFreePump (review item)
Item
Intended UseContinuous infusion ofmedication into anintraoperative site forgeneral surgery andpain management.The pump itself is forgeneral infusion use.Continuous infusion oflocal anesthetic into asurgical site forpostoperative painmanagementContinuous infusion ofmedication into atarget site for painmanagement
Routes ofAdministrationPercutaneous,subcutaneous,intramuscular, andepiduralPercutaneousPercutaneous,subcutaneous, andepidural
ContraindicationsNot for intravenousdelivery. Not intendedfor blood, bloodproducts, lipids, or fatemulsionsNot for epidural,subcutaneous, orvascular drugdelivery. Not fordelivery of blood,blood products, orTPNNot for intravenousdelivery. Not intendedfor blood, bloodproducts, lipids, or fatemulsions
ReuseRe-usable pump,single useadministration setsSingle UseSingle Use
Fill Volumes100 ml100 or 200 ml100 or 200 ml
Flow Rates0.5,1,2,4, or 10 ml/hr0.5,1,or 2 ml/hr1,2, or 4 ml/hr
Flow controlMicro-bore tubing withmedication filterMicro-bore tubing with5 micron medicationfilterMicro-bore tubing with5 micron medicationfilter
Pump MechanismSpring-scissors platecompressing PVC bagSpring-poweredsyringe plungerSpring-poweredsyringe plunger
PowerCompressed springCompressed springCompressed spring
Components andMaterialsConform with ISO10993 part 1 for fluidpathConform with ISO10993 part 1 for fluidpathConform with ISO10993 part 1 for fluidpath
Safety/AlarmsNone except Fluidlevel indicator tomonitor flowNone except plungermovement monitorsflowNone except plungermovement monitorsflow
PackagingTyvek-sealed traycontaining pump,administration sets,and accessories.Flow restrictors, andy- connector sets,may be separatelypackagedTyvek-sealed traycontaining pump,administration sets,and accessories.Flow restrictors, and yconnector sets, maybe separatelypackagedTyvek-sealed traycontaining pump,administration sets,and accessories.Flow restrictors, y-connector sets, andcatheter sets may beseparately packaged

Comparison to legally marketed Devices

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Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH AND HUMAN SERVICES, USA" around the perimeter. Inside the circle is a stylized representation of a human figure, composed of three overlapping profiles, with the arms raised.

MAR 3 0 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Sgarlato Laboratories, Incorporated C/O Michael McDougall, Ph.D. Regulatory Affairs Michann Partners LLC 2315 South Bascom Avenue Suite #200 Campbell, California 95008

Re: K043204

Ro4920 |
Trade/Device Name: Sgarlato PainFree Pump; Sgarlato Pain Control Infusion Pump Regulation Number: 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: FRN Dated: February 24, 2005 Reccived: March 16, 2005

Dear Dr. McDougall:

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 mendments, 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 (1 Mr.), it hay be doged 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 r lease be advised that I Dri 3 issualled or our device complies with other requirements of the Act that I DA has made a decemmations administered by other Federal agencies. You must of any I cactar stututes and regaranents, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set CI'N Fatt 607), adoning (21 OFR Part 820); and if applicable, the electronic form in the quality systems (Sections 531-542 of the Act); 21 CFR 1000-1050. product radiation conta of pro neeting your device as described in your Section 510(k) This letter will anow you to ogin mailing of substantial equivalence of your device to a legally premarket notication: The PDF Intelling sification 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 If you desire specific arrive ior Jose (240) 276-0115. Also, please note the regulation entitled, Contact the Office of Coursemarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small other general miorinational 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/industry/support/index.html.

Sincerely yours,

Sulfite. Michael O. md.

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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K043204

Sgarlato Laboratories, Inc.

510(k) PainFree Pump - Additional Indication for Use, Section D, Page 4.1

Indications for Use

K043204 510(k) Number (if known):

Sgarlato PainFree Pump; Sgarlato Pain Control Infusion Pump Device Name:

Indications For Use:

The Sgarlato PainFree Pump is a single use, general purpose infusion device intended to provide continuous infusion of medication (such as local anesthetics or corticosteroids) directly into a target site for the purpose of pain relief. Infusion may be carried out via percutaneous, subcutaneous, and epidural routes. The PainFree Pump may be used to provide continuous infusion of a local anesthetic directly into an intraoperative site for postoperative management of pain following surgery. It is suitable for use as an ambulatory device. It is not intended for vascular drug delivery, hyperalimentation, or the delivery of blood or blood products.

Prescription Use Yes (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

i.e. 10 m

ision Sign-Off) Chision of Anesthesiology, General Hospital, in setion Control, Dental Devices

1 (k) Number _ N 443244

Page 1 of 1

§ 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).