K Number
K110023
Device Name
INFUSION ADAPTER C100
Manufacturer
Date Cleared
2011-04-12

(99 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The indication for use is admixing of drug into an IV container and administration/transfer of drug from the container to an external IV line, while minimizing exposure to potentially hazardous drugs aerosols and spills that can occur during the admixing, administration and disposal process.
Device Description
The Injector is a sterile device for single-use within the PhaSeal® closed transfer device system for preparation and administration of parenteral drugs.
More Information

No
The summary describes a mechanical device for drug preparation and administration, with no mention of AI or ML capabilities. Performance studies focus on physical integrity and chemical compatibility.

No
The device is described as an "Injector" that is part of a "closed transfer device system for preparation and administration of parenteral drugs," specifically for "admixing of drug into an IV container and administration/transfer of drug from the container to an external IV line." Its function is to minimize exposure to hazardous drugs during these processes. This indicates it is a drug delivery accessory rather than a device that directly treats a condition or ailment.

No

The device is described as an "Injector" for the "admixing of drug into an IV container and administration/transfer of drug from the container to an external IV line," and its purpose is to "minimize exposure to potentially hazardous drug aerosols and spills." This function is for drug preparation and delivery, not for diagnosing a condition or disease.

No

The device description explicitly states "The Injector is a sterile device for single-use within the PhaSeal® closed transfer device system for preparation and administration of parenteral drugs." and describes physical performance testing related to the device's integrity and material properties, indicating it is a physical medical device, not software-only.

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

Here's why:

  • Intended Use: The intended use is focused on the admixing and administration of drugs into a patient's vascular system. This is a therapeutic and drug delivery function, not a diagnostic one.
  • Device Description: The device is described as a sterile device for single-use within a closed transfer system for the preparation and administration of parenteral drugs. This further reinforces its role in drug handling and delivery.
  • Lack of Diagnostic Elements: There is no mention of the device being used to analyze samples (blood, urine, tissue, etc.) or to provide information about a patient's health status or disease.
  • Anatomical Site: The anatomical site is the "patient's vascular system," which is where the drug is administered, not where a diagnostic sample would typically be collected or analyzed by an IVD.

In vitro diagnostics are devices used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or screening purposes. This device's function is entirely related to the safe handling and delivery of drugs to a patient.

N/A

Intended Use / Indications for Use

The indication for use is admixing of drug into an IV container and administration/transfer of drug from the container to an external IV line, while minimizing exposure to potentially hazardous drugs aerosols and spills that can occur during the admixing, administration and disposal process.

Product codes

LHI

Device Description

The Injector is a sterile device for single-use within the PhaSeal® closed transfer device system for preparation and administration of parenteral drugs.

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)

Performance testing – general performance:

  • Modification: Performance testing refer to verify integrity of the device and compatibility with the relevant other PhaSeal components.
  • Test Performed: Pulling force, torque test in connection to other PhaSeal components, liquid flow, air tightness, handling tests,
  • Passed: Yes

Material testing – specific requirements:

  • Modification: Specific requirements refer to integrity of the material in combination with the aggressive chemicals.
  • Test Performed: Functional and mechanical properties on product after 24h and 72h of chemical exposure with Etopside, Taxo and Busulfani
  • Passed: Yes

Biocompatibility:

  • Modification: The Infusion Adapter is indirect invasive, duration normally 1-2 hours, may be 24-48 hours if patient is hospitalised.
  • Test Performed: Systemic Injection test, Cytotoxicity, Hemolysis, Dermal sensitization, Intracutaneous test and Physicochemical tests - plastic.
  • Passed: Yes

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

Not Found

Predicate Device(s)

K023747

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

KI10023 1981

ATTACHMENT 5

APR 1 2 2011

510(K) SUMMARY

Summarv of Safety and Effectiveness

In accordance with 21 CFR 807.92, the following information constitutes the Carmel Pharma ab summary for the Infusion Adapter C100 included in:

PhaSeal® - A Closed System Drug Transfer Device for Preparation and Administration of Parenteral Drugs

SUBMITTER'S NAME: Carmel Pharma AB . ้า Aminogatan 30 ADDRESS: SE-43153 Mölndal Sweden . . . . . . . . . . . ..............................................................................................................................................................................

CONTACT PERSON: TELEPHONE NUMBER: FAX NUMBER: DATE OF SUBMISSION:

Kiell Andreasson +46 31 7030400 +46 31 7030404 December 10, 2010

1. Identification of device

Proprietary Name:PhaSeal Infusion Adapter
Common Name:I.V.-Fluid-Transfer-Set
Classification Status:Class II per 21 CFR 880.5440
Product code:LHI

2. Equivalent devices

Infusion Adapter C100 is previously cleared in K023747.

Description of the Device 3.

The Injector is a sterile device for single-use within the PhaSeal® closed transfer device system for preparation and administration of parenteral drugs.

Intended use. 4.

The intended use of this device is to administer fluids from a container to a patient's vascular system through a needle or catheter inserted into the vein.

1

K110023 pg 2

:

Technological characteristics, comparison to predicate device. 5.

Infusion Adapter

:4

: \

SubjectC100C100 K023747Equiv.
Indication for useThe indication for use is
admixing of drug into an IV
container and
administration/transfer of drug
from the container to an
external IV line, while
minimizing exposure to
potentially hazardous drugs
aerosols and spills that can
occur during the admixing,
administration and disposal
process.The Infusion Adapter serves as
the connecting part between the
IV bag and an external IV line
(e.g. IV regulators). The Infusion
Adapter has a built in Connector
which makes it possible to admix
drugs into the infusion solution
using the sealed PhaSeal double
membrane techniqueYes
Intended useThe intended use of this device
is to administer fluids from a
container to a patient's vascular
system through a needle or
catheter inserted into the vein.The intended use of this device is
to administer fluids from one a
container to a patient's vascular
system through a needle or
catheter inserted to a vein. The
infusion adapter mates with the
PhaSeal injector bayonet fitting
which prevents drug spillage into
the environmentYes
Flushing of system
prior to useNoYes
MaterialSpike port: TPE
Spike housing: PP
Spike Cap: PPSpike port: TPE
Spike housing: ABS
Spike Cap: PPYes
Fitting connectionSpike housing: to Injector and
to infusion bag
Spike port: to external spike
included in an administration
setSpike housing: to Injector and
to infusion bag
Spike port: to external spike
included in an administration
setYes
Sterilization methodEtOEtOYes

2

Summary of design control activities 6.

Performance testing – general performance

ModificationTest PerformedPassed
Performance testing refer to verify integrity of the
device and compatibility with the relevant other
PhaSeal components.Pulling force, torque test in
connection to other PhaSeal
components, liquid flow, air
tightness, handling tests,Yes

Material testing – specific requirements

ModificationTest PerformedPassed
Specific requirements refer to integrity of the
material in combination with the aggressive
chemicals.Functional and mechanical
properties on product after 24h
and 72h of chemical exposure
with Etopside, Taxo and
BusulfaniYes

Biocompatibility

ModificationTest PerformedPassed
The Infusion Adapter is indirect invasive,
duration normally 1-2 hours, may be 24-48
hours if patient is hospitalised.Systemic Injection test,
Cytotoxicity, Hemolysis, Dermal
sensitization, Intracutaneous test
and Physicochemical tests -
plastic.Yes

7. Discussion of performance testing.

The tests performed show that that Infusion Adapter C100 fulfil the stated requirements and therefore comply with the claims of the intended use.

8. Conclusion

Based on comparison to the predicate device, we come to the conclusion that the Infusion Adapter C100 included in the PhaSeal System, is substantially equivalent to previously cleared predicate devices and presents no new concerns about safety and effectiveness.

p47

12110023

3

Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter. Inside the circle is an image of an eagle with its wings spread, with three stripes representing the feathers. The eagle is facing to the right.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring. MD 20993-0002

Mr. Kjell Andreasson Manager, Regulatory Affairs Carmel Pharma AB Aminogatan 30 Mölndal SWEDEN S431 53

APR 1 2 2011

Re: K110023

Trade/Device Name: Infusion Adapter C100 Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: LHI Dated: March 1, 2011 Received: March 8, 2011

Dear Mr. Andreasson:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

4

Page 2 - Mr. Andreasson

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to

http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours.

hh fo

Anthony Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Attachment 1

Indications for Use Statement

510(k) Number (if known)K110023
Device NameInfusion Adapter C100
Indications for UseThe indication for use is admixing of drug into an IV container and administration/transfer of drug from the container to an external IV line, while minimizing exposure to potentially hazardous drugs aerosols and spills that can occur during the admixing, administration and disposal process.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use: Yes (Per 21 CFR 801. 109)

OR Over-The-Counter Use: No

RC. 4/8/11

(Division Sign-Off)

(Division Sign-Off)
Division of Anesthesiology, General Hospita
Infection Control and Dental Devices
510(k) Number:

K 110023 Page 1 of 1