K Number
K113471
Date Cleared
2012-10-18

(331 days)

Product Code
Regulation Number
880.5440
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

This device is intended for administration of drug solution, or blood sampling into/from a Reservoir implanted in the body.

Device Description

The Nipro Huber Infusion Set is a standard non-coring Huber type needle and administration set. The device is designed for use with a vascular access infusion system and is intended for use as an intravascular administration set to access surgically implanted subcutaneous vascular ports in a standard manner for the purposes of fluid or drug infusion and blood sampling. The basic structure of the device consists of a cannula, fixing rotating wings, a clamp, tube and luer connector. This device is also available with Y- tube and a injection plug. The needle is bent at a 90° angle and is available in gauges 19, 20 and 22 and in lengths of ¾ " - 1 ½".

AI/ML Overview

Here's an analysis of the acceptance criteria and the study proving the device meets them, based on the provided text:

Device: NIPRO Huber Infusion Set


1. Table of Acceptance Criteria and Reported Device Performance

Performance Test NameAcceptance CriteriaReported Device Performance
1. Flow rate19G: 41-52 ml/min20G: 24-38 ml/min22G: 10-15 ml/min24G: 4-6 ml/min"successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
2. Air leakage – pressure enduranceMust show no signs of air leakage of 50 [kPa] for 15 seconds."successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
3. Set Leakage – Endurance testWith y-site: 1.8MPaWithout y-site: 3.7MPa"successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
4. Wrapping paper leakageMust not leak under the condition of 1.1[kPa] for 10 seconds."successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
5. Cannula/Hub adhesive strength measurement19G: ≥ 69 N20G: ≥ 54 N22G: ≥ 34 N24G: ≥ 22 N"successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
6. Popping needle tip inspectionNo sound of puncture popping noise."successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
7. Tensile Adhesive strength (Hub / tube, Y connector / tube, Connecting tube / connector)Must withstand a static tensile force of 15[N] for 15 seconds."successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
8. Test for particulate matterContamination Index I = Na - Nb 90"successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
9. Injection Site (rubber button)Must show no signs of air leakage of 50 [kPa] for 15 seconds."successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
10. Transportation TestingWithstand distribution environment"successfully met the requirements for these standards." (Implies meeting or exceeding listed criteria.)
Biocompatibility Tests (ISO 10993 Parts 4, 5, 10, 11)Per requirements of ISO 10993 for prolonged duration, indirect blood path contacting device."Biocompatibility tests were performed according to ISO 10993 Parts 4, 5, 10 and 11 as a prolonged duration, indirect blood path contacting device." (Implies successful conformance.)

Note: The document explicitly states: "NIPRO Huber Infusion Set successfully met the requirements for these standards. In addition, it met or exceeded the acceptance criteria for the following performa[nce tests]." This indicates that the device's performance aligned with all specified acceptance criteria.


2. Sample Size Used for the Test Set and Data Provenance

The document does not specify the sample size used for each of the performance tests.

Regarding data provenance:

  • Country of Origin: Not explicitly stated for the testing data. However, the submitter is Nipro Medical Corporation (Miami, FL, USA), and some standards referenced are international (ISO) and some Japanese (JIS, JP).
  • Retrospective or Prospective: Not specified. Standard performance testing of a medical device prior to market release is typically prospective, but the document does not explicitly state this.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

This section is not applicable as the tests described are objective, quantitative performance measurements of a physical medical device, not clinical evaluations requiring expert interpretation (e.g., image analysis, diagnosis). The "ground truth" for these tests are the physical standards and measurement protocols themselves.


4. Adjudication Method for the Test Set

This section is not applicable. As mentioned above, the tests are objective performance measurements, not subjective evaluations requiring adjudication.


5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was Done

No, an MRMC comparative effectiveness study was not done. This type of study typically involves human readers (e.g., radiologists) interpreting cases (e.g., medical images) with and without AI assistance to measure the AI's impact on human performance. The NIPRO Huber Infusion Set is a physical medical device (an infusion set), not an AI-powered diagnostic or assistive tool, so an MRMC study is irrelevant to its evaluation.


6. If a Standalone Study (i.e., algorithm only without human-in-the-loop performance) was Done

Yes, the "performance testing" detailed in the document can be considered a standalone evaluation of the device's physical and functional characteristics. The tests listed (flow rate, leakage, adhesive strength, etc.) evaluate the device itself, independent of human interaction beyond operating the testing equipment. Since this is not an AI algorithm, the "algorithm only" aspect doesn't directly apply, but the principle of evaluating the device's intrinsic performance is met.


7. The Type of Ground Truth Used

The ground truth used for these performance tests is based on established national and international standards and specifications for medical devices, specifically infusion sets and catheters. These include:

  • ISO standards (ISO 8536-4, ISO 10555-3, ISO 7864, ISO 594-1, ISO 11135-1, ISO 10993 parts 4, 5, 10, 11)
  • USP (United States Pharmacopeia) standards (USP 31 <151>, USP 31 <161>)
  • JIS (Japanese Industrial Standards) (JIS T3221:2005)
  • JP (Japanese Pharmacopoeia) (JP15)
  • ASTM (American Society for Testing and Materials) (ASTM D4169-05)
  • IAEA (International Atomic Energy Agency) (IAEA-TECDOC-539)

The acceptance criteria listed (e.g., specific flow rates, pressure tolerances, tensile strength values) are derived from these standards, representing the "ground truth" for what constitutes acceptable performance for this class of device.


8. The Sample Size for the Training Set

This section is not applicable. This is a physical medical device. There is no concept of a "training set" in the context of its performance testing as there would be for an AI model.


9. How the Ground Truth for the Training Set Was Established

This section is not applicable for the same reasons as point 8.

{0}------------------------------------------------

Image /page/0/Picture/0 description: The image shows the logo for Nipro Medical Corporation. The logo consists of a stylized infinity symbol on the left, followed by the word "NIPRO" in bold, sans-serif font. Below "NIPRO" is the text "MEDICAL CORPORATION" in a smaller, sans-serif font. The logo is black and white.

3150 NW 107" Avenue, Miami FL 33172 Tel: 305.599.7174 Fax: 305.592.4621

K 113471

510(k) Summary - NIPRO Huber Infusion Set

(21 CFR 807.92)

OCT 1 8 2012

1.Submitter:Nipro Medical CorporationFDA Registration No: 1056186
Contact Person:Jessica Oswald
Prepared on:21 November 2011
2.Trade Name:NIPRO Huber Infusion Set
Common Name:Huber Infusion Set
Classification Name:Intravascular Administration Set
Classification Code:FPA (per 21 CFR 880.5440)Class II
3.Predicate Device:NIPRO Huber Infusion Set (K895770)

4. Device Description:

The Nipro Huber Infusion Set is a standard non-coring Huber type needle and administration set. The device is designed for use with a vascular access infusion system and is intended for use as an intravascular administration set to access surgically implanted subcutaneous vascular ports in a standard manner for the purposes of fluid or drug infusion and blood sampling.

5. Indication for Use:

This device is intended for administration of drug solution, or blood sampling into/from a Reservoir implanted in the body.

6. Technological Characteristics

The basic structure of the device consists of a cannula, fixing rotating wings, a clamp, tube and luer connector. This device is also available with Y- tube and a injection plug. The needle is bent at a 90° angle and is available in gauges 19, 20 and 22 and in lengths of ¾ " - 1 ½".

{1}------------------------------------------------

7. Performance Testing

Testing of the NIPRO Huber Needle Infusion Set was completed in conformance with the
following standards: following standards:

Reference NumberStandard Title
ISO 8536-4:2010Infusion equipment for medical use, Part 4: Infusion sets for single use,gravity feed
ISO 10555-3:1996Sterile single use catheters, Part 3: central venous catheters
ISO 7864:1993Sterile hypodermic needles for single use
ISO 594-1:1986Conical fittings with a 6% (Luer) taper for syringes, needles and certainother medical equipment – Part 1:General requirements
ISO 11135-1:2007Sterilization of health care products – Ethylene oxide – Part 1:Requirements for the development, validation, and routine control of asterilization process for medical devices.
ISO 10993-5:2009Biological Evaluation of Medical Devices – Test for In Vitro Cytotoxicity
ISO 10993-4:2002Biological Evaluation of Medical Devices – Selection of Test forInteraction with Blood
ISO 10993-10:2002Biological Evaluation of Medical Devices – Test for Irritation andDelayed-Type Hypersensitivity
ISO 10993-11:2006Biological Evaluation of Medical Devices – Test for Systemic Toxicity
IAEA-TECDOC-539Guidelines for Industrial Radiation Sterilization of Disposable MedicalProducts (Cobalt-60 Gamma Irradiation)
USP 31<151> Pyrogen Test (USP Rabbit Test)
USP 31<161> Transfusion and Infusion Assemblies and Similar Medical Devices
JIS T3221:2005Single-use needle for infusion port
JP15The Japanese Pharmacopoeia, Fifteenth Edition
ASTM D4169-05Standard Practice for Performing Testing of Shipping Containers andSystems

NIPRO SafeTouch Huber Infusion Set successfully met the requirements for these standards.
In addition, it met or exceeded the acceptance criteria for the follow in the follow In addition, it met or infasion set saccessfully hier the requirements for these standards.
In addition, it met or exceeded the acceptance criteria for the following performa

Performance Test NameAcceptance Criteria
1. Flow rate19G: 41-52 ml/min20G: 24-38 ml/min22G: 10-15 ml/min24G: 4-6 ml/minPredicate Device 20G
2. Air leakage – pressure enduranceMust show no signs of air leakage of50 [kPa] for 15 seconds.
3. Set Leakage – Endurance testWith y-site: 1.8MPa Without y-site:3.7MPa

NIPRO Huber Infusion Set

.

-5.2-

{2}------------------------------------------------

Performance Test NameAcceptance Criteria
4. Wrapping paper leakageMust not leak under the condition of 1.1[kPa] for 10 seconds.
5. Cannula/Hub adhesive strengthmeasurement19G: ≥ 69 N20G: ≥ 54 N22G: ≥ 34 N24G: ≥ 22 N
6. Popping needle tip inspectionNo sound of puncture popping noise.
7. TensileAdhesive strengtha. Hub / tube b. Y connector / tube c. Y connector / tubed. Connecting tube / connectorMust withstand a static tensile force of 15[N] for 15 seconds.
8. Test for particulate matterContamination Index $I = Na - Nb 90$
9. Injection Site (rubber button)Must show no signs of air leakage of 50 [kPa] for 15 seconds.
10. Transportation TestingWithstand distribution environment

8. Substantial Equivalence

The Nipro Huber Infusion Sets are identical in physical properties, materials, configurations and having the same intended use as the predicate device (i.e., the original Exel Huber Infusion Set [K895770]). Although the manufacturing process for the needle bevel has been modified, performance testing shows that the performance of the new Nipro Huber infusion Sets is similar in most performance test and is significantly better in the Coring Test. Therefore, no new issues of safety or effectiveness are introduced by these changes.

NIPRO Huber Infusion Set

-5.3-

{3}------------------------------------------------

모두 - 인천 Nipro Huber Infusion Sets
사용 및 서울 대통령 및 공급 업체 및 공급 업체 및 공 Specification, pecification in the Predicate Predicate
القرن المقابل المنتجات المنتجات المتحدة المنتخب المنتجات المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاومة المقاوم

Physical and Material
NeedleComponentsMaterialsComponentsMaterials
CannulaStainless SteelCannulaStainless Steel
ProtectorPVCProtectorPC
Wing UnitAVF Rotary HubPVCAVF Rotary HubPVC
AVF Rotary WingPEAVF Rotary WingPE
Joint TubePVCJoint TubePVC
TubeTubePVCTubePVC
Y TubePCY TubePC
ConnectorRubber Button1RRubber Button1R
Rubber ButtonPVCRubber ButtonPVC
CapCap
Mini Clamp CPOMMini Clamp CPOM
Luer ConnectorPCLuer ConnectorPC
Leur CapPPLeur CapPP
BondEpoxide-based adhesiveEpoxide-based adhesive
Urethane-based adhesiveUrethane-based adhesive
LubricantsSilicone oilSilicone oil
AvailableType A: Y-site with rubber buttonType A: Y-site with rubber button
ConfigurationsType B: Without Y-SiteType B: Without Y-Site
Type C: Y-site with luer lockType C: Y-site with luer lock
Mechanical
Instructions forUseSameSame
Operational
Device TypeStandard non-coring Huber needleSame
BiologicalBiocompatibility tests were performedaccording to ISO 10993 Parts 4, 5, 10and 11 as a prolonged duration, indirectblood path contacting device.Same
SterilizationMethodEthylene oxideSame

PVC:polyvinyl chloride PE:polyethylene PP:polypropylene POM: polyoxymethylene PC:polycarbonate IR:isoprene rubber PEI: polyetherimide ﻧ

7

NIPRO Huber Infusion Set

.

-5.4-

{4}------------------------------------------------

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/4/Picture/1 description: The image is a seal for the Department of Health & Human Services - USA. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

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

OCT 18 2012

Nipro Medical Corporation Ms. Jessica Oswald-McLeod Regulatory Affairs 3150 North West 107TH Avenue Miami. Florida 33172

Re: K113471

Trade/Device Name: Nipro Huber Infusion Set, Excel Huber Infusion Set Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: October 10, 2012 Received: October 11, 2012

Dear Ms. Oswald-McLeod:

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.

{5}------------------------------------------------

Page 2- Ms. Oswald-McLeod

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,

Anthony Imer

Anthony D. 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

{6}------------------------------------------------

Indications for Use

510(k) Number (if known): K113471

Device Name: NIPRO Huber Infusion Set /EXEL Huber Infusion Set

Indications for Use:

This device is intended for administration of drug solution, or blood sampling into/from a Reservoir implanted in the body.

Prescription Use X (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Rldi Cl 10/17/12

(Division Sign-Off)
Division of Anesthesiology, General Hospital
Division of Anesthesiology, Gental Devices
Confestion Control, Dental Devices (Division of Anesthesion of Anesthesion of Antess
Infection Control, Dental Demices of Antestion Coontrol, Infection Coontrol

Page 1 of 1

510(k) Number

§ 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.