K Number
K122686
Device Name
ACCU-CHEK ULTRAFLEX INFUSION SET
Date Cleared
2012-11-16

(73 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The ACCU-CHEK® Ultraflex is an infusion set for the subcutaneous infusion of insulin administered with microdosage insulin pumps.
Device Description
The ACCU-CHEK Ultraflex is an ethylene oxide sterilized, single-use, disconnectable infusion set with soft cannula perpendicular to the adhesive, for transfusion of insulin into the subcutaneous tissue. The infusion set includes a stainless steel introducer needle to facilitate insertion of the soft cannula into the dermis. The unit is designed to interface with commercially available insulin infusion pumps with suitable luer connections. The insulin infusion pump systems are designed to control the delivery of U100 insulin as prescribed by a health care professional. The system (infusion set, insulin infusion pump, and insulin) is indicated for patients with insulin dependent diabetes mellitus.
More Information

Not Found

No
The summary describes a mechanical infusion set and does not mention any AI or ML components or functionalities.

Yes
The device is used for the subcutaneous infusion of insulin, which is a therapeutic intervention for patients with insulin-dependent diabetes mellitus.

No
The device is described as an "infusion set for the subcutaneous infusion of insulin," indicating it is used for delivery of substances, not for diagnosing conditions.

No

The device description clearly describes a physical infusion set with a soft cannula, introducer needle, and adhesive, which are hardware components.

Based on the provided text, the ACCU-CHEK® Ultraflex is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for the "subcutaneous infusion of insulin administered with microdosage insulin pumps." This describes a device used in vivo (within the body) for delivering medication.
  • Device Description: The description details a device for "transfusion of insulin into the subcutaneous tissue," involving a cannula and introducer needle for insertion into the body.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens from the human body (like blood, urine, tissue) in vitro (outside the body) to provide information for diagnosis, monitoring, or screening. The ACCU-CHEK Ultraflex does not perform any such analysis of bodily specimens.

Therefore, the ACCU-CHEK Ultraflex is a medical device used for drug delivery, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The ACCU-CHEK® Ultraflex is an infusion set for the subcutaneous infusion of insulin administered with microdosage insulin pumps.

Product codes (comma separated list FDA assigned to the subject device)

FPA

Device Description

The ACCU-CHEK Ultraflex is an ethylene oxide sterilized, single-use, disconnectable infusion set with soft cannula perpendicular to the adhesive, for transfusion of insulin into the subcutaneous tissue. The infusion set includes a stainless steel introducer needle to facilitate insertion of the soft cannula into the dermis. The unit is designed to interface with commercially available insulin infusion pumps with suitable luer connections. The insulin infusion pump systems are designed to control the delivery of U100 insulin as prescribed by a health care professional. The system (infusion set, insulin infusion pump, and insulin) is indicated for patients with insulin dependent diabetes mellitus.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

subcutaneous tissue

Indicated Patient Age Range

Not Found

Intended User / Care Setting

healthcare professional

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)

Non-clinical testing of the modified ACCU-CHEK Ultraflex Infusion Set demonstrated that the device meets the requirements for its intended use. The data also demonstrates that the ACCU-CHEK Ultraflex Infusion Set is substantially equivalent to the predicate device. Non-clinical testing included: soft cannula length confirmation, introducer needle length confirmation, insertion force, and system functional verification testing. Clinical testing was not required to validate the device modification or support substantial equivalence.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K101196 ACCU-CHEK Ultraflex Infusion Set

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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

K122686

510(k) Summary Page 1 of 2

ACCU-CHEK®Ultraflex Infusion Set

510(k) Summary

Date of Summary:August 29, 2012
Submitter:Roche Diabetes Care AG
Kirchbergstrasse 190
CH-3401 Burgdorf, Switzerland
NOV 16 2012
Contact Person:Catherine Green
Regulatory Affairs Manager
Roche Diabetes Care AG
Kirchbergstrasse 190, CH-3401 Burgdorf, Switzerland
Tel: +41-34-424 2272, catherine.green@roche.com
Device Trade Name:ACCU-CHEK® Ultraflex Infusion Set
Device Common Name:Subcutaneous infusion set
Classification name:Intravascular administration set
Regulation Number:21 CFR 880.5440
Product Code and Class:FPA, Class II
Predicate DeviceK101196 ACCU-CHEK Ultraflex Infusion Set

Device Description

The ACCU-CHEK Ultraflex is an ethylene oxide sterilized, single-use, disconnectable infusion set with soft cannula perpendicular to the adhesive, for transfusion of insulin into the subcutaneous tissue. The infusion set includes a stainless steel introducer needle to facilitate insertion of the soft cannula into the dermis. The unit is designed to interface with commercially available insulin infusion pumps with suitable luer connections. The insulin infusion pump systems are designed to control the delivery of U100 insulin as prescribed by a health care professional. The system (infusion set, insulin infusion pump, and insulin) is indicated for patients with insulin dependent diabetes mellitus.

Intended Uses

The ACCU-CHEK Ultraflex is an infusion set for the subcutaneous infusion of insulin administered with microdosage insulin pumps.

1

Technological Characteristics

The modified ACCU-CHEK Ultraflex infusion set uses the same materials and design as the predicate device. The modified ACCU-CHEK Ultraflex infusion set provides a 6mm cannula length variant. The predicate device includes cannula lengths of 8mm and 10mm. There are no other significant differences between the modified ACCU-CHEK Ultraflex and the predicate ACCU-CHEK Ultraflex. The fundamental scientific technology, indications for use, intended use, materials, design, sterilization and packaging are identical between the proposed and predicate devices.

Dimensional characteristics of the predicate compared to the modified device are listed below. ·

FeaturePredicateModified
Cannula length8mm, 10mm6mm, 8mm, 10mm
Tube Length30, 60, 80, 110 cm30, 60, 80, 110 cm
Tubing ID/OD0.39 mm x 1.46 mm0.39 mm x 1.46 mm
Priming Volume
(average for tube set + 1
IU for priming head set)69μl, 104μl, 128μl, 163μl69μl, 104μl, 128μl, 163μl

Performance Standards

To date, no performance standards that affect this device have been finalized under Section 514 of the Act.

FDA has published a guidance document for review of intravascular administration sets entitled, Guidance on Premarket Notification for Intravascular Administrations Sets. FDA has also published a guidance document for review of external infusion pumps entitled. Guidance On The Content Of Premarket Notification [510(k)] Submissions For External Infusion Pumps and a draft update entitled, Guidance for Industry and FDA Staff - Total Product Life Cycle: Infusion Pump - Premarket Notification [510(k)] Submissions. FDA has published a guidance document for review of medical devices with sharps entitled, Supplementary Guidance on Premarket Notifications for Medical Devices with Sharps Injury Prevention Features: Guidance for Industry and FDA. Roche has evaluated this modified device according to the recommendations provided in these guidance documents and our internal system development guidelines and standard operating procedures.

Testing Conclusions

Non-clinical testing of the modified ACCU-CHEK Ultraflex Infusion Set demonstrated that the device meets the requirements for its intended use. The data also demonstrates that the ACCU-CHEK Ultraflex Infusion Set is substantially equivalent to the predicate device. Non-clinical testing included: soft cannula length confirmation, introducer needle length confirmation, insertion force, and system functional verification testing.

Clinical testing was not required to validate the device modification or support substantial equivalence.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

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 stylized eagle with three tail feathers, representing the department's commitment to health, human services, and well-being. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular fashion around the eagle.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

November 16, 2012

Ms. Catherine Green Regulatory Affairs Manager Roche Diabetes Care AG Kirchbergstrasse 190 Burgdorf, Switzerland CH-3401

Re: K122686

Trade/Device Name: ACCU-CHEK® Ultraflex Infusion Set Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: October 18, 2012 Received: October 19, 2012

Dear Ms. Green:

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.

3

Page 2 - Ms. Green

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 vours,

( Le trans ": Weter -

DN: c=US, o=U.S. Government, ou=HHS. ou=FDA. ou=People cn=Anthony D. Watson, 0.9.2342.19200300.100.1.1=13000 92402

Anthony D. Watson, B.S., M.S., M.B.A. Director

Division of Anesthesiology, General Hospital, Respiratory, 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): K 122686

Device Name: ACCU-CHEK® Ultraflex Infusion Set

Indications For Use:

The ACCU-CHEK® Ultraflex is an infusion set for the subcutaneous infusion of insulin administered with microdosage insulin pumps.

Digitally signed by Richard C.
Chapman
Date: 2012.11.16 08:33:21 -05'00'

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

·K 122686 510(k) Numbar:

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 IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)