K Number
K140133
Device Name
INFUSET FLOW CONTROL EXTENSION SET
Date Cleared
2014-05-15

(118 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Infuset™ Flow Control Extension Set is intended for use with the RMS Freedom 60 Syringe Infusion Pump System to provide flow rate control to administer fluids from a contained to a patient's vascular system.
Device Description
EMED Infuset™ Flow Control Extension Sets are disposable devices allowing users to obtain a controlled and precise rate of fluid flow when used with the RMS Freedom 60 Syringe Infusion Pump System. Each Infuset™ Flow Control Extension Sets consist of a given length of medium-density PVC tubing and rigid PVC standard luer lock connectors. Robust componentry and bonding techniques allow the Infuset™ Flow Control Extension Sets to withstand fluid pressures up to 25 psi. These sets can be physically connected to fluid sources compatible with the Freedom60 Syringe Infusion System and patient administrations sets using the standard luer lock connectors. The Infuset™ Flow Control Extension Sets are provided sterile for single use. The Infuset™ Flow Control Extension Sets rely upon the properties inherent to the static fluid path dimensions dictated by the Infuset™ Flow Control Extension Set length and tubing inner diameter to provide a precise, controlled flow rate. This follows the Poiseuille equation in that pressure, length of fluid path, diameter of fluid path, and viscosity of a fluid in a system directly influence resultant flow rates of that fluid. Available configurations with differing lengths and tubing diameters offer users several target flow rates to choose from.
More Information

Not Found

No
The device description relies on static physical properties and the Poiseuille equation for flow control, with no mention of AI or ML.

No.
The device described is an extension set that provides flow rate control for administering fluids, but it does not directly treat or diagnose a disease or condition; it is an accessory to a therapeutic device (the infusion pump).

No.
The document describes a device that controls the flow rate of fluids being administered to a patient, which is a therapeutic function, not a diagnostic one used to identify a disease or condition.

No

The device description explicitly details physical components like PVC tubing and luer lock connectors, and the performance studies focus on physical properties like flow rate and pressure, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is to "administer fluids from a contained to a patient's vascular system." This describes a device used for delivering substances into the body, not for testing samples from the body to diagnose or monitor a condition.
  • Device Description: The description focuses on the physical properties of the tubing and connectors for controlling fluid flow. It does not mention any components or functions related to analyzing biological samples.
  • Anatomical Site: The anatomical site is the "patient's vascular system," which is where the fluid is being delivered, not where a sample is being taken for analysis.
  • Performance Studies: The performance studies focus on flow rate control and pressure, which are relevant to fluid delivery, not diagnostic testing.

IVD devices are used to examine specimens derived from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, monitoring, or treatment of a disease or condition. This device does not perform such a function.

N/A

Intended Use / Indications for Use

The Infuset™ Flow Control Extension Set is intended for use with the RMS Freedom 60 Syringe Infusion Pump System to provide flow rate control to administer fluids from a contained to a patient's vascular system.

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

FPA

Device Description

EMED Infuset™ Flow Control Extension Sets are disposable devices allowing users to obtain a controlled and precise rate of fluid flow when used with the RMS Freedom 60 Syringe Infusion Pump System.

Each Infuset™ Flow Control Extension Sets consist of a given length of medium-density PVC tubing and rigid PVC standard luer lock connectors. Robust componentry and bonding techniques allow the Infuset™ Flow Control Extension Sets to withstand fluid pressures up to 25 psi. These sets can be physically connected to fluid sources compatible with the Freedom60 Syringe Infusion System and patient administrations sets using the standard luer lock connectors. The Infuset™ Flow Control Extension Sets are provided sterile for single use.

The Infuset™ Flow Control Extension Sets rely upon the properties inherent to the static fluid path dimensions dictated by the Infuset™ Flow Control Extension Set length and tubing inner diameter to provide a precise, controlled flow rate. This follows the Poiseuille equation in that pressure, length of fluid path, diameter of fluid path, and viscosity of a fluid in a system directly influence resultant flow rates of that fluid. Available configurations with differing lengths and tubing diameters offer users several target flow rates to choose from.

This basic construction and principle of action are essentially identical to that of the predicate flow control accessory that has had market clearance and been actively marketed for decades.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

patient's vascular system

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)

Table 5-2 summarizes testing results performed to establish conformance of the Infuset™ Flow Control Extension Sets to internal product specifications and requirements, as well as equivalence to the predicate device.

Flow Rate Control (0.9% saline at 20-23°C, with Freedom60):

  • Range: 202-2244 ml/hr
  • Precision: Less than 5% RSD
  • Accuracy: +/- 10%

Pressure: Not Less than 25 psi

The outcomes of these tests further indicate that the Infuset™ Flow Control Extension Set is substantially equivalent to the predicate accessory in performance, effectiveness, and safety.

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.

K933652

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

MAY 1 5 2014

Section 5. 510(k) Summary

K Number

Submission Date:

January 16, 2014

General Information

Classification

Trade Name

Class II

Infuset™ Flow Control Extension Set

Common Name:

I.V. Flow Controller

Classification Name and Reference:

Intravascular Administration Set

21 CFR §880.5440

Submitter

Peter Kollings EMED Technologies Corporation 1264 Hawks Flight Ct., Ste. 200 El Dorado Hills, Ca 95762 Tel: 916.932.0071 x114 Fax: 916.932.0074

Intended Use

Infuset™ Flow Control Extension Sets are intended for use with the RMS Freedom 60 Syringe Infusion Pump System to provide flow rate control to administer fluids from a container to a patient's vascular system.

Predicate Device(s)

Freedom 60 Syringe Infusion Pump System (K933652)

Device Description

EMED Infuset™ Flow Control Extension Sets are disposable devices allowing users to obtain a controlled and precise rate of fluid flow when used with the RMS Freedom 60 Syringe Infusion Pump System.

Each Infuset™ Flow Control Extension Sets consist of a given length of medium-density PVC tubing and rigid PVC standard luer lock connectors. Robust componentry and bonding techniques allow the Infuset™ Flow Control Extension Sets to withstand fluid pressures up to 25 psi. These sets can be physically connected to fluid sources

1

compatible with the Freedom60 Syringe Infusion System and patient administrations sets using the standard luer lock connectors. The Infuset™ Flow Control Extension Sets are provided sterile for single use.

The Infuset™ Flow Control Extension Sets rely upon the properties inherent to the static fluid path dimensions dictated by the Infuset™ Flow Control Extension Set length and tubing inner diameter to provide a precise, controlled flow rate. This follows the Poiseuille equation in that pressure, length of fluid path, diameter of fluid path, and viscosity of a fluid in a system directly influence resultant flow rates of that fluid. Available configurations with differing lengths and tubing diameters offer users several target flow rates to choose from.

This basic construction and principle of action are essentially identical to that of the predicate flow control accessory that has had market clearance and been actively marketed for decades.

Materials and Characteristics

Infuset™ Flow Control Extension Sets are equivalent in performance, physical properties, using similar materials, and having the same indications for use as the predicate. Therefore no new issues of safety or effectiveness are introduced by the minimal differences in design.

Table 5-1 below provides a comparison of technological and other characteristics of the EMED Infuset™ Flow Control Extension Sets and the predicate.

| | Infuset™ Flow Control
Extension Sets | RMS Precision Flow Rate
Tubing Sets (K933652) |
|------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications
for Use | Intended for use with the RMS
Freedom 60 Syringe Infusion
Pump System to provide flow
rate control to administer fluids
from a container to a patient's
vascular system. | Intended for use with the RMS
Freedom 60 Syringe Infusion
Pump System to provide flow
rate control to administer fluids
from a container to a patient's
vascular system. |
| Material | PVC | PVC |
| Design –
Lengths | 7.5 cm - 97 cm | 34.3 cm - 100 cm |
| Design –
components | Male Luer Lock
Tubing
Female Luer Lock
Slide Clamp | Male Luer Lock
Tubing
Female Luer Lock
Slide Clamp |

Table 5-1

2

| | Infuset™ Flow Control
Extension Sets | RMS Precision Flow Rate
Tubing Sets (K933652) |
|-----------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Design -
Approximate
Residual
Volume | 0.10 – 0.20 ml | 0.01 – 0.09 ml |
| Principle of
Flow Rate
Control | The internal fluid path
dimensions of each Infuset
configuration is fixed, thereby
providing a single flow rate for
each configuration. | The internal fluid path
dimensions of each RMS flow
rate tubing set configuration is
fixed, thereby providing a single
flow rate for each configuration. |
| Method of
Sterilization | Ethylene Oxide (ETO) | Radiation |

Performance

Table 5-2 below summarizes testing results performed to establish conformance of the Infuset™ Flow Control Extension Sets to internal product specifications and requirements, as well as equivalence to the predicate device.

Table 5-2

| | Infuset™ Flow Control
Extension Sets. | RMS Precision Flow
Rate Tubing Sets
(K933652) |
|----------------------------------------------------------------------|-------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------|
| Flow Rate Control
(0.9% saline at 20-
23°C, with
Freedom60) | Range:
202-2244 ml/hr

Precision
Less than 5% RSD

Accuracy:
+/- 10% | Range:
47 - 1743 ml/hr

Precision
Less than 5% RSD

Accuracy:
-27% to + 38% |
| Pressure | Not Less than 25 psi | Not Less than 15 psi |

The outcomes of these tests further indicate that the Infuset™ Flow Control Extension Set is substantially equivalent to the predicate accessory in performance, effectiveness, and safety.

3

Biocompatibility

In accordance with ISO 10993-1:2009 and based on the intended use of the Infuset™ Flow Control Extension Sets, studies were performed including the following: cytotoxicity, sensitization, irritation, acute systemic toxicity, pyrogenicity, and hemocompatibility. Table 5-3 presents a summary of testing and results indicating compliance with biocompatibility standards.

Table 5-3

| Standard | Test Name | Test
Result | Other Name |
|--------------|----------------------------|----------------|---------------------------------------------------------|
| ISO 10993-5 | Cytotoxicity | Pass | Neutral Red Uptake |
| ISO 10993-10 | Sensitization | Pass | Kligman Maximization |
| ISO 10993-10 | Irritation | Pass | Intracutaneous Injection |
| ISO 10993-11 | Acute systemic
toxicity | Pass | Systemic Injection |
| ISO 10993-11 | Pyrogenicity | Pass | Rabbit Pyrogen |
| ISO 10993-4 | Hemocompatibility | Pass | Unactivated Partial Throbmoplastin
Time |
| ASTM 756 | Hemocompatibility | Pass | Hemolysis (complete) |
| USP | LAL Endotoxin
Test | Pass | LAL Endotoxin Quantitation Test
(Kinetic-QCL Method) |

Sterility, Shelf-life, and Packaging

The Infuset™ Flow Control Extension Sets will be sterilized to a sterility assurance level (SAL) of 10t and with a shelf life of 5 years.

Summary of Substantial Equivalence

EMED Technologies Corporation Infuset™ Flow Control Extension Sets are substantially equivalent to the commercially available predicate device accessory in terms of function, safety, performance, intended use, technology/principles and mechanical properties. Differences between the EMED Infuset™ Flow Control Extension Sets and the predicate do not raise any new issues of safety or effectiveness.

4

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ood and Drug Administration 903 New Hampshire Avenue Document Control Center - WO66-G60 Silver Spring, MD 20993-0002

May 15, 2014

EMED Technologies Corporation Peter Kollings Director Regulatory Affairs and Quality Assurance 1264 Hawks Flight Ct., Ste. 200 El Dorado Hills, CA 95762

Re: K140133

Trade/Device Name: Infuset Flow Control Extension Set Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular administration set Regulatory Class: Class II Product Code: FPA Dated: April 11, 2014 Received: April 15, 2014

Dear Mr. Kollings:

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 - Mr. Kollings

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. 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,

Mary S. Runner -S

Erin I. Keith, M.S. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K140133

Device Name

Infuset™ Flow Control Extension Set

Indications for Use (Describe)

The Infuset™ Flow Control Extension Set is intended for use with the RMS Freedom 60 Syringe Infusion Pump System to provide flow rate control to administer fluids from a contained to a patient's vascular system.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

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

Form Approved: OMB No. 0910-0120

Expiration Date: January 31, 2017

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FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

Digitally signed by Richard C. Chapman Date: 2014.05.15 11:50:03 -04'00'

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