K Number
K150513
Device Name
Imed Technology Intravascular Administration Set, Imed Technology Extension Set
Date Cleared
2015-05-28

(90 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
IMed Technology Intravascular administration sets and Imed Technology Extension sets intended use is to deliver sterile, infusion fluid from a container to the patient with or without flow control features. IMed Technology infusion tubing may act as an extension of other infusion tubing in delivering intravenous fluids from a container to patient.
Device Description
IMed Technology, Intravascular administration/extension set is sterile, non-pyrogenic, non-DEHP PVC tubing with the following combination of components. a. Universal Spike. Universal spike is constructed from ABS material and has a hydrophobic vent for transfer of fluids from closed containers such as infusion bottles. The spike dimensions are variable to deliver fluid at 10, 15, 20 and 60 drops per ml. Alternatively, the spike may have a luer lock at one end which connects to non-DEHP tubing for the purposes of transporting intravenous fluids from a vial to the patient. b. Drip chamber with 15 micron filter. The drip chamber is constructed from non-DEHP PVC or EVA, is flexible and has inbuilt 15 micron particulate disc filter which filters solution passing through it. c. Non-DEHP PVC tubing. Variable length non-DEHP PVC tubing with differing ID/OD combinations to ensure tubing performance. Extension tubing shall have ID/OD combinations of 0.03"/0.05" (minibore), 0.01"/0.03" (microbore), various lengths; 7" to 60". Infusion tubing shall have ID of 0.1" and OD of 0.125". Various combinations of the above tubing shall be designed to deliver desired performance. d. Flow Regulator. A commercially available dial type flow regulator may be incorporated in-line to control the flow rate of infusion fluids. The flow regulator will provide standard graduations of 5ml/hr to a maximum of 250ml/hr. The flow regulator shall be constructed from medical grade ABS and medical grade silicone disc. Optionally, a rate restricted tubing may be also incorporated in the infusion set whereby the ID and length of the tubing has been calibrated to provide a specific flow rate at gravity pressure from liquid height of 36-40" e. Roller clamp. A roller clamp may be inserted in combination with the above components to control flow rate or to turn fluid flow on and off. Roller clamp shall be constructed from medical grade ABS plastic f. Slide clamp. A slide clamp may be inserted in combination with the above components to turn the fluid flow on and off. Slide clamp shall be constructed from medical grade ABS material. g. Luer locks. Female luer locks and male luer locks may be a part of the infusion set as required and shall be constructed from medical grade ABS or non-DEHP hard PVC or medical grade PP. h. Filters. In-line air eliminating filters may be incorporated into the infusion tubing. These filters will have pore size of 0.2 micron or 1.2 micron and shall be constructed from medical grade PVC or medical grade ABS and cellulose acetate membrane. i. "Y" site (not made with natural rubber latex) or pre-approved needleless "Y" site for secondary infusions or medication administration. The "Y" site shall be integrated in combination with the above components and shall be constructed from hard PVC or PP or ABS (all components are medical grade). In case of an "injection port" (not made with natural rubber latex), the material shall be medical grade silicone.
More Information

Not Found

No
The device description details purely mechanical components for fluid delivery and flow control. There is no mention of any software, algorithms, or data processing that would indicate the use of AI or ML.

No.
The device is used to deliver sterile infusion fluid from a container to the patient; it does not treat a disease or condition itself.

No

This device is an infusion tubing set designed to deliver fluids to a patient, not to diagnose a medical condition. Its components facilitate fluid transfer and flow control.

No

The device description details numerous physical components made of various materials (ABS, PVC, EVA, silicone, PP, cellulose acetate membrane). This clearly indicates it is a hardware device, not software-only.

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

Here's why:

  • Intended Use: The intended use is clearly stated as "to deliver sterile, infusion fluid from a container to the patient". This describes a device used for administering substances into the body, not for testing samples from the body to diagnose conditions.
  • Device Description: The components listed (spikes, drip chambers, tubing, clamps, filters, luer locks, Y-sites) are all consistent with devices used for intravenous fluid administration. There are no components described that would be used for analyzing biological samples.
  • Lack of IVD Characteristics: The description does not mention any features related to:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring specific substances in samples
    • Providing diagnostic information

Therefore, the IMed Technology Intravascular administration sets and Imed Technology Extension sets are devices for administering fluids intravenously, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

IMed Technology Intravascular administration set and Imed Technology Extension sets intended use is to deliver sterile, infusion fluid from a container to the patient with or without flow control features. IMed Technology infusion tubing may act as an extension of other infusion tubing in delivering intravenous fluids from a container to patient.

Prescription Use
AND/OR
Over-The-Counter Use

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

FPA

Device Description

IMed Technology, Intravascular administration/extension set is sterile, non-pyrogenic, non-DEHP PVC tubing with the following combination of components.

  • Universal Spike. Universal spike is constructed from ABS material and has a a. hydrophobic vent for transfer of fluids from closed containers such as infusion bottles. The spike dimensions are variable to deliver fluid at 10, 15, 20 and 60 drops per ml. Alternatively, the spike may have a luer lock at one end which connects to non-DEHP tubing for the purposes of transporting intravenous fluids from a vial to the patient.
  • Drip chamber with 15 micron filter. The drip chamber is constructed from nonb. DEHP PVC or EVA, is flexible and has inbuilt 15 micron particulate disc filter which filters solution passing through it.
  • Non-DEHP PVC tubing. Variable length non-DEHP PVC tubing with differing C. ID/OD combinations to ensure tubing performance. Extension tubing shall have ID/OD combinations of 0.03"/0.05" (minibore), 0.01"/0.03" (microbore), various lengths; 7" to 60". Infusion tubing shall have ID of 0.1" and OD of 0.125". Various combinations of the above tubing shall be designed to deliver desired performance.
  • d. Flow Regulator. A commercially available dial type flow regulator may be incorporated in-line to control the flow rate of infusion fluids. The flow regulator will provide standard graduations of 5ml/hr to a maximum of 250ml/hr. The flow regulator shall be constructed from medical grade ABS and medical grade silicone disc. Optionally, a rate restricted tubing may be also incorporated in the infusion set whereby the ID and length of the tubing has been calibrated to provide a specific flow rate at gravity pressure from liquid height of 36-40"
  • e. Roller clamp. A roller clamp may be inserted in combination with the above components to control flow rate or to turn fluid flow on and off. Roller clamp shall be constructed from medical grade ABS plastic
  • f. Slide clamp. A slide clamp may be inserted in combination with the above components to turn the fluid flow on and off. Slide clamp shall be constructed from medical grade ABS material.
  • g. Luer locks. Female luer locks and male luer locks may be a part of the infusion set as required and shall be constructed from medical grade ABS or non-DEHP hard PVC or medical grade PP.
  • h. Filters. In-line air eliminating filters may be incorporated into the infusion tubing. These filters will have pore size of 0.2 micron or 1.2 micron and shall be constructed from medical grade PVC or medical grade ABS and cellulose acetate membrane.
  • i. "Y" site (not made with natural rubber latex) or pre-approved needleless "Y" site for secondary infusions or medication administration. The "Y" site shall be integrated in combination with the above components and shall be constructed from hard PVC or PP or ABS (all components are medical grade). In case of an "injection port" (not made with natural rubber latex), the material shall be medical grade silicone.

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)

Bench Testing: USP Physicochemical tests for plastics and performance testing compliant with ISO Standards. Meets the acceptance criteria as specified in ISO 8536-4: 2010.

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.

Acta Medical Intravascular Administration Set (K121803)

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

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

May 28, 2015

Imed Technology, Inc. Mr. Kyle Adams President 2544 Tarpley Rd., Suite 112 Carrollton, Texas 75006

Re: K150513

Trade/Device Name: Imed Technology Intravascular Administration Sets and Imed Technology Extension Set Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: January 28, 2015 Received: February 27, 2015

Dear Mr. Adams:

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.

1

Page 2 - Mr. Kyle Adams

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/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Tina Kiang -S

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

Enclosure

2

Indications for Use

510(k) Number (if known):__K150513

Device Name: I Med Technology Intravascular Administration Set and Imed Technology Extension sets

Indications For Use: IMed Technology Intravascular administration set and Imed Technology Extension sets intended use is to deliver sterile, infusion fluid from a container to the patient with or without flow control features. IMed Technology infusion tubing may act as an extension of other infusion tubing in delivering intravenous fluids from a container to patient.

Prescription Use ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------(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)

3

IMed Technology, LLC

Date Submitted:May 1, 2015
Submitted By:iMed Technology, Inc
2515 Tarpley Road, Suite 104
Carrollton, TX 75006
Tel: 972-732-7333
Contact email: kyle.adams@imedtechnology.com
Subject Device Name:Imed Technology Intravascular Administration sets
and Imed Technology Extension sets
Common Name of Device:Intravascular Administration Set
Predicate Device:Acta Medical Intravascular Administration Set (K121803)
Panel:General Hospital and Personal Use
Product Code:FPA
Device Classification:21 CFR880.5440, Class II

4

Name & Model Numbers of Devices.

    1. IMEDINF01, Intravascular administration set
    1. IMEDINF02, Intravascular administration set with 0.2 micron filter
    1. IMEDINF03, Intravascular administration set with flow regulator
    1. IMEDINF04, Intravascular administration set with flow regulator, 0.2 micron filter
    1. IMEDEXT01, Minibore extension set

Other Model Numbers and configurations may be assembled per customer request

Device Classification

  • Set, Administration, Intravascular a.
  • b. FPA
  • 21CFR880.5440 C.
  • d. Device Classification II

Indications For Use

IMed Technology Intravascular administration sets and Imed Technology Extension sets intended use is to deliver sterile, infusion fluid from a container to the patient with or without flow control features. IMed Technology infusion tubing may act as an extension of other infusion tubing in delivering intravenous fluids from a container to patient.

Device Description

IMed Technology, Intravascular administration/extension set is sterile, non-pyrogenic, non-DEHP PVC tubing with the following combination of components.

  • Universal Spike. Universal spike is constructed from ABS material and has a a. hydrophobic vent for transfer of fluids from closed containers such as infusion bottles. The spike dimensions are variable to deliver fluid at 10, 15, 20 and 60 drops per ml. Alternatively, the spike may have a luer lock at one end which connects to non-DEHP tubing for the purposes of transporting intravenous fluids from a vial to the patient.
  • Drip chamber with 15 micron filter. The drip chamber is constructed from nonb. DEHP PVC or EVA, is flexible and has inbuilt 15 micron particulate disc filter which filters solution passing through it.
  • Non-DEHP PVC tubing. Variable length non-DEHP PVC tubing with differing C. ID/OD combinations to ensure tubing performance. Extension tubing shall have ID/OD combinations of 0.03"/0.05" (minibore), 0.01"/0.03" (microbore), various lengths; 7" to 60". Infusion tubing shall have ID of 0.1" and OD of 0.125". Various combinations of the above tubing shall be designed to deliver desired performance.

5

  • d. Flow Regulator. A commercially available dial type flow regulator may be incorporated in-line to control the flow rate of infusion fluids. The flow regulator will provide standard graduations of 5ml/hr to a maximum of 250ml/hr. The flow regulator shall be constructed from medical grade ABS and medical grade silicone disc. Optionally, a rate restricted tubing may be also incorporated in the infusion set whereby the ID and length of the tubing has been calibrated to provide a specific flow rate at gravity pressure from liquid height of 36-40"
  • e. Roller clamp. A roller clamp may be inserted in combination with the above components to control flow rate or to turn fluid flow on and off. Roller clamp shall be constructed from medical grade ABS plastic
  • f. Slide clamp. A slide clamp may be inserted in combination with the above components to turn the fluid flow on and off. Slide clamp shall be constructed from medical grade ABS material.
  • g. Luer locks. Female luer locks and male luer locks may be a part of the infusion set as required and shall be constructed from medical grade ABS or non-DEHP hard PVC or medical grade PP.
  • h. Filters. In-line air eliminating filters may be incorporated into the infusion tubing. These filters will have pore size of 0.2 micron or 1.2 micron and shall be constructed from medical grade PVC or medical grade ABS and cellulose acetate membrane.
  • i. "Y" site (not made with natural rubber latex) or pre-approved needleless "Y" site for secondary infusions or medication administration. The "Y" site shall be integrated in combination with the above components and shall be constructed from hard PVC or PP or ABS (all components are medical grade). In case of an "injection port" (not made with natural rubber latex), the material shall be medical grade silicone.

Specification & Dimensions

IMed Technology, Intravascular Administration Set will have the following dimensional specifications:

  • a. Infusion tubing OD = 4.1mm, ID = 3.0mm (approximately)
  • b. Extension tubing regular bore OD = 2.7mm, ID = 1.6mm (approximately)
  • c. Extension tubing minibore OD = 2.0mm, ID = 1.0mm (approximately)
  • d. Extension tubing microbore OD = 1.6mm. ID = 0.6mm (approximately)
  • e. Additional custom dimensions may be manufactured for customers
  • f. Length may vary from 5" for extension set to 105" for primary infusion set

Materials

Acrylonitrile Butadiene Styrene Non-DEHP Poly Vinyl Chloride Polypropylene (non fluid pathway material, utilized in protective caps only) Silicone

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COMPARISON TABLE

IMed Technology Intravascular Administration Set Comparison To Acta Medical Intravascular Administration Set (K121803)

| Feature | Details | Predicate Device
K121803 | Conclusion |
|-------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------|
| Intended Use | IMed
Technology,
Intravascular
Administration
set intended use
is to deliver
sterile, infusion
fluid from a
container to the
patient with or
without flow
control features. | Acta Medical
Intravascular
Administration set
intended use is to
deliver sterile,
infusion fluid from a
container to the
patient with or
without flow control
features. | Substantially
Equivalent |
| Design and Materials
of Construction | The materials of
construction for the
proposed device are
exactly the same as the
materials for the
predicate product | The design and
materials of
construction remain
the same as the
predicate product. | Substantially
Equivalent |
| Labeling | Compliant with
21CFR807.87 | Compliant with
21CFR807.87 | Substantially
Equivalent |
| Biocompatibility | Meets requirements for
ISO 10993-1, External
Communicating Device,
Blood Path Indirect,
Contact Duration A | Meets requirements
for ISO 10993-1,
External
Communicating
Device, Blood Path
Indirect, Contact
Duration A | Substantially
Equivalent |
| Bench Testing | USP Physicochemical
tests for plastics and
performance testing
compliant with ISO
Standards | USP
Physicochemical
tests for plastics and
performance testing
compliant with ISO
Standards | Substantially
Equivalent |
| Sterilization | Sterility assurance level
of 10-6 | Sterility assurance
level of 10-6 | Substantially
Equivalent |
| Labeling | As per Guidance Document | As per Guidance Document | Substantially Equivalent |
| ISO 8536-4:2010 tests
for Intravascular
Administration sets | Meets the acceptance
criteria as specified in
ISO 8536-4: 2010 | Meets the
acceptance criteria
as specified in ISO
8536-4: 2010 | Substantially
Equivalent |

7

Substantial Equivalence:

IMed Technology, Intravascular Administration Set is substantially equivalent to the predicate device, Acta Medical Intravascular Administration Set (K121803). The component materials, indication for use, SAL are substantially equivalent and present no additional concerns as compared to the predicate device.