K Number
K151969
Device Name
Hospira Extension Sets
Manufacturer
Date Cleared
2016-01-19

(187 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Hospira Extension sets are indicated for the delivery of fluids from a container to a patient's vascular system.
Device Description
The Hospira Extension Sets are intended for use as gravity sets. Hospira Extension sets are comprised of various components including the following: male luer adapter with cap, tubing, female luer adapter, flow control device, in-line adapter, injection site assembly, and Dial-A-Flo. Extension sets are configured to ensure the intended use of the device is met. Hospira Extension sets are intended for the delivery of fluids from a container to a patient's vascular system. The sets are disposable devices for single patient use.
More Information

No
The device description and performance studies focus on the physical components and basic fluid delivery function, with no mention of AI/ML terms or capabilities.

No
The device is used for the delivery of fluids, which is a supportive function rather than directly treating a disease or condition.

No

Explanation: The device is described as an extension set for delivering fluids to a patient's vascular system. Its purpose is to facilitate fluid delivery, not to diagnose a condition.

No

The device description clearly lists physical components such as tubing, luer adapters, and a flow control device, indicating it is a hardware-based medical device.

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

Here's why:

  • Intended Use: The intended use is "for the delivery of fluids from a container to a patient's vascular system." This describes a device used in vivo (within the body) for administering substances, not for testing samples in vitro (outside the body) to diagnose conditions.
  • Device Description: The description details components like tubing, luers, and flow control devices, which are typical of infusion sets used for delivering fluids directly to a patient. There is no mention of components or functions related to analyzing biological samples.
  • Lack of IVD Indicators: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring analytes
    • Providing diagnostic information
    • Reagents or test kits

The device is clearly intended for direct patient treatment through fluid delivery, which falls under the category of therapeutic or delivery devices, not in vitro diagnostics.

N/A

Intended Use / Indications for Use

Hospira Extension Sets are indicated for the delivery of fluids from a container to a patient's vascular system.

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

FPA

Device Description

The Hospira Extension Sets are intended for use as gravity sets. Hospira Extension sets are comprised of various components including the following: male luer adapter with cap, tubing, female luer adapter, flow control device, in-line adapter, injection site assembly, and Dial-A-Flo. Extension sets are configured to ensure the intended use of the device is met. Hospira Extension sets are intended for the delivery of fluids from a container to a patient's vascular system. The sets are disposable devices for single patient use.

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)

Performance testing was conducted to ensure the device performs as intended in accordance with applicable standards. All testing is acceptable.
The product Sterility Assurance Level is 10-6.
New performance data has been generated to ensure the device performs as intended in accordance with ISO 594-1, ISO 594-2, and ISO 8536-4. All testing is acceptable.
ISO Standard Section Tested ISO 594-1 4.1 Gauging, 4.2 Liquid Leakage, 4.3 Air Leakage, 4.4 Separation Force, 4.5 Stress Cracking.
ISO 594-2 4.1 Gauging, 4.2 Liquid Leakage, 4.3 Separation Force, 4.4 Unscrewing Torque, 4.5 Ease of Assembly, 4.6 Resistance to Overriding, 4.7 Stress Cracking.
ISO 8536-4 6.1 Particulate Contamination, 6.2 Leakage, 6.3 Tensile Strength, 6.6 Tubing, 6.7 Fluid Filter, 6.9 Flow Regulator, 6.10 Flow Rate, 6.11 Injection Site, 6.12 Male Conical Fitting, 6.13 Protective Caps.
Sterilization validation has been conducted based on the ANSI/AAMI/ISO 11137-1 and ANSI/AAMI/ISO 11737-1 international standards for sterilization of medical devices. All testing is acceptable. The product Sterility Assurance Level is 10-6.

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.

K142974, K142433

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.

K970855

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

January 19, 2016

Hospira, Inc. Mr. Charles Neitzel Senior Regulatory Affairs Specialist 375 Field Drive Lake Forest, Illinois 60045

Re: K151969

Trade/Device Name: Hospira Extension Sets Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Sets Regulatory Class: II Product Code: FPA Dated: December 15, 2015 Received: December 17, 2015

Dear Mr. Charles Neitzel:

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

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 Industry and Consumer Education 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. 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 Industry and Consumer Education 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 vours.

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

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Indications for Use

510(k) Number (if known) K151969

Device Name Hospira Extension Sets

Indications for Use (Describe)

Hospira Extension sets are indicated for the delivery of fluids from a container to a patient's vascular system.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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Image /page/3/Picture/1 description: The image shows the logo for Hospira. The logo consists of the word "Hospira" in a gray, sans-serif font, with a stylized graphic above it. The graphic is composed of three curved lines that converge at the top, resembling a stylized leaf or abstract shape. The overall design is simple and modern.

510(k) Summary Section 5

A summary of 510(k) substantial equivalence information in accordance with the requirements of 21 CFR 807.92 for Hospira Extension Sets.

Submitter Information
NameHospira, Incorporated
AddressD-393, Bldg. H3
375 North Field Drive
Lake Forest, IL. 60046
Phone number(224) 212-6087
Fax number(224) 212-5401
Establishment Registration
Number3005579246 (Owner/Operator #9063339)
Name of contact personCharles Neitzel, Senior Regulatory Affairs Specialist
Date preparedJanuary 13, 2016
Name of device
Trade or proprietary nameHospira Extension Sets
Common or usual nameI.V Administration Sets
Classification nameIntravascular Administration Set, 21 CFR 880.5440, Class II
Product Code(s)FPA
Legally marketed device(s) to
which equivalence is claimedExtension Sets - K142974
Hospira Extension Sets – K142433
Reason for 510(k) submissionThe changes addressed in this submission include:
  1. Hospira is changing the tubing material formulation currently used in Hospira
    Extension Sets.
  2. Hospira is replacing the needleless valve Clave™ component on certain IV
    administration Hospira Extension Sets with the MicroClave™ component. |
    | Device description | The Hospira Extension Sets are intended for use as gravity sets. Hospira Extension
    sets are comprised of various components including the following: male luer adapter
    with cap, tubing, female luer adapter, flow control device, in-line adapter, injection
    site assembly, and Dial-A-Flo. Extension sets are configured to ensure the intended
    use of the device is met. Hospira Extension sets are intended for the delivery of fluids
    from a container to a patient's vascular system. The sets are disposable devices for
    single patient use. |
    | Intended Use of Device | Hospira Extension set is intended for the delivery of fluids from a container to a
    patient's vascular system. |

4

Image /page/4/Picture/1 description: The image shows the Hospira logo. The logo features the company name "Hospira" in a simple, sans-serif font. Above the name is an abstract graphic consisting of three curved lines that converge at a point, resembling stylized leaves or a modern arch. The logo is presented in grayscale.

Summary of the technological characteristics of the device compared to the predicate device
CharacteristicPredicateProposed Device
Indications for UseHospira Extension Sets are indicated for the delivery of fluids from a container to a patient's vascular system.Hospira Extension Sets are indicated for the delivery of fluids from a container to a patient's vascular system.
Design and Materials of ConstructionThe design and materials of construction are as cleared under the predicate 510(k)The design and materials of construction remain the same as the predicate product with the following exceptions:
  1. Hospira is changing the tubing material formulation currently used in Extension Sets.
  2. Hospira is replacing the ClaveTM component on certain IV administration Extension Sets with the MicroClaveTM component.

The MicroClave performs functionally the same as the Clave, for the same intended use, and is comprised of similar materials. The Microclave is a cleared component under ICU Medical 510(k) K970855 establishing substantial equivalence. | | | | | | | | | | | | | | |
| Summary of non-clinical tests for determination of substantial equivalence | All materials of construction for Hospira Extension Sets meet the applicable material test requirements for ISO 10993 | New data has been generated demonstrating that all materials of construction for Hospira Extension Sets meet the applicable material test requirements for ISO 10993.
ISO Standard Biological Effect Tested ISO 10993-4 Hemocompatibility ISO 10993-5 Cytotoxicity ISO 10993-10 Sensitization ISO 10993-11 Intracutaneous Reactivity Systemic Toxicity Suacute Toxicity Subchronic Toxicity Pyrogenicity | | | | | | | | | | | | | | |

5

Image /page/5/Picture/1 description: The image shows the Hospira logo. The logo features the company name "Hospira" in a simple, sans-serif font, with the letters in a light gray color. Above the name is an abstract graphic consisting of three curved lines that converge at a point, creating a sense of movement or flow. The lines are in varying shades of gray, with the central line being the darkest.

| Summary of Performance Testing | Performance testing was conducted to ensure the device performs as intended in accordance with applicable standards. All testing is acceptable.

The product Sterility Assurance Level is 10-6. | New performance data has been generated to ensure the device performs as intended in accordance with ISO 594-1, ISO 594-2, and ISO 8536-4. All testing is acceptable. | | | | | | | | | | |
|--------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|--|--|--|--|--|--|--|--|--|
| | | ISO Standard Section Tested ISO 594-1 4.1 Gauging
4.2 Liquid Leakage
4.3 Air Leakage
4.4 Separation Force
4.5 Stress Cracking ISO 594-2 4.1 Gauging
4.2 Liquid Leakage
4.3 Separation Force
4.4 Unscrewing Torque
4.5 Ease of Assembly
4.6 Resistance to Overriding
4.7 Stress Cracking ISO 8536-4 6.1 Particulate Contamination
6.2 Leakage
6.3 Tensile Strength
6.6 Tubing
6.7 Fluid Filter
6.9 Flow Regulator
6.10 Flow Rate
6.11 Injection Site
6.12 Male Conical Fitting
6.13 Protective Caps Sterilization validation has been conducted based on the ANSI/AAMI/ISO 11137-1 and ANSI/AAMI/ISO 11737-1 international standards for sterilization of medical devices. All testing is acceptable. The product Sterility Assurance Level is 10-6. | | | | | | | | | | |

Conclusion

Hospira Extension Sets meet the functional claims and intended use as described in the product labeling. Hospira Extension Sets are substantially equivalent to the predicate device.