K Number
K153605
Device Name
ivWatch Model 400
Manufacturer
Date Cleared
2016-02-11

(56 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The iv Watch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand. The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The iv Watch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.
Device Description
The ivWatch Model 400 is a medical device that provides continuous, noninvasive monitoring of human tissue adjacent to peripheral intravenous (PIV) insertion sites on the forearm and dorsal aspect of the hand to aid in the early detection of infiltration and extravasation events. The ivWatch Model 400 consists of the ivWatch Patient Monitor (IPM), a reusable optical sensor cable and a single-use sensor receptacle. The ivWatch Model 400 uses visible and near-infrared light to measure changes in the optical properties of the tissue near a PIV insertion site. The IPM contains an optical system that generates visible and near-infrared light signals that are sent through the optical sensor cable to the patient's skin. Simultaneously, the IPM measures the light reflected back through the optical sensor cable from the patient's skin. Measured changes between the emitted and reflected signal are processed by proprietary ivWatch signal processing algorithms to determine if an infiltration event may have occurred. If changes in the optical properties of the tissue near the peripheral IV insertion site are consistent with an infusate pooling in the subcutaneous tissue, the IPM emits audible and visual notifications intended to prompt the clinician to inspect the peripheral IV site for a possible infiltration event.
More Information

Not Found

No
The description mentions "proprietary ivWatch signal processing algorithms" but does not use terms like AI, ML, deep learning, or neural networks. The focus is on processing optical property changes, which can be done with traditional signal processing techniques.

No.
The device is indicated for detection of infiltrations and extravasations, not for treatment. It is an adjunctive device for assessment and prompts clinicians for inspection, but does not provide therapy itself.

Yes

The device is indicated for the "detection of subcutaneous infiltrations and extravasations" and is used to "assess patients for subcutaneous infiltrations and extravasations," which are diagnostic functions.

No

The device description explicitly states that the ivWatch Model 400 consists of hardware components: the ivWatch Patient Monitor (IPM), a reusable optical sensor cable, and a single-use sensor receptacle. It also describes the physical process of emitting and receiving light signals.

Based on the provided information, the ivWatch Model 400 is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, monitoring, or treatment of disease or conditions.
  • ivWatch Model 400 Function: The ivWatch Model 400 works by non-invasively monitoring the optical properties of tissue adjacent to a PIV insertion site on the patient's skin. It uses light to detect changes in the tissue itself, not by analyzing a specimen taken from the body.
  • Intended Use: The intended use is to detect subcutaneous infiltrations and extravasations by monitoring the tissue, not by analyzing a biological sample.

Therefore, the ivWatch Model 400 falls under the category of a non-invasive medical device that monitors physiological changes in the body, rather than an IVD that analyzes biological specimens.

N/A

Intended Use / Indications for Use

The iv Watch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand.

The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The iv Watch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.

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

PMS

Device Description

The ivWatch Model 400 is a medical device that provides continuous, noninvasive monitoring of human tissue adjacent to peripheral intravenous (PIV) insertion sites on the forearm and dorsal aspect of the hand to aid in the early detection of infiltration and extravasation events. The ivWatch Model 400 consists of the ivWatch Patient Monitor (IPM), a reusable optical sensor cable and a single-use sensor receptacle.

The ivWatch Model 400 uses visible and near-infrared light to measure changes in the optical properties of the tissue near a PIV insertion site. The IPM contains an optical system that generates visible and near-infrared light signals that are sent through the optical sensor cable to the patient's skin. Simultaneously, the IPM measures the light reflected back through the optical sensor cable from the patient's skin. Measured changes between the emitted and reflected signal are processed by proprietary ivWatch signal processing algorithms to determine if an infiltration event may have occurred. If changes in the optical properties of the tissue near the peripheral IV insertion site are consistent with an infusate pooling in the subcutaneous tissue, the IPM emits audible and visual notifications intended to prompt the clinician to inspect the peripheral IV site for a possible infiltration event.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

optical measurements (visible and near-infrared light)

Anatomical Site

forearm or dorsal aspect of the hand

Indicated Patient Age Range

18 years old or greater

Intended User / Care Setting

used by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.
hospital setting

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)

ivWatch has performed the following non-clinical/design verification testing based on the risk analysis conducted. The 510(k) submission included a summary of these design control activities to assure that the risks were adequately mitigated. The risks identified included biocompatibility and reprocessing. The mitigation for biocompatibility risks was to repeat the testing that was previously performed on the sensor cable sheathing of the predicate device per ISO 10993-1: Biological evaluation of medical devices, Part 1: Evaluation and testing. The reprocessing risks were mitigated by repeating the low-level disinfection validation and cleaning validation that was performed on the sensor cable of the predicate. The results of these tests demonstrate that the sensor cable modification of the ivWatch Model 400 is substantially equivalent to the sensor cable of the predicate device based on predetermined acceptance criteria. Clinical testing was not required for this submission.

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

Biocompatibility Testing Performed on the sheathing of the sensor cable:
Sensitization: Per ISO 10993-10:2010, Non-sensitizer (Pass)
Irritation: Per ISO 10993-10:2010, Non-irritant (Pass)
Cytotoxicity: Per ISO 10993-5:2009, Non-toxic (Pass)

Reprocessing Validation Performed on the sensor cable:
Low Level Disinfection: Per AAMI TIR12 -2010, AAMI TIR30-2011 and Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling (Pass)
Cleaning: (Pass)

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.

K142374

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

§ 880.5725 Infusion pump.

(a)
Identification. An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/1 description: The image is a logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around a symbol. The symbol is a stylized representation of a human figure, with three profiles overlapping to create a sense of depth and connection.

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

February 11, 2016

ivWatch, LLC Ms. Jaclyn Lautz Director of Regulatory Affairs and Quality Assurance 469 Mclaws Circle Williamsburg, Virginia 23185

Re: K153605 Trade/Device Name: ivWatch Model 400 Regulation Number: 21 CFR 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: PMS Dated: January 12, 2016 Received: January 14, 2016

Dear Ms. Lautz:

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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) 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/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 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) K153605

Device Name ivWatch Model 400

Indications for Use (Describe)

The iv Watch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand.

The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The iv Watch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the iv Watch Model 400.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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Image /page/3/Picture/0 description: The image shows the logo for IVWatch. The logo consists of a black teardrop shape with the letters "iv" in white inside the teardrop. To the right of the teardrop is the word "Watch" in a stylized font. The logo is simple and modern, and it is likely used to represent a company or product related to intravenous therapy or monitoring.

ivWatch, LLC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

7 SPECIAL 510(K) SUMMARY

7.1 Administrative

Submitter NameivWatch, LLC
Applicant Address469 McLaws Circle
Williamsburg, VA 23185
Phone855-489-2824
Fax757-645-4760
Primary ContactJaclyn Lautz, Director of
Regulatory Affairs and Quality
Assurance
Primary Contact Emailjaclyn.lautz@ivwatch.com
Primary Contact Phone855-489-2824 x7023
Date PreparedJanuary 12, 2016

7.2 Device

Trade NameivWatch Model 400
ManufacturerivWatch, LLC
510(k) NumberK153605
Device ClassII
Classification NameInfusion Pump
Regulation Number21 CFR 880.5725
Product CodePMS (Peripheral Intravenous
(PIV) Infiltration Monitor)

7.3 Predicate Device

Trade NameivWatch Model 400
ManufacturerivWatch, LLC
510(k) NumberK142374
Device ClassII
Classification NameInfusion Pump
Regulation Number21 CFR 880.5725
Product CodeMRZ (Accessories, Pump,
Infusion)

4

Image /page/4/Picture/0 description: The image shows the logo for IV Watch. The logo consists of a stylized black teardrop shape with a grid pattern in the upper left corner. The text "ivWatch" is written in a modern, sans-serif font to the right of the teardrop shape. The "i" and "v" are connected, and the "W" is stylized with a curved line.

ivWatch IIC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

7.4 Device Description

The ivWatch Model 400 is a medical device that provides continuous, noninvasive monitoring of human tissue adjacent to peripheral intravenous (PIV) insertion sites on the forearm and dorsal aspect of the hand to aid in the early detection of infiltration and extravasation events. The ivWatch Model 400 consists of the ivWatch Patient Monitor (IPM), a reusable optical sensor cable and a single-use sensor receptacle.

The ivWatch Model 400 uses visible and near-infrared light to measure changes in the optical properties of the tissue near a PIV insertion site. The IPM contains an optical system that generates visible and near-infrared light signals that are sent through the optical sensor cable to the patient's skin. Simultaneously, the IPM measures the light reflected back through the optical sensor cable from the patient's skin. Measured changes between the emitted and reflected signal are processed by proprietary ivWatch signal processing algorithms to determine if an infiltration event may have occurred. If changes in the optical properties of the tissue near the peripheral IV insertion site are consistent with an infusate pooling in the subcutaneous tissue, the IPM emits audible and visual notifications intended to prompt the clinician to inspect the peripheral IV site for a possible infiltration event.

Indications For Use 7.5

The indications for use are identical to the predicate device.

The ivWatch Model 400 is indicated for the detection of subcutaneous infiltrations and extravasations of 10 cc or less of optically clear, uncolored infusates, as an adjunctive device to the clinical evaluation in the hospital setting of patients 18 years old or greater with peripherally-inserted IVs (PIVs) on the forearm or dorsal aspect of the hand. The device is indicated to assess patients for subcutaneous infiltrations and extravasations but should not serve as a substitute for regular clinician assessment of the PIV site. The ivWatch Model 400 is intended for use by physicians, or under the direction of a physician, who have been trained in the use of the ivWatch Model 400.

7.6 Comparison of Modified Device with the Predicate Device

The subject device has the same technological characteristics and intended use as compared to the predicate device (K142374). The ivWatch Model 400 consists of the ivWatch patient monitor, a single-use sensor receptacle and a reusable optical sensor cable. There have been no changes to the ivWatch patient monitor and the single-use sensor receptacle of the subject device compared to the predicate device submission. The sensor cable of the subject device is the only component of the ivWatch Model 400 that has been modified. Specifically, the sensor cable sheathing, which is the outer protective layer encasing the flexible glass fibers, has been modification of the subject device's sheathing includes removing an additive and changing the colorant.

5

Image /page/5/Picture/0 description: The image shows the logo for "ivWatch". The logo consists of a stylized water droplet shape on the left, with the letters "iv" inside the droplet. To the right of the droplet, the word "Watch" is written in a modern, sans-serif font. There is a small trademark symbol after the word "Watch".

ivWatch IIC 469 McLaws Circle Williamsburg, VA 23185

| Item | Predicate Device - ivWatch
Model 400
K142374 | Subject Device – ivWatch
Model 400
K153605 | |
|--------------------------------------------------------|----------------------------------------------------|--------------------------------------------------|---------------------------------|
| Monitor | ivWatch Patient Monitor | ivWatch Patient Monitor | |
| Sterile, disposable
patient-contacting
component | ivWatch Sensor Receptacle | ivWatch Sensor Receptacle | |
| Sensor
Cable | Formulation | Pellethane 80AE
Biosafe
2.7% Propell | Pellethane 80AE
2.7% Propell |
| | Colorant | Pantone 2975C | Pantone 646C |
| | Extrusion
Method | Co-extrusion | Single extrusion |

Performance Data 7.7

ivWatch has performed the following non-clinical/design verification testing based on the risk analysis conducted. The 510(k) submission included a summary of these design control activities to assure that the risks were adequately mitigated. The risks identified included biocompatibility and reprocessing. The mitigation for biocompatibility risks was to repeat the testing that was previously performed on the sensor cable sheathing of the predicate device per ISO 10993-1: Biological evaluation of medical devices, Part 1: Evaluation and testing. The reprocessing risks were mitigated by repeating the low-level disinfection validation and cleaning validation that was performed on the sensor cable of the predicate. The results of these tests demonstrate that the sensor cable modification of the ivWatch Model 400 is substantially equivalent to the sensor cable of the predicate device based on predetermined acceptance criteria. Clinical testing was not required for this submission.

Performance CharacteristicAcceptance CriteriaResult
Biocompatibility
Testing
Performed on
the sheathing
of the sensor
cableSensitizationPer ISO 10993-10:2010, Non-
sensitizerPass
IrritationPer ISO 10993-10:2010, Non-
irritantPass
CytotoxicityPer ISO 10993-5:2009, Non-toxicPass
Reprocessing
Validation
Performed on
the sensorLow Level
DisinfectionPer AAMI TIR12 -2010, AAMI
TIR30-2011 and Reprocessing
Medical Devices in Health
Care Settings: ValidationPass
CleaningPass

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Image /page/6/Picture/0 description: The image shows the logo for "ivWatch". The logo consists of a stylized black teardrop shape with three small white squares inside, followed by the text "ivWatch" in a clean, sans-serif font. A vertical black line is present on the right side of the logo.

ivWatch, LLC 469 McLaws Circle Williamsburg, VA 23185

1.855.IVWATCH (489.2824) Fax: 757.645.4760 www.ivwatch.com

cable

Methods and Labeling

7.8 Conclusions

The risks associated with the modified ivWatch Model 400 have been identified and the design control activities demonstrate adequate risk mitigation. The modified ivWatch Model 400 is substantially equivalent to the predicate device.