K Number
K162811
Device Name
MR Conditional CGA 870
Date Cleared
2017-03-02

(147 days)

Product Code
Regulation Number
868.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Essex MR Conditional CGA 870 pressure regulators are used with a portable oxygen delivery system intended to provide supplemental oxygen to adults in hospital, sub-acute care, and pre-hospital / ground transport settings. It is offered in models that are MR-conditional (per ASTM F2052-15), and may be used during MR imaging for static magnetic fields of 3.0 T or less.
Device Description
The Essex MR Conditional CGA 870 pressure regulator is designed to be installed on a medical CGA 870 post valve cylinder, regulate high pressure oxygen from 500 to 2,000 psig nominal, deliver a specific amount of oxygen to an attached flow selector, and be ignition resistant. The device consists of: - A yoke style inlet fitting per CGA 870. - A pressure regulator section is to reduce the pressure from 500-2,000 psig to 50 psig nominal. - A flow selector valve to control the flow at the regulated pressure between 0 and 25 L/min. - Made of materials which meet the MR Conditional requirements of ASTM F2052-15. This is identical to our Class I, exempt model CGA 870 except for different materials to allow for the device to meet the ASTM F2052-15 - Standard Test Method for Measurement of Magnetically Induced Displacement Force on Medical Devices in the Magnetic Resonance Environment.
More Information

Not Found

No
The device description and performance studies focus on mechanical regulation of oxygen flow and MR compatibility, with no mention of AI or ML algorithms for data analysis, decision-making, or control.

No.
The device is an oxygen pressure regulator designed to be part of a portable oxygen delivery system, but it does not directly provide therapeutic benefits; instead, it regulates oxygen flow.

No

The device is a pressure regulator for oxygen delivery, not a diagnostic tool. Its function is to regulate and deliver oxygen, not to identify or measure health conditions.

No

The device description explicitly details physical components like a yoke style inlet fitting, pressure regulator section, and flow selector valve, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is to provide supplemental oxygen to adults in various healthcare settings. This is a therapeutic and life-support function, not a diagnostic one.
  • Device Description: The device is a pressure regulator designed to manage the flow of oxygen from a cylinder. This is a mechanical device for delivering a substance, not for analyzing biological samples.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in biological samples
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions

The device's function is purely related to the delivery of oxygen for therapeutic purposes.

N/A

Intended Use / Indications for Use

The Essex MR Conditional CGA 870 pressure regulators are used with a portable oxygen delivery system intended to provide supplemental oxygen to adults in hospital, sub-acute care, and pre-hospital / ground transport settings. It is offered in models that are MR-conditional (per ASTM F2052-15), and may be used during MR imaging for static magnetic fields of 3.0 T or less.

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

CAN

Device Description

The Essex MR Conditional CGA 870 pressure regulator is designed to be installed on a medical CGA 870 post valve cylinder, regulate high pressure oxygen from 500 to 2,000 psig nominal, deliver a specific amount of oxygen to an attached flow selector, and be ignition resistant.

The device consists of:

  • A yoke style inlet fitting per CGA 870. The regulator can be installed on any cylinder with a CGA 870 connection.
  • A pressure regulator section is to reduce the pressure from 500-2,000 psig to 50 psig nominal.
  • A flow selector valve to control the flow at the regulated pressure between 0 and 25 L/min.
  • Made of materials which meet the MR Conditional requirements of ASTM F2052-15.

This is identical to our Class I, exempt model CGA 870 except for different materials to allow for the device to meet the ASTM F2052-15 - Standard Test Method for Measurement of Magnetically Induced Displacement Force on Medical Devices in the Magnetic Resonance Environment.

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

adults

Intended User / Care Setting

hospital, sub-acute care, and pre-hospital / ground transport settings.
Environments of Use: All healthcare settings including:

  • Hospital, including intra-hospital transport
  • Outpatient
  • Imaging center (MRI Suite)
  • Pre-hospital

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 Summary:

  • CGA E-4: Standard for Gas Pressure Regulators
    • par. 4.1 Operating Temperature Range
    • par. 4.2.2.3 Resistance to Ignition (Oxygen Service)
    • par. 4.4 Gas Tightness
    • par. 4.5 Mechanical Resistance
    • par. 4.6 Endurance
    • par. 5.4 Pressure Relief Devices
    • par. 6.1 Pressure Regulation Coefficient, i
    • par. 6.2 Static Increment, SI
    • par. 6.3 Flow Regulation
    • par. 6.4 Flow Capacity
  • CGA E-7: American National Standard for Medical Gas Regulators and Flowmeters
    • par. 5.4 Relief Valves
    • par. 5.6.1 Minimum Burst Strength
    • par. 5.6.2 Leakage
    • par. 5.7 Temperature for Storage and Operation
  • ISO 10524: Pressure Regulators and Pressure Regulators with Flow-Metering Devices for Medical Gas Systems
    • par. 7.3 Pressure relief valve
    • par. 7.5 Resistance to ignition
    • par. 7.8 Gas tightness
    • par. 7.9.3 Mechanical resistance (high pressure section burst)
    • par. 7.9.4 Mechanical resistance (low pressure section burst)
    • par. 8.0 Environmental temperatures
  • EN 738-1: Pressure Regulators for use with Medical Gases
    • par. 5.4.2.7 Performance, functional, and flow characteristics
    • par. 5.4.2.8 Relief valve
    • par. 5.4.2.9 Leakage
    • par. 5.4.2.10 Mechanical Strength
    • par. 5.4.2.11 Resistance to ignition
  • MR Conditional Testing per ASTM F2052-15 (Note testing was done according to ASTM F2052-06 but there are no testing differences between the 2006 version and the 2015 version.
  • Biocompatibility (VOC and PM2.5)

Bench Testing:

  • The performance testing is based upon standards for material, construction, ignition, MRI compatibility, and accuracy.
  • Discussion - Based upon the testing and comparison to the standards, we can find the subject device and the predicate and reference devices to be substantially equivalent.

Biocompatibility of Materials:

  • ISO 10993-1 would consider the materials in the gas pathway as - Externally communicating, Tissue / Dentin / Bone contact, Permanent Duration.
  • The materials were evaluated per CGA E-4 for ignition and for biocompatibility via VOC and PM23.5 The testing demonstrated that the materials were biocompatible for their intended use.
  • Discussion – The materials were found to be compatible for their intended use and identical to the reference.

Animal Testing:
There was no animal testing.

Clinical Testing:
There was no clinical testing.

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.

Essex CGA 870 oxygen pressure regulator (Class 1, exempt)

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.

K101792 – Linde – LIV Portable Oxygen System

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

§ 868.2700 Pressure regulator.

(a)
Identification. A pressure regulator is a device, often called a pressure-reducing valve, that is intended for medical purposes and that is used to convert a medical gas pressure from a high variable pressure to a lower, more constant working pressure. This device includes mechanical oxygen regulators.(b)
Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 868.9.

0

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

March 2, 2017

Essex Industries, Inc. % Paul Dryden Consultant 7700 Gravois St. Louis, Missouri 63123

Re: K162811

Trade/Device Name: MR Conditional CGA 870 Regulation Number: 21 CFR 868.2700 Regulation Name: Pressure Regulator Regulatory Class: Class I Product Code: CAN Dated: January 27, 2017 Received: January 31, 2017

Dear Paul Dryden:

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.

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 (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.

1

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,

Lori A. Wiggins -S

for

Tina Kiang, Ph.D. Acting 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) K162811

Device Name MR Conditional CGA 870

Indications for Use (Describe)

The Essex MR Conditional CGA 870 pressure regulators are used with a portable oxygen delivery system intended to provide supplemental oxygen to adults in hospital / ground transport settings. It is offered in models that are MR-conditional (per ASTM F2052-15), and may be used during MR imaging for static magnetic fields of 3.0 T or less.

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

☑ Prescription Use (Part 21 CER 801 Subpart D)
☐ Over-The-Counter Use (21 CFR 801 Subpart C)

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3

510(k) Summary Page 1 of 6 3/2/2017

Essex Industries, Inc. 7700 Gravois St. Louis, MO 63123

| Official Contact: | Russ Jacobsmeyer - Vice President of Engineering
Tel – 314.338.8723 |
|----------------------------------------|-----------------------------------------------------------------------------------------------------------|
| Proprietary or Trade Name: | Essex MR Conditional CGA 870 |
| Common/Usual Name: | Cylinder, Compressed Gas, and Valve |
| Classification Name/Code: | CAN - Cylinder, Compressed Gas, and Valve
Class I, 21 CFR 868.2700 |
| Predicate Device:
Reference Device: | Essex CGA 870 oxygen pressure regulator (Class 1, exempt)
K101792 – Linde – LIV Portable Oxygen System |

Device Description:

The Essex MR Conditional CGA 870 pressure regulator is designed to be installed on a medical CGA 870 post valve cylinder, regulate high pressure oxygen from 500 to 2,000 psig nominal, deliver a specific amount of oxygen to an attached flow selector, and be ignition resistant.

The device consists of:

  • A yoke style inlet fitting per CGA 870. .
    • The regulator can be installed on any cylinder with a CGA 870 connection. O
  • A pressure regulator section is to reduce the pressure from 500-2,000 psig to 50 psig nominal. ●
  • A flow selector valve to control the flow at the regulated pressure between 0 and 25 L/min. ●
  • Made of materials which meet the MR Conditional requirements of ASTM F2052-15.

This is identical to our Class I, exempt model CGA 870 except for different materials to allow for the device to meet the ASTM F2052-15 - Standard Test Method for Measurement of Magnetically Induced Displacement Force on Medical Devices in the Magnetic Resonance Environment.

Indications for Use:

The Essex MR Conditional CGA 870 pressure regulators are used with a portable oxygen delivery system intended to provide supplemental oxygen to adults in hospital, sub-acute care, and pre-hospital / ground transport settings. It is offered in models that are MR-conditional (per ASTM F2052-15), and may be used during MR imaging for static magnetic fields of 3.0 T or less.

Environments of Use: Their environments of use include all healthcare settings including:

  • Hospital, including intra-hospital transport ●
  • Outpatient
  • Imaging center (MRI Suite) ●
  • Pre-hospital ●

Contraindications: None.

Summary of substantial equivalence

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510(k) Summary Page 2 of 6 3/2/2017

The proposed device has been compared to the predicate Essex CGA 870 oxygen pressure regulator (Class 1, exempt) for the technical characteristics, see Table 1 and the reference device for environment of use, MR Conditional, and see Table 2.

Device Comparison

DescriptionPredicateSubject Device
CGA 870 Device, Class I, exemptMR Conditional CGA 870
Device NameCGA 870MR Conditional CGA 870
Device Classification
& Product codeClass I / CANClass I / CAN
Prescription DeviceYesYes
Indications for UseThe Essex CGA 870 pressure regulator
is a portable oxygen delivery system
intended to provide supplemental
oxygen too pediatrics and adults in
hospital, sub-acute care, and pre-hospital
/ ground transport settings.The Essex MR Conditional CGA 870
pressure regulators are used with a
portable oxygen delivery system
intended to provide supplemental
oxygen to adults in hospital, sub-acute
care, and pre-hospital / ground
transport settings. It is offered in
models that are MR-conditional (per
ASTM F2052-15), and may be used
during MR imaging for static magnetic
fields of 3.0 T or less.
Flow selector and
Flow OutletYesYes
Fixed pressure
outletYes ~ 50 psigYes ~ 50 psig
Cylinder On/OffYesYes
Filling PortNo
When cylinder is empty the device is
attached to a new cylinderNo
When cylinder is empty the device is
attached to a new cylinder
Contents GaugeYes / activeYes / active
Excess FlowNoNo
Burst DiskBurst Disk is located on the cylinder
post valve.Burst Disk is located on the cylinder
post valve.
Single stage piston
typeYesYes
MR ConditionalN/A3.0 Tesla or less
Pressure Inlet2000 psig2000 psig
Flow rates0-25 L/min0-25 L/min
Operating Pressure
range500-2000 psig500-2000 psig
Operating
Temperature Range-20°F to 130°F-20°F to 130°F

Table 1 - Comparison of Predicate Essex CGA 870 to the Subject Device -MR Conditional CGA 870

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510(k) Summary Page 3 of 6 3/2/2017

DescriptionPredicateSubject Device
StandardsCGA 870 Device, Class I, exemptMR Conditional CGA 870
ISO 10524-1ISO 10524-1
CGA E-4CGA E-4
CGA E-7CGA E-7
EN 738-1EN 738-1
ASTM F2052-15
BiocompatibilityExternally communicating, Tissue,Externally communicating, Tissue,
Permanent durationPermanent duration
VOCVOC
PM2.5PM2.5

Table 2 - Comparison of Reference Linde LIV (K101792) to the Subject Device -MR Conditional CG 870

DescriptionReference DeviceSubject Device
Linde LIV - K101792MR Conditional CGA 870
Device NameLIVMR Conditional CGA 870
Device Classification
& Product codeUnclassified/ECXClass I / CAN
Prescription DeviceYesYes
Indications for UseThe LIV is an integrated portable oxygen
delivery system intended to provide
supplemental oxygen to pediatrics and
adults. The device is MR-conditional (per
ASTM F2503-05*), and intended for use
during MR imaging for MRI systems up to
3.0T.

Compressed gas cylinders in service or in
storage shall be stabilized or otherwise
secured to prevent falling and rolling. | The Essex MR Conditional CGA 870
pressure regulators are used with a
portable oxygen delivery system intended
to provide supplemental oxygen to adults
in hospital, sub-acute care, and pre-
hospital / ground transport settings. It is
offered in models that are MR-conditional
(per ASTM F2052-15), and may be used
during MR imaging for static magnetic
fields of 3.0 T or less. |
| Flow selector and
Flow Outlet | Yes | Yes |
| Fixed pressure
outlet | Yes ~ 50 psig | Yes ~ 50 psig |
| Cylinder On/Off | Yes | Yes |
| Filling Port | Yes | When cylinder is empty the device is
attached to a new cylinder |
| Contents Gauge | Yes / active | Yes / active |
| Excess Flow | No | No |
| Burst Disk | Yes integral to the system | Burst Disk is located on the cylinder post
valve. |
| Single stage piston
type | Yes | Yes |
| Hand grip | Yes | No |
| Access ports | Yes | No |
| MR Conditional | 3.0 Tesla | 3.0 Tesla or less |
| Pressure Inlet | 2000 psig | 2000 psig |

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510(k) Summary Page 4 of 6 3/2/2017

DescriptionReference DeviceSubject Device
Linde LIV - K101792MR Conditional CGA 870
DISS 1240 fittingsYesNo
Not applicable
Flow rates0-25 L/min0-25 L/min
Operating Pressure rangeUp to 3000 psig500-2000 psig
Operating Temperature Range-20°F to 130°F
ISO 10524-3
ASTM G173-03
CGA E-7
CGA 540
ASTM F2503-05*ISO 10524-1
CGA E-4
CGA E-7
EN 738-1
ASTM F2052-15*
Standards
BiocompatibilityExternally communicating, Tissue,
Permanent durationExternally communicating, Tissue,
Permanent duration
VOC
PM2.5

*Note ASTM F2503-05 is a device marking and labeling standard whereas ASTM F2052-15 is the Testing and Performance standard.

The proposed MR Conditional CGA 870 is viewed as substantially equivalent to the predicate device for the performance, intended use and technical characteristics and the reference device for the addition of the MR conditional environment of use. In the tables above, we have outlined the similarities and differences, if any, between the subject device, the predicate and reference devices.

Indications -

  • The MR Conditional CGA 870 is a standalone oxygen pressure regulator intended to provide supplemental oxygen.
  • Discussion - The indications for the predicate and reference are similar with the predicate. One can find the indications for use to be similar and the differences do not raise any concerns of safety or effectiveness compared to the predicate or reference devices.

Patient Population -

  • It is intended for adult patients requiring supplemental oxygen ●
  • Discussion The patient population is similar to the predicate and reference device. There are ● no differences that raise any concerns of safety or effectiveness compared to the predicate or reference devices.

Environment of Use -

  • For use in all healthcare settings hospitals, ambulatory, imaging centers, pre-hospital. ●
  • Discussion The environments of use are similar to the predicate and reference devices. The . addition of MR Conditional use has been demonstrated to meet the standard which would not raise any new concerns of safety and effectiveness.

Technology -

  • The principle of pressure regulating is based upon a single stage piston style with adjustable flow rates, flow gauge, burst disk and use of a separate cylinder.

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510(k) Summary Page 5 of 6 3/2/2017

  • . Discussion - This technology is identical to the predicate device and similar to the reference.

Differences

The only difference between the reference and the subject device is the change in materials to be MR Conditional. The difference between the reference and the subject device is that the predicate is an integrated regulator and the subject device is not. Discussion - These differences do not raise any new concerns of safety or effectiveness.

Non-clinical Testing Summary -

We have performed a number of tests appropriate for the proposed device. These tests include:

  • CGA E-4: Standard for Gas Pressure Regulators ●
    • o par. 4.1 Operating Temperature Range
      • par. 4.2.2.3 Resistance to Ignition (Oxygen Service) O
      • par. 4.4 Gas Tightness O
      • par. 4.5 Mechanical Resistance O
      • par. 4.6 Endurance O
      • par. 5.4 Pressure Relief Devices O
      • par. 6.1 Pressure Regulation Coefficient, i O
      • par. 6.2 Static Increment, SI O
      • par. 6.3 Flow Regulation O
      • par. 6.4 Flow Capacity O
  • CGA E-7: American National Standard for Medical Gas Regulators and Flowmeters ●
    • par. 5.4 Relief Valves റ
    • par. 5.6.1 Minimum Burst Strength O
    • par. 5.6.2 Leakage o
    • o par. 5.7 Temperature for Storage and Operation
  • ISO 10524: Pressure Regulators and Pressure Regulators with Flow-Metering Devices for Medical Gas Systems
    • o par. 7.3 Pressure relief valve
    • par. 7.5 Resistance to ignition O
    • par. 7.8 Gas tightness O
    • par. 7.9.3 Mechanical resistance (high pressure section burst) O
    • par. 7.9.4 Mechanical resistance (low pressure section burst) O
    • par. 8.0 Environmental temperatures O
  • EN 738-1: Pressure Regulators for use with Medical Gases ●
    • par. 5.4.2.7 Performance, functional, and flow characteristics o
    • O par. 5.4.2.8 Relief valve
    • par. 5.4.2.9 Leakage o
    • par. 5.4.2.10 Mechanical Strength O
    • par. 5.4.2.11 Resistance to ignition O
  • MR Conditional Testing per ASTM F2052-15 (Note testing was done according to ASTM ● F2052-06 but there are no testing differences between the 2006 version and the 2015 version.
  • Biocompatibility (VOC and PM2.5) ●

Bench Testing -

  • The performance testing is based upon standards for material, construction, ignition, MRI ● compatibility, and accuracy.

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510(k) Summary Page 6 of 6 3/2/2017

  • . Discussion - Based upon the testing and comparison to the standards, we can find the subject device and the predicate and reference devices to be substantially equivalent.

Biocompatibility of Materials -

  • ISO 10993-1 would consider the materials in the gas pathway as - Externally communicating, Tissue / Dentin / Bone contact, Permanent Duration.
  • The materials were evaluated per CGA E-4 for ignition and for biocompatibility via VOC and . PM23.5 The testing demonstrated that the materials were biocompatible for their intended use.
  • Discussion – The materials were found to be compatible for their intended use and identical to the reference.

Animal Testing:

There was no animal testing.

Clinical Testing:

There was no clinical testing.

Substantial Equivalence Conclusion:

The sponsor has demonstrated through performance testing and non-clinical testing that the proposed device is substantially equivalent to the predicate and reference devices.