K Number
K172884
Device Name
Arisure Closed Vial Adapter
Manufacturer
Date Cleared
2017-10-03

(12 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Arisure™ Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies for reconstitution or dispensing of medication. The Arisure™ Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents.
Device Description
The Arisure Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies for reconstitution or dispensing of medication. The Arisure Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents. The Arisure Closed Vial Adapter is a mechanically closed device, designed to retain vapors produced from medications in the attached vial.
More Information

Not Found

No
The device description and performance studies focus on mechanical properties and fluid handling, with no mention of AI/ML terms or functionalities.

No
The device is described as an adapter for medication vials, intended for reconstitution or dispensing of medication, rather than for treating a medical condition itself. Its function is to retain vapors from medications.

No

The device is described as an adapter for medication vials used for reconstitution or dispensing of medication, and its performance studies focus on mechanical and material properties, not diagnostic capabilities.

No

The device description explicitly states it is a "mechanically closed device" and the performance studies focus on physical characteristics like detachment force, flow rate, and biocompatibility, indicating it is a hardware device.

Based on the provided information, the Arisure™ Closed Vial Adapter is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use is for the reconstitution or dispensing of medication from vials. This is a process related to drug preparation and administration, not the diagnosis of disease or other conditions.
  • Device Description: The description focuses on the mechanical function of the device to retain vapors during medication handling. This is a safety and efficiency feature for drug preparation, not a diagnostic function.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples, detecting analytes, or providing information for diagnosis, monitoring, or screening.
  • Performance Studies: The performance studies listed (Misuse Test, Detachment Force, Flow Rate, etc.) are related to the physical and functional performance of the device in handling medication vials, not its ability to perform a diagnostic test.

IVD devices are specifically designed to be used in vitro (outside the body) to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnostic purposes. The Arisure™ Closed Vial Adapter does not fit this description.

N/A

Intended Use / Indications for Use

The Arisure™ Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthes, and pharmacies for reconstitution or dispensing of medication. The Arisure™ Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents.

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

LHI

Device Description

The Arisure Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies for reconstitution or dispensing of medication. The Arisure Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents.

The Arisure Closed Vial Adapter is a mechanically closed device, designed to retain vapors produced from medications in the attached vial.

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

healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies

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)

The performance data supplied with this submission demonstrates that the Arisure Closed Vial Adapter meets all specified requirements and is substantially equivalent to the predicate device.

The following tests were conducted on the Arisure Closed Vial Adapter device to demonstrate equivalency of the performance characteristics to the predicate device(s):

  • Misuse Test
  • Detachment Force (Horizontal)
  • Detachment Force (Vertical)
  • Flow Rate
  • Trapped Air Volume
  • Residual Fluid
  • Vial attachment force
  • Vial pressure
  • Valve Detachment Torque
  • Biocompatibility - ISO 10993
    • Cytotoxicity by Elution Test (Cytotoxicity)
    • Intracutaneous Reactivity (Irritation or Intracutaneous Reactivity)
    • Maximization Test for Delayed Hypersensivity (Sensitization)
    • Acute Systemic Toxicity (Systemic Toxicity (Acute))
    • Evaluation of Hemocompatibility: Interaction with Blood (Hemolysis)
    • Materials Mediated Pyrogenicity
  • Chemical Compatibility
  • Sterile package integrity testing
  • Distribution testing
  • Shelf Life 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.

K132863

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.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of the department's name arranged in a circular fashion around a symbol. The symbol is a stylized representation of three human profiles facing right, stacked on top of each other. The profiles are rendered in a dark color, contrasting with the white background.

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

October 3, 2017

Yukon Medical, LLC % Mark Job Responsible Third Party Official Regulatory Technology Services, LLC 1394 25th Street, NW Buffalo, Minnesota 55313

Re: K172884

Trade/Device Name: Arisure™ Closed Vial Adapter Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: Class II Product Code: LHI Dated: December 8, 2016 Received: September 21, 2017

Dear Mark Job:

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

1

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.

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 (DICE) 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 (DICE) 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,

Tara A. Ryan -S

for Tina Kiang, PhD Acting 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)

Device Name Arisure™ Closed Vial Adapter

Indications for Use (Describe)

The Arisure™ Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthes, and pharmacies for reconstitution or dispensing of medication. The Arisure™ Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents.

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)

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5.2.

510(k) Summary 5.

5.1. Submitter Information

Company Name:Yukon Medical, LLC
Company Address:4021 Stirrup Creek Drive
Suite 200Durham, NC 27703
Company Phone:(919) 595-8250
Company Fax:(919) 595-8251
Contact Person:Pam McNulty, Director QA and Compliance
Yukon Medical
Phone: 919-595-8253
Fax: 919-595-8251
Email: pmcnulty@yukonmedical.com
Prepared By:Soorya Kumar, Project Engineer
Yukon Medical
Phone: 919-636-6976
Fax: 919-595-8251
Email: skumar@yukonmedical.com
Date Summary
Prepared:25 August, 2017
Device Identification
Trade/Proprietary Name:13mm Arisure™ Closed Vial Adapter
20mm Arisure™ Closed Vial Adapter
28mm Arisure™ Closed Vial Adapter
Common Name:Vial Adapter
Classification Name:Intravascular Administration Set
Regulation Number:21 CFR 880.5440
Class:II
Classification Panel:General Hospital
Product Code:LHI, I.V. Fluid Transfer Set

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5.3. Predicate Device

The Arisure Closed Vial Adapter is substantially equivalent to the following predicate device:

DeviceManufacturer510(k)Date Cleared
SmartSite® VialShieldYukon MedicalK132863October 4, 2013

5.4. Device Description

The Arisure Closed Vial Adapter is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies for reconstitution or dispensing of medication. The Arisure Closed Vial Adapter is indicated for use with rubber-stopper medication vials for reconstitution or dispensing of medications, including chemotherapy agents.

The Arisure Closed Vial Adapter is a mechanically closed device, designed to retain vapors produced from medications in the attached vial.

5.5. Intended Use

Arisure Closed Vial AdapterPredicate Device
The ArisureTM Closed Vial Adapter is intended for
use by healthcare professionals in a wide variety of
healthcare environments including hospitals,
healthcare facilities, and pharmacies for
reconstitution or dispensing of medication. The
ArisureTM Closed Vial Adapter is indicated for use
with rubber-stopper medication vials for
reconstitution or dispensing of medications,
including chemotherapy agents.The SmartSite® VialShield is intended for use by
healthcare professionals in a wide variety of
healthcare environments including hospitals,
healthcare facilities, and pharmacies for
reconstitution or dispensing of medication. The
SmartSite® VialShield is indicated for use with
rubber-stopper medication vials for reconstitution
or dispensing of medications, including
chemotherapy agents.

The Arisure Closed Vial Adapter's intended use is equivalent to that of the SmartSite VialShield.

5.6. Indications for Use

Arisure Closed Vial AdapterPredicate Device
The Arisure™ Closed Vial Adapter is intended forThe SmartSite® VialShield is intended for use by
use by healthcare professionals in a wide variety ofhealthcare professionals in a wide variety of
healthcare environments including hospitals,healthcare environments including hospitals,
healthcare facilities, and pharmacies forhealthcare facilities, and pharmacies for
reconstitution or dispensing of medication. Thereconstitution or dispensing of medication. The
Arisure™ Closed Vial Adapter is indicated for useSmartSite® VialShield is indicated for use with
with rubber-stopper medication vials forrubber-stopper medication vials for reconstitution
reconstitution or dispensing of medications,or dispensing of medications, including
including chemotherapy agents.chemotherapy agents.

The Arisure Closed Vial Adapter's indications for use is equivalent to that of the SmartSite VialShield.

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5.7. Predicate Device Comparison - Technical Characteristics

Equivalency of technical characteristics is demonstrated through a direct comparison of the Arisure Closed Vial Adapter device and the predicate devices listed in the table below.

| Technical
Characteristics | Subject Device:
Arisure Closed Vial
Adapter | Predicate Device:
SmartSite®
VialShield | Equivalence
(Y/N) |
|---------------------------------|---------------------------------------------------|------------------------------------------------------------|----------------------|
| Hydrophobic Filter | Yes | Yes | Y |
| Spike | Yes | Yes | Y |
| Locking Shroud | Yes | Yes | Y |
| Luer Access | Arisure Neutral Valve
(ANV) | SmartSite® Needle
Free Valve | Y |
| Materials
(Fluid Contacting) | • Polycarbonate
• Silicone
• MABS | • Acrylic
multipolymer
• Silicone
• Polycarbonate | Y |

Spike

The spike is used to penetrate a standard medication vial stopper and provide fluid and filtered air paths.

The subject device and the predicate both have equivalent dual lumen spikes; one lumen for fluid transfer and the other which allows for pressure equalization with vented air.

Locking Shroud

The purpose of the locking shroud is to secure the device to a standard medication vial after the stopper is penetrated. Both the subject and predicate device utilize a locking shroud with retention tabs to ensure device security atop a vial.

Luer Access

All configurations of the subject device and predicate device use a needle free valve for luer access to the device.

Hydrophobic Filter

Both the subject and predicate device use a hydrophobic filter membrane in their respective designs. This filter serves four purposes in both devices: 1) The filter prevents particulates from leaving the devices when air is introduced; 2) The filter prevents contaminants in the surrounding environment from entering the secured drug vial; 3) The filter prevents liquid from leaving the device during misuse conditions, where the devices are inverted when liquid is injected; 4) The filter allows the air pressure in the vial to acclimate with ambient air pressure, preventing the build-up of pressure in the vial.

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Materials

The subject Arisure Closed Vial Adapter device is constructed of polymeric components, of those components the following are fluid contacting:

  • . Arisure Closed Vial Adapter
    • Vial Adapter, Membrane Retention Ring, Bell Housing: o Methyl Methacrylate Acrylonitrile Butadiene Styrene
    • o Arisure Neutral Valve: Polycarbonate, Silicone, Fluorosilicone

The subject and predicate devices have been tested and meet the biological requirements outlined in ISO 10993-1.

5.8. Predicate Device Comparison - Performance Characteristics

The performance data supplied with this submission demonstrates that the Arisure Closed Vial Adapter meets all specified requirements and is substantially equivalent to the predicate device.

The following tests were conducted on the Arisure Closed Vial Adapter device to demonstrate equivalency of the performance characteristics to the predicate device(s):

  • . Misuse Test
  • Detachment Force (Horizontal) ●
  • Detachment Force (Vertical) ●
  • Flow Rate ●
  • Trapped Air Volume
  • Residual Fluid ●
  • Vial attachment force ●
  • Vial pressure ●
  • Valve Detachment Torque
  • . Biocompatibility - ISO 10993
    • Cytotoxicity by Elution Test (Cytotoxicity) o
    • Intracutaneous Reactivity (Irritation or Intracutaneous Reactivity) o
    • Maximization Test for Delayed Hypersensivity (Sensitization) o
    • Acute Systemic Toxicity (Systemic Toxicity (Acute)) O
    • Evaluation of Hemocompatibility: Interaction with Blood (Hemolysis) o
    • o Materials Mediated Pyrogenicity
  • Chemical Compatibility ●
  • Sterile package integrity testing ●
  • . Distribution testing
  • Shelf Life Testing

Note:

Both the subject and predicate devices contain needle free valves, which has been previously validated for ISO-594 compliance, microbial ingress, and multiple/extended activation.

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5.9. Conclusion

Test results demonstrate that the Arisure™ Closed Vial Adapter is as safe, as effective, and performs as well as the legally marketed device designated as the predicate device.

Based on comparisons of the device's intended use, technology and performance characteristics, the subject device is substantially equivalent to the indicated predicate device.