K Number
K201356
Date Cleared
2021-02-12

(267 days)

Product Code
Regulation Number
868.5140
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Plastic LOR Syringe is intended for use in conjunction with an epidural needle, to verify the needle tip placement in the epidural space by the loss of Resistance technique, it will be filled with air and/or saline during use. The loss of Resistance Syringe is not intended for injection or aspiration. The syringe will be sold sterile individually packaged, and as part of a sterile kit.

Device Description

The Plastic LOR syringe is a piston syringe of three pieces. It consists of barrel, plunger and piston. The barrel is available with Luer slip, NRFit lock, NRFit Slip male connector. The Plastic LOR syringe is provided in combinations of four connectors and four syringe capacities (5ml, 7ml, 10ml, 20ml). The device is a sterile finished disposable device, supplied sterile to the end user and non-sterile will be supplied to Anesthetic Conduction Kit manufacturers to be sterile and packaged into kit. The Plastic LOR syringe is a single use device which will be supplied as sterile individually packaged and the non-sterile bulk packed. The sterilized by Ethylene Oxide Gas to achieve a SAL of 10° and supplied sterility maintenance package which could maintain the sterility of the device during the s helf life of five years.

AI/ML Overview

This document is a 510(k) Summary for a Plastic LOR Syringe. The purpose of this summary is to demonstrate that the device is substantially equivalent to legally marketed predicate devices.

Here's the breakdown of the acceptance criteria and the study information:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria are primarily derived from various ISO and ASTM standards for syringes, neuraxial, and Luer connectors, as well as biocompatibility and sterilization standards. The reported device performance indicates compliance with these standards.

Acceptance Criteria CategorySpecific Standard/ClauseReported Device Performance
Physical/MechanicalClause 5 of ISO 7886-1:2017 (General requirements)Conforms to requirements
Clause 6 of ISO 7886-1:2017 (Extraneous matter)Conforms to requirements
Clause 7 of ISO 7886-1:2017 (Lubricant)Conforms to requirements
Clause 8 of ISO 7886-1:2017 (Tolerance on graduated capacity)Conforms to requirements
Clause 9 of ISO 7886-1:2017 (Graduated scale)Conforms to requirements
Clause 10 of ISO 7886-1:2017 (Barrel)Conforms to requirements
Clause 11 of ISO 7886-1:2017 (Piston stopper/plunger assembly)Conforms to requirements
Clause 12 of ISO 7886-1:2017 (Nozzle)Conforms to requirements
Clause 13 of ISO 7886-1:2017 (Performance)Conforms to requirements
Neuraxial Small-Bore ConnectorClause 5 of ISO 80369-6:2016 (Dimensional requirements)Conforms to requirements
Clause 6.1 of ISO 80369-6:2016 (Fluid leakage)Conforms to requirements
Clause 6.2 of ISO 80369-6:2016 (Sub-atmospheric pressure air leakage)Conforms to requirements
Clause 6.3 of ISO 80369-6:2016 (Stress cracking)Conforms to requirements
Clause 6.4 of ISO 80369-6:2016 (Resistance to separation from axial load)Conforms to requirements
Clause 6.5 of ISO 80369-6:2016 (Resistance to separation from unscrewing)Conforms to requirements
Clause 6.6 of ISO 80369-6:2016 (Resistance to overriding)Conforms to requirements
Luer ConnectorClause 5 of ISO 80369-7:2016 (Dimensional requirements)Conforms to requirements
Clause 6.1 of ISO 80369-7:2016 (Fluid leakage)Conforms to requirements
Clause 6.2 of ISO 80369-7:2016 (Sub-atmospheric pressure air leakage)Conforms to requirements
Clause 6.3 of ISO 80369-7:2016 (Stress cracking)Conforms to requirements
Clause 6.4 of ISO 80369-7:2016 (Resistance to separation from axial load)Conforms to requirements
Clause 6.5 of ISO 80369-7:2016 (Resistance to separation from unscrewing)Conforms to requirements
Clause 6.6 of ISO 80369-7:2016 (Resistance to overriding)Conforms to requirements
Sterile Barrier PackagingASTM F1886/F1886M-16 (Visual inspection)Maintained integrity
ASTM F88/F88-15 (Seal strength)Maintained integrity
ASTM F1929-15 (Dye penetration test)Maintained integrity
Sterilization & Shelf LifeISO 10993-7:2008 (EO residue)EO ECH residue did not exceed the limit
USP 39-NF 34 <85> (Bacteria Endotoxin Limit)Endotoxin limit did not exceed 2.15 EU/device
Shelf Life Evaluation (Physical, Mechanical, Chemical, Package Tests on aging samples)Maintained performance during claimed shelf life (5 years)
Biocompatibility(Implicitly based on ISO 10993 for indirect contact, <24 hours)No negative impacts from materials: Cytotoxicity (Passed), Sensitization (Passed), Intracutaneous reactivity (Passed), Acute Systemic Toxicity (Passed), Pyrogen (Passed), Particulate testing (Passed).
Connector Compatibility(Implicitly tested against incompatible connectors)Would not be connected with incompatible connector (verified)

2. Sample size used for the test set and the data provenance

The document does not specify the exact sample sizes for each non-clinical test (e.g., how many syringes were tested for fluid leakage, or how many samples for biocompatibility tests). It simply states that "Non clinical tests were conducted to verify that the proposed device met all design specifications."

The data provenance is from non-clinical tests conducted by Jiangsu Caina Medical Co., Ltd. (the manufacturer). The country of origin of the testing data is presumably China, where the manufacturer is located. The tests are retrospective in the sense that they were performed to support the 510(k) submission for an already developed device.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable as this is a non-clinical submission for a physical medical device (syringe), not an AI/software device that requires expert-established ground truth for a test set. The "ground truth" here is compliance with established international and national standards.

4. Adjudication method for the test set

This information is not applicable for the same reasons as point 3. Testing against standards does not typically involve adjudication in the way AI/software studies do.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

No, a multi-reader multi-case (MRMC) comparative effectiveness study was not done. This is a 510(k) submission for a physical medical device (Plastic LOR Syringe), which does not involve human readers or AI assistance.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done

No, a standalone algorithm performance study was not done. This device is a physical medical instrument, not an algorithm.

7. The type of ground truth used

The "ground truth" for this submission is compliance with recognized consensus standards (ISO, ASTM, USP) for medical devices, materials, and sterilization, as well as the demonstration of substantial equivalence to predicate devices based on these tests.

8. The sample size for the training set

This information is not applicable as this is a physical medical device. There is no AI model or "training set" involved in its development or regulatory submission.

9. How the ground truth for the training set was established

This information is not applicable as there is no training set for this type of device.

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February 12, 2021

Jiangsu Caina Medical Co., Ltd % Diana Hong General Manager Mid-Link Consulting Co., Ltd P.O Box 120-119 Shanghai, 200120 China

Re: K201356

Trade/Device Name: Plastic LOR Syringe Regulation Number: 21 CFR 868.5140 Regulation Name: Anesthesia conduction kit Regulatory Class: Class II Product Code: CAZ Dated: January 12, 2021 Received: January 13, 2021

Dear Diana Hong:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

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requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

for Todd Courtney Assistant Director DHT1C: Division of ENT, Sleep Disordered Breathing, Respiratory and Anesthesia Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K201356

Device Name Plastic LOR Syringe

Indications for Use (Describe)

The Plastic LOR Syringe is intended for use in conjunction with an epidural needle, to verify the needle tip placement in the epidural space by the loss of Resistance technique, it will be filled with air and/or saline during use. The loss of Resistance Syringe is not intended for injection. The syringe will be sold sterile individually packaged, and as part of a sterile kit.

Type of Use (Select one or both, as applicable)
X Prescription Use (Part 21 CFR 801 Subpart D)Over-The-Counter Use (21 CER 801 Subnart C)

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510(k) Summary

This 510(k) Summary is being submitted in accordance with requirements of Title 21, CFR Section 807.92.

The as signed 510(k) Number: _K201356

    1. Date of Preparation: 2/10/2021
    1. Sponsor Identification

Jiangsu Caina Medical Co., Ltd. No.23, Huanxi Road, Zhutang Town, Jiangyin City, Jiangsu, 214415, China

Establishment Registration Number: 3005670221

Contact Person: Jianwei Pan Position: Management Representative Tel: +86-510-8686 6666-8027 Fax: +86-510-8686 6666-8009 Email:jianwei.pan @cainamed.com

    1. Designated Submission Correspondent
      Ms. Diana Hong (Primary Contact Person) Ms. Jing Cheng (Alternative Contact Person)

Mid-Link Consulting Co., Ltd P.O. Box 120-119, Shanghai, 200120, China

Tel: +86-21-22815850, Fax: 360-925-3199 Email: info@mid-link.net

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4. Identification of Proposed Device

Trade Name: Plastic LOR Syringe Common Name: Loss of Resistance Syringe Models: 5 ml Luer lock, 5ml Luer slip, 5ml NRfit lock, 5ml NRfit Slip; 7 ml Luer lock, 7ml Luer slip, 7ml NRfit lock, 7ml NRfit Slip; 10 ml Luer lock, 10ml Luer slip, 10ml NRfit lock, 10ml NRfit Slip; 20 ml Luer lock, 20ml Luer slip, 20ml NRfit lock, 20ml NRfit Slip;

Regulatory Information

Classification Name: Anesthesia conduction kit; Classification: II; Product Code: CAZ; Regulation Number: 21CFR 868.5140; Review Panel: Anesthesiology;

Indication for Use:

The Plastic LOR Syringe is intended for use in conjunction with an epidural needle, to verify the needle tip placement in the epidural space by the loss of Resistance technique, it will be filled with air and/or saline during use. The loss of Resistance Syringe is not intended for injection or aspiration. The syringe will be sold sterile individually packaged, and as part of a sterile kit.

Device Description

The Plastic LOR syringe is a piston syringe of three pieces. It consists of barrel, plunger and piston. The barrel is available with Luer slip, NRFit lock, NRFit Slip male connector. The Plastic LOR syringe is provided in combinations of four connectors and four syringe capacities (5ml, 7ml, 10ml, 20ml).

The device is a sterile finished disposable device, supplied sterile to the end user and non-sterile will be supplied to Anesthetic Conduction Kit manufacturers to be sterile and packaged into kit. The Plastic LOR syringe is a single use device which will be supplied as sterile individually packaged and the non-sterile bulk packed. The sterilized by Ethylene Oxide Gas to achieve a SAL of 10° and supplied sterility maintenance package which could maintain the sterility of the device during the s helf life of five years. The intended patient population is adults.

  • ર. Identification of Predicate Device
    Predicate device 1 510(k) Number: K061737

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Product Name: BusseLoss of Resistance Syringe

Predicate device 2 510(k) Number: K190345 Product Name: VPC

6. Non-Clinical Test Conclusion

Non clinical tests were conducted to verify that the proposed device met all design specifications and is Substantially Equivalent (SE) to the predicate device. The testing included the following items :

Physical, Mechanical, Chemical testing listed in following table were performed on the proposed device. The test results show that the device conforms with the requirements of related standards.

General requirementsClause 5 of ISO 7886-1:2017
Extraneous matterClause 6 of ISO 7886-1:2017
LubricantClause 7 of ISO 7886-1:2017
Tolerance on graduated capacityClause 8 of ISO 7886-1:2017
Graduated scaleClause 9 of ISO 7886-1:2017
BarrelClause 10 of ISO 7886-1:2017
Piston stopper/ plunger assemblyClause 11 of ISO 7886-1:2017
NozzleClause 12 of ISO 7886-1:2017
PerformanceClause 13 of ISO 7886-1:2017
Dimensional requirements forneuraxial SMALL-BORECONNECTORClause 5 of ISO 80369-6:2016
Fluid leakageClause 6.1 of ISO 80369-6:2016
Sub-atmospheric pressure airleakageClause 6.2 of ISO 80369-6:2016
Stress crackingClause 6.3 of ISO 80369-6:2016
Resistance to speration form axialloadClause 6.4 of ISO 80369-6:2016
Resistance to separation fromunscrewingClause 6.5 of ISO 80369-6:2016
Resistance to overidingClause 6.6 of ISO 80369-6:2016
Dimensional requirements forLUER CONNECTORClause 5 of ISO 80369-7:2016
Fluid leakageClause 6.1 of ISO 80369-7:2016

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Sub-atmospheric pressure air leakageClause 6.2 of ISO 80369-7:2016
Stress crackingClause 6.3 of ISO 80369-7:2016
Resistance to speration form axial loadClause 6.4 of ISO 80369-7:2016
Resistance to separation from unscrewingClause 6.5 of ISO 80369-7:2016
Resistance to overidingClause 6.6 of ISO 80369-7:2016

Sterile barrier packaging testing were performed on the proposed device, which include visual inspection (ASTM F1886/F1886M-16), seal strength (ASTM F88/F88-15) and dye penetration test (ASTM F1929-15). The test result showed that the device package can maintain its integrity.

Sterilization and shelf life testing listed in following table were performed on the proposed device. EO ECH residue did not exceed the limit of ISO 10993-7. Endotoxin limit did not exceed 20EU/device. Shelf life test result showed that the device can maintain its performance during the claimed shelf life.

EO residueISO 10993-7:2008
ECH residueISO 10993-7:2008
Bacteria Endotoxin LimitUSP 39-NF 34 <85>
Shelf Life EvaluationPhysical, Mechanical, Chemical, Package Testswere performed on aging samples to verify theclaimed shelf life of the device

Connector Compatibility Test

In order to prove that the connector of the proposed device will not have the risk of incorrect connection with the connector of other incompatible device, connector compatibility test was carried out, which proved that the proposed device would not be connected with incompatible connector.

Biocompatibility testing

The contact level of the proposed device is indirect contact duration is limited contact (<24 hours). The proposed device was evaluated for the following tests. The results for the biocompatibility testing showed that there are no negative impacts from the materials that are used in the proposed device.

  • Cytotoxicity,

  • Sensitization,

  • A Intracutaneous reactivity,

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  • ) Acute Systemic Toxicity,
  • ) Pyrogen
  • Particulate testing

    1. Clinical Test Conclusion

No clinical study is included in this submission.

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8. Substantially Equivalent (SE) Comparis on

Table 1 Substantially Equivalent Comparison
-----------------------------------------------
ITEMProposed DevicePredicate Device 1K061737Predicate Device 2K190345Remark
ProductPlastic LOR SyringeBusse Loss ofResistance SyringeVPC/
Product CodeCAZCAZCAZSE
RegulationNumber21 CRF 880.514021 CRF 880.514021 CRF 880.5140SE
ClassClass IIClass IIClass IISE
Indication forUseThe Plastic LORSyringe is intendedfor use inconjunction with anepidural needle, toverify the needle tipplacement in theepidural space by theloss of Resistancetechnique, it will befilled with air and/orsaline during use.The loss ofResistance Syringe isnot intended forinjection oraspiration. Thesyringe will be soldsterile individuallypackaged, and as partof a sterile kit.The Busse Loss ofResistance Syringe isintended for use inconjunction with anepidural needle, toverify the needle tipplacement in theepidural space by theloss of Resistancetechnique, it will befilled with air and/orsaline during use.The loss ofResistance Syringe isnot intended forinjection oraspiration. Thesyringe will be soldsterile individuallypackaged, and as partof a sterile kit.The VPC (VisualPressure Control)NRFitTM(ISO80369-6) andLUER (ISO80369-7)Loss of ResistanceSyringe is intendedfor use inconjunction with anepidural needle, toverify the needle tipplacement in theepidural space by theloss of Resistancetechnique, it will befilled with air and/orsaline during use.The loss ofResistance Syringe isnot intended forinjection oraspiration. TheSyringe will be soldsterile individuallypackaged, and aspart of a sterile kit.Analysis1
ConfigurationBarrel (luer lock, luerslip, NRFit lock,NRFit slip)Barrel (luer lock/luerslip)Barrel (luer lock,NRFit lock)Analysis2
PlungerPlungerPlungerSE
PistonPistonPistonSE
Operation ModeFor manual use onlyFor manual use onlyFor manual use onlySE
Product statesSterile product;Non-sterile productSterile product;Sterile product;Non-sterile productAnalysis1
Single UseSingle UseSingle UseSingle UseSE
Label/LabelingComplied with 21CFR part 801Complied with 21CFR part 801Complied with 21CFR part 801SE
Syringe Volume5ml, 7ml, 10ml,20ml,10ml10mlAnalysis3
SyringeConnector TypeLuer Lock, Luer Slip,NRFit Lock, NRFitSlipLuer Lock ,Luer Slipluer lock, NRFitlock,Analysis2
SyringePerformanceComplied withISO 7886-1ISO 80369-6ISO 80369-7Complied withISO 7886-1ISO 80369-7Complied withISO 7886-1ISO 80369-6ISO 80369-7SE
Materials
SyrinBarrelPolypropylene (PP)Plastic material, detailPlastic material, detailAnalysis 4
gePlungerPolypropylene (PP)material of eachmaterial of each
PistonSilicone compoundcomponent isunknowncomponent isunknown
Biocompatibility
IrritationNo intracutaneousreactivityComplied with ISO10993-1, detailComplied with ISO10993-1, detailAnalysis4
SensitizationNo skin sensitizationtesting items areunknowntesting items areunknown
SystemicToxicityNo systemic toxicityunknownunknown
HemolysisNo Hemolysis
PyrogenNo Pyrogen
Sterilization
MethodEO Sterilized ornon-sterileUnknownEO Sterilized ornon-sterileAnalysis5
SAL10-610-610-6
Endotoxin Limit2.15 EU per deviceUnknownUnknown

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Analysis 1 –Indications for Use and Product States

The proposed device and predicate devices have the same indications for use. They are all intended for use in conjunction with an epidural needle, to verify the needle tip placement in the epidural space by the loss of Resistance technique, and they all state that the syringe will be sold sterile individually

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packaged, and as part of a sterile kit.

Both the proposed device and predicate device 2 supplied sterile product and non-sterile product. The sterile product is provided directly to the end user, and the non-sterile product will be provided to medical device manufactures to be sterilized and packaged. Therefore, we believe the final sentence of the indications for use, the syringe will be sold sterile individually packaged, and as part of a sterile kit, is appropriate.

Analysis 2-Configuration

The connect type between proposed device and predicate device 1 and 2 is different. The predicate device 1 has luer lock and luer slip connector, the predicate device 2 has luer lock and NRFit lock connector. Although the NRFit slip connector is not included in the predicate device, the NRFit slip connector of the proposed device meets the requirements of ISO 80369-6 standard. Therefore, this difference does not affect substantially equivalency on safety and effectiveness.

Analysis 3-Syringe Volume

The Syringe volume for proposed device is different from the predicate devices 1 and 2. However, this difference is just in dimension. Different volume device will be selected by physician per clinical condition. Additionally, the performance of syringe has been evaluated and the test results met the requirements of ISO 7886-1. Therefore, this difference on syringe volume does not raise new questions on the proposed device's safety and effectiveness.

Analysis 4-Patient-contact material and biocompatibility

The detail patient-contact material and biocompatibility testing items for predicate device1 and 2 is unknown. However, the biocompatibility test for proposed device has been conducted and the test results showed that there are no negative impacts from the materials that are used in the proposed device. In addition, we believe that the biocompatibility testing items are appropriate based on the contact level of the proposed device. Therefore, the differences on patient-contact material and biocompatibility testing items will not raise new questions on the proposed device's safety and effectiveness.

Analysis 5-Sterilization

The proposed device and the predicate devices have the same sterilization method and SAL. The endotoxin limit of the proposed device is 2.15EU, the endotoxin limit of predicate device 1 and 2 is unknown. Although the proposed device will not contact cerebrospinal fluid, its endotoxin limit still meets the requirement of 2.15EU. We believe the difference on endotoxin limit will not raise new questions on the proposed device's safety and effectiveness.

9. Substantially Equivalent (SE) Conclusion

Based on the comparison and analysis above, the proposed devices are determined to be Substantially

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Equivalent (SE) to the predicatedevices.

§ 868.5140 Anesthesia conduction kit.

(a)
Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional, or local anesthesia. The device may contain syringes, needles, and drugs.(b)
Classification. Class II (performance standards).