K Number
K202622
Device Name
Halyard Lavender, Low Dermatitis Potential, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and and Fentanyl Citrate
Date Cleared
2021-01-07

(119 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentany1 Citrate are disposable devices intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner. These gloves were tested for use with the following chemotherapy drugs and Fentanyl Citrate as per ASTM -D6978-05 : The following chemotherapy drugs and concentration had NO breakthrough detected up to 240 minutes: Azacitidine (25 mg/ml) Bendamustine HCl (5 mg/ml) Bleomycin Sulfate (15 mg/ml) Bortezomib (1 mg/ml) Busulfan (6 mg/ml) Capecitabine (26 mg/ml) Carboplatin (10 mg/ml) Carlzomib (2 mg/ml) Cetuximab (2 mg/ml) Chloroquine (50 mg/ml) Cisplatin (1 mg/ml) Cladribine (1 mg/ml) Cyclophosphamide (20 mg/ml) Cyclosporin A (100 mg/ml) Cytarabine (Cytosine) (100 mg/ml) Cytovene (Ganciclovir) (10 mg/ml) Dacarbazine (DTIC) (10 mg/ml) Dactinomycin (0.5 mg/ml) Daunorubicin HCl (5 mg/ml) Decitabine (5 mg/ml) Docetaxel (10 mg/ml) Doxorubicin HCl (2 mg/ml) Epirubicin HCl (Ellence) (2 mg/ml) Etoposide (Toposar) (20 mg/ml) Fludarabine (25 mg/ml) 5-Fluorouracil (50 mg/ml) Fulvestrant (50 mg/ml) Gemcitabine (38 mg/ml) Idarubicin (1 mg/ml) Ifosfamide (50 mg/ml) Irinotecan HCl (20 mg/ml) Leuprolide Acetate Salt (5 mg/ml) Mechlorethamine HCl (1 mg/ml) Melphalan (5 mg/ml) Methotrexate (25 mg/ml) Mitomycin C (0.5 mg/ml) Mitoxantrone (2 mg/ml) Oxaliplatin (5 mg/ml) Paclitaxel (6 mg/ml) Pemetrexed (25 mg/ml) Raltitrexed (0.5 mg/ml) Retrovir (10 mg/ml) Rituximab (10 mg/ml) Temsirolimus (25 mg/ml) Topotecan HCl (1 mg/ml) Triclosan (2 mg/ml) Trisenox (1 mg/ml) Vinblastine Sulfate (1 mg/ml) Vincristine (1 mg/ml) Vinorelbine (10 mg/ml) Zoledronic Acid (0.8 mg/ml) The following chemotherapy drugs and concentration showed breakthrough detected in less than 60 minutes: Carmustine (3.3 mg/ml) No breakthrough up to 0.3 minutes. Thiotepa (10 mg/ml) No breakthrough up to 30.9 minutes. The following hazardous drugs (opioids) and concentration had NO breakthrough detected up to 240 minutes: Fentanyl Citrate Injection (100 mcg/2 ml) Warning: Not for Use With: Carmustine, ThioTEPA
Device Description
Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentanyl Citrate are disposable, lavender colored, chlorinated, nitrile, powder-free, textured fingertip, ambidextrous, patient examination gloves.
More Information

Not Found

No
The device is a physical medical glove and the summary focuses on its material properties and resistance to chemicals, with no mention of software, algorithms, or data processing.

No
This device, Halyard Lavender Nitrile, Powder-Free Exam Gloves, is intended to prevent contamination between patient and examiner and protect the examiner from certain chemotherapy drugs and fentanyl citrate. It is a barrier device for protection and does not provide therapy or treatment for a disease or condition.

No

Explanation: The device is an exam glove intended to prevent contamination. It does not diagnose any condition or disease.

No

The device is a physical glove, not software. The description details its material, physical properties, and testing against chemical permeation.

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

Here's why:

  • Intended Use: The intended use clearly states the gloves are "disposable devices intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner." This describes a barrier device used for protection during medical examinations.
  • IVD Definition: An In Vitro Diagnostic device is defined as a medical device that is used to perform tests on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Lack of Diagnostic Function: The description of the gloves and their testing focuses on their barrier properties and resistance to permeation by certain drugs. There is no mention of the gloves being used to analyze samples or provide diagnostic information about a patient's health.

The testing for chemotherapy drugs and Fentanyl Citrate is related to the safety and performance of the barrier function of the gloves when exposed to these substances, not for diagnosing anything.

N/A

Intended Use / Indications for Use

The Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentany1 Citrate are disposable devices intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner. These gloves were tested for use with the following chemotherapy drugs and Fentanyl Citrate as per ASTM -D6978-05 :

The following chemotherapy drugs and concentration had NO breakthrough detected up to 240 minutes: Azacitidine (25 mg/ml) Bendamustine HCl (5 mg/ml) Bleomycin Sulfate (15 mg/ml) Bortezomib (1 mg/ml) Busulfan (6 mg/ml) Capecitabine (26 mg/ml) Carboplatin (10 mg/ml) Carlzomib (2 mg/ml) Cetuximab (2 mg/ml) Chloroquine (50 mg/ml) Cisplatin (1 mg/ml) Cladribine (1 mg/ml) Cyclophosphamide (20 mg/ml) Cyclosporin A (100 mg/ml) Cytarabine (Cytosine) (100 mg/ml) Cytovene (Ganciclovir) (10 mg/ml) Dacarbazine (DTIC) (10 mg/ml) Dactinomycin (0.5 mg/ml) Daunorubicin HCl (5 mg/ml) Decitabine (5 mg/ml) Docetaxel (10 mg/ml) Doxorubicin HCl (2 mg/ml) Epirubicin HCl (Ellence) (2 mg/ml) Etoposide (Toposar) (20 mg/ml) Fludarabine (25 mg/ml) 5-Fluorouracil (50 mg/ml) Fulvestrant (50 mg/ml) Gemcitabine (38 mg/ml) Idarubicin (1 mg/ml) Ifosfamide (50 mg/ml) Irinotecan HCl (20 mg/ml) Leuprolide Acetate Salt (5 mg/ml) Mechlorethamine HCl (1 mg/ml) Melphalan (5 mg/ml) Methotrexate (25 mg/ml) Mitomycin C (0.5 mg/ml)
Mitoxantrone (2 mg/ml) Oxaliplatin (5 mg/ml) Paclitaxel (6 mg/ml) Pemetrexed (25 mg/ml) Raltitrexed (0.5 mg/ml) Retrovir (10 mg/ml) Rituximab (10 mg/ml) Temsirolimus (25 mg/ml) Topotecan HCl (1 mg/ml) Triclosan (2 mg/ml) Trisenox (1 mg/ml) Vinblastine Sulfate (1 mg/ml) Vincristine (1 mg/ml) Vinorelbine (10 mg/ml) Zoledronic Acid (0.8 mg/ml)

The following chemotherapy drugs and concentration showed breakthrough detected in less than 60 minutes: Carmustine (3.3 mg/ml) No breakthrough up to 0.3 minutes. Thiotepa (10 mg/ml) No breakthrough up to 30.9 minutes.

The following hazardous drugs (opioids) and concentration had NO breakthrough detected up to 240 minutes: Fentanyl Citrate Injection (100 mcg/2 ml)

Warning: Not for Use With: Carmustine, ThioTEPA

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

LZC, LZA, QDO

Device Description

Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentanyl Citrate are disposable, lavender colored, chlorinated, nitrile, powder-free, textured fingertip, ambidextrous, patient examination gloves. The devices follow consensus standards: ASTM D5151-06 Standard Test Method for Detection of Holes in Medical Gloves ASTM D6319-10 Standard Specification for Nitrile Examination Gloves for Medical Applications ASTM D6124-06 Standard Test Method for Residual Powder on Medical Gloves ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs ISO 10993-11:2017, Biological evaluation of medical devices - Part 11: Tests for Systemic Toxicity ISO 10993-10: 2010: Biological evaluation of medical devices - Part 10: Tests for Irritation and Skin Sensitization

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

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs:
The following chemotherapy drugs and concentration had NO breakthrough detected up to 240 minutes: Azacitidine (25 mg/ml), Bendamustine HCl (5 mg/ml), Bleomycin Sulfate (15 mg/ml), Bortezomib (1 mg/ml), Busulfan (6 mg/ml), Capecitabine (26 mg/ml), Carboplatin (10 mg/ml), Car-lzomib (2 mg/ml), Cetuximab (2 mg/ml), Chloroquine (50 mg/ml), Cisplatin (1 mg/ml), Cladribine (1 mg/ml), Cyclophosphamide (20 mg/ml), Cyclosporin A (100 mg/ml), Cytarabine (Cytosine) (100 mg/ml), Cytovene (Ganciclovir) (10 mg/ml), Dacarbazine (DTIC) (10 mg/ml), Dactinomycin (0.5 mg/ml), Daunorubicin HCl (5 mg/ml), Decitabine (5 mg/ml), Docetaxel (10 mg/ml), Doxorubicin HCl (2 mg/ml), Epirubicin HCl (Ellence) (2 mg/ml), Etoposide (Toposar) (20 mg/ml), Fludarabine (25 mg/ml), 5-Fluorouracil (50 mg/ml), Fulvestrant (50 mg/ml), Gemcitabine (38 mg/ml), Idarubicin (1 mg/ml), Ifosfamide (50 mg/ml), Irinotecan HCl (20 mg/ml), Leuprolide Acetate Salt (5 mg/ml), Mechlorethamine HCl (1 mg/ml), Melphalan (5 mg/ml), Methotrexate (25 mg/ml), Mitomycin C (0.5 mg/ml), Mitoxantrone (2 mg/ml), Oxaliplatin (5 mg/ml), Paclitaxel (6 mg/ml), Pemetrexed (25 mg/ml), Raltitrexed (0.5 mg/ml), Retrovir (10 mg/ml), Rituximab (10 mg/ml), Temsirolimus (25 mg/ml), Topotecan HCl (1 mg/ml), Triclosan (2 mg/ml), Trisenox (1 mg/ml), Vinblastine Sulfate (1 mg/ml), Vincristine (1 mg/ml), Vinorelbine (10 mg/ml), Zoledronic Acid (0.8 mg/ml).
The following chemotherapy drugs and concentration showed breakthrough detected in less than 60 minutes: Carmustine (3.3 mg/ml) No breakthrough up to 0.3 minutes. Thiotepa (10 mg/ml) No breakthrough up to 30.9 minutes.

The following hazardous drugs (opioids) and concentration had NO breakthrough detected up to 240 minutes: Fentanyl Citrate Injection (100 mcg/2 ml).

ASTM D5151-06 Standard Test Method for Detection of Holes in Medical Gloves:
Testing of the subject device shows it meets the 2.5% AQL requirement in the standards for leakage. The device meets the acceptance criteria of the standard.

ASTM D6124-06 Standard Test Method for Residual Powder on Medical Gloves:
Residual powder on the subject device is an average of 0.4 mg/glove within the powder-free limit of

§ 880.6250 Non-powdered patient examination glove.

(a)
Identification. A non-powdered patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. A non-powdered patient examination glove does not incorporate powder for purposes other than manufacturing. The final finished glove includes only residual powder from manufacturing.(b)
Classification. Class I (general controls). The device, when it is a finger cot, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 880.9.

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food & Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" in a square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in a sans-serif font.

January 7, 2021

O & M Halyard, Inc. Steven Dowdley Associate Director 1 Edison Drive Alpharetta, Georgia 30005

Re: K202622

Trade/Device Name: Halyard Lavender, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentanyl Citrate Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, Product Code: LZC, LZA, QDO Dated: December 4, 2020 Received: December 10, 2020

Dear Steven Dowdley:

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.

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 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 (QS) 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: Elizabeth F. Claverie-Williams, MS Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K202622

Device Name

Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentanyl Citrate

Indications for Use (Describe)

The Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentany1 Citrate are disposable devices intended for medical purposes that is worn on the examiner's hand to prevent contamination between patient and examiner. These gloves were tested for use with the following chemotherapy drugs and Fentanyl Citrate as per ASTM -D6978-05 :

The following chemotherapy drugs and concentration had NO breakthrough detected up to 240 minutes: Azacitidine (25 mg/ml) Bendamustine HCl (5 mg/ml) Bleomycin Sulfate (15 mg/ml) Bortezomib (1 mg/ml) Busulfan (6 mg/ml) Capecitabine (26 mg/ml) Carboplatin (10 mg/ml) Carlzomib (2 mg/ml) Cetuximab (2 mg/ml) Chloroquine (50 mg/ml) Cisplatin (1 mg/ml) Cladribine (1 mg/ml) Cyclophosphamide (20 mg/ml) Cyclosporin A (100 mg/ml) Cytarabine (Cytosine) (100 mg/ml) Cytovene (Ganciclovir) (10 mg/ml) Dacarbazine (DTIC) (10 mg/ml) Dactinomycin (0.5 mg/ml) Daunorubicin HCl (5 mg/ml) Decitabine (5 mg/ml) Docetaxel (10 mg/ml) Doxorubicin HCl (2 mg/ml) Epirubicin HCl (Ellence) (2 mg/ml) Etoposide (Toposar) (20 mg/ml) Fludarabine (25 mg/ml) 5-Fluorouracil (50 mg/ml) Fulvestrant (50 mg/ml) Gemcitabine (38 mg/ml) Idarubicin (1 mg/ml) Ifosfamide (50 mg/ml) Irinotecan HCl (20 mg/ml) Leuprolide Acetate Salt (5 mg/ml) Mechlorethamine HCl (1 mg/ml) Melphalan (5 mg/ml) Methotrexate (25 mg/ml) Mitomycin C (0.5 mg/ml)

3

Mitoxantrone (2 mg/ml) Oxaliplatin (5 mg/ml) Paclitaxel (6 mg/ml) Pemetrexed (25 mg/ml) Raltitrexed (0.5 mg/ml) Retrovir (10 mg/ml) Rituximab (10 mg/ml) Temsirolimus (25 mg/ml) Topotecan HCl (1 mg/ml) Triclosan (2 mg/ml) Trisenox (1 mg/ml) Vinblastine Sulfate (1 mg/ml) Vincristine (1 mg/ml) Vinorelbine (10 mg/ml) Zoledronic Acid (0.8 mg/ml)

The following chemotherapy drugs and concentration showed breakthrough detected in less than 60 minutes: Carmustine (3.3 mg/ml) No breakthrough up to 0.3 minutes. Thiotepa (10 mg/ml) No breakthrough up to 30.9 minutes.

The following hazardous drugs (opioids) and concentration had NO breakthrough detected up to 240 minutes: Fentanyl Citrate Injection (100 mcg/2 ml)

Warning: Not for Use With: Carmustine, ThioTEPA

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

| Prescription Use (Part 21 CFR 801 Subpart D)

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

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4

510(k) Summary for K202622 Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with Chemotherapy Drugs and Fentanyl Citrate

| Date Summary

was PreparedDecember 4, 2020
510(k) SubmitterO & M Halyard, Inc.
1 Edison Drive
Alpharetta, GA 30005
Primary Contact for
this 510(k) SubmissionSteven Dowdley, RAC
Tel: 678-451-8062
Email: steven.dowdley@hyh.com
Marketed Common NameHalyard Lavender Nitrile Powder-Free Exam Gloves
Device Submission Trade Name
and DescriptionHalyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use
Device Common NameMedical Exam Gloves
Device Product Code
and Classification NameLZA Class I, 21 CFR §880.6250 Patient Examination Glove
LZC Class I, 21 CFR §880.6250 Patient Examination Glove, Specialty;
QDO Class I, 21 CFR §880.6250 Fentanyl and other opioid protection glove
Predicate DeviceHalyard Lavender, Powder-Free Exam Gloves Tested for Use with
Chemotherapy Drugs (K180646)
Subject Device DescriptionHalyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with
Chemotherapy Drugs and Fentanyl Citrate are disposable, lavender colored,
chlorinated, nitrile, powder-free, textured fingertip, ambidextrous, patient
examination gloves. The devices follow consensus standards:
ASTM D5151-06 Standard Test Method for Detection of Holes in Medical
Gloves
ASTM D6319-10 Standard Specification for Nitrile Examination Gloves for
Medical Applications
ASTM D6124-06 Standard Test Method for Residual Powder on Medical
Gloves
ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical
Gloves to Permeation by Chemotherapy Drugs
ISO 10993-11:2017, Biological evaluation of medical devices - Part 11:
Tests for Systemic Toxicity
ISO 10993-10: 2010: Biological evaluation of medical devices - Part 10:
Tests for Irritation and Skin Sensitization
for medical purposes that is worn on the examiner's hand to prevent
contamination between patient and examiner. These gloves were tested for
use with the following chemotherapy drugs and Fentanyl Citrate as per ASTM
-D6978-05 :
The following chemotherapy drugs and concentration had NO breakthrough
detected up to 240 minutes:
Azacitidine (25 mg/ml)
Bendamustine HCl (5 mg/ml)
Bleomycin Sulfate (15 mg/ml)
Bortezomib (1 mg/ml)
Busulfan (6 mg/ml)
Capecitabine (26 mg/ml)
Carboplatin (10 mg/ml)
Carlzomib (2 mg/ml)
Cetuximab (2 mg/ml)
Chloroquine (50 mg/ml)
Cisplatin (1 mg/ml)
Cladribine (1 mg/ml)
Cyclophosphamide (20 mg/ml)
Cyclosporin A (100 mg/ml)
Cytarabine (Cytosine) (100 mg/ml)
Cytovene (Ganciclovir) (10 mg/ml)
Dacarbazine (DTIC) (10 mg/ml)
Dactinomycin (0.5 mg/ml)
Daunorubicin HCl (5 mg/ml)
Decitabine (5 mg/ml)
Docetaxel (10 mg/ml)
Doxorubicin HCl (2 mg/ml)
Epirubicin HCl (Ellence) (2 mg/ml)
Etoposide (Toposar) (20 mg/ml)
Fludarabine (25 mg/ml)
5-Fluorouracil (50 mg/ml)
Fulvestrant (50 mg/ml)
Gemcitabine (38 mg/ml)
Idarubicin (1 mg/ml)
Ifosfamide (50 mg/ml)
Irinotecan HCl (20 mg/ml)
Leuprolide Acetate Salt (5 mg/ml)
Mechlorethamine HCl (1 mg/ml)
Melphalan (5 mg/ml)
Methotrexate (25 mg/ml)
Mitomycin C (0.5 mg/ml)
Mitoxantrone (2 mg/ml)
Oxaliplatin (5 mg/ml)
Paclitaxel (6 mg/ml)
Pemetrexed (25 mg/ml)
Raltitrexed (0.5 mg/ml)
Retrovir (10 mg/ml)
Rituximab (10 mg/ml)
Temsirolimus (25 mg/ml)Indications for UseThe Halyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use with
Chemotherapy Drugs and Fentanyl Citrate are disposable devices intended
Topotecan HCl (1 mg/ml)
Triclosan (2 mg/ml)
Trisenox (1 mg/ml)
Vinblastine Sulfate (1 mg/ml)
Vincristine (1 mg/ml)
Vinorelbine (10 mg/ml)
Zoledronic Acid (0.8 mg/ml)
The following chemotherapy drugs and concentration showed breakthrough
detected in less than 60 minutes:
Carmustine (3.3 mg/ml) No breakthrough up to 0.3 minutes.
Thiotepa (10 mg/ml) No breakthrough up to 30.9 minutes.
The following hazardous drugs (opioids) and concentration had NO
breakthrough detected up to 240 minutes:
Fentanyl Citrate Injection (100 mcg/2 ml)
Warning: Do not use with Carmustine or Thiotepa.
Technological Characteristics Comparison Table
Subject Device K202622Predicate Device K180646Comparison
FDA Product CodeLZC, LZA, QDOLZC, LZASame
FDA ClassificationClass IClass ISame
Regulation Number880.6250880.6250Same
Common NameMedical Exam GloveMedical Exam GloveSame
Device Trade NameHalyard Lavender Nitrile, Powder-
Free Exam Gloves Tested for Use
with Chemotherapy Drugs and
Fentanyl CitrateHalyard Lavender, Powder-Free
Exam Gloves Tested for Use with
Chemotherapy Drugs
Intended UseHalyard Lavender Nitrile, Powder-Free Exam Gloves Tested for Use
with Chemotherapy Drugs and
Fentanyl Citrate are disposable
devices intended for medical
purposes that is worn on the
examiner's hand to prevent
contamination between patient
and examiner.
These gloves were tested for use
with chemotherapy drugs listed on
the label.The Halyard Lavender, Powder-Free Exam Gloves Tested for Use
with Chemotherapy Drugs are
disposable device intended for
medical purposes that is worn on
the examiner's hand to prevent
contamination between patient
and examiner.
These gloves were tested for use
with chemotherapy drugs listed
on the label.Same
Technological
CharacteristicsThe glove is a colored, nitrile,
powder-free, textured fingertip,
ambidextrous, patient examination
glove.The glove is a colored, nitrile,
powder-free, textured fingertip,
ambidextrous, patient
examination glove.Same
Sizes of glovesXS, S, M, L, XLXS, S, M, L, XLSame
TextureTextured fingertipsTextured fingertipsSame
SterilityNon-SterileNon-SterileSame
BiocompatibilityBased ISO 10993 Biological
evaluation of Medical devices –
Test for Systemic Injection, the test
article was considered non-toxic.
Meets the acceptance criteria.Based ISO 10993 Biological
evaluation of Medical devices –
Test for Systemic Injection, the
test article was considered non-toxic.
Meets the acceptance
criteria.Same
Based on ISO 10993- Biological
evaluation of Medical Devices –
Test for Skin Irritation, the device
extracts were not found to cause a
systemic response in the animal
model. Meets the acceptance
criteria.Based on ISO 10993- Biological
evaluation of Medical Devices –
Test for Skin Irritation, the device
extracts were not found to cause a
systemic response in the animal
model. Meets the acceptance
criteria.
Performance Data for Chemotherapy Drugs
StandardResults
Subject DevicesResults
Predicate Devices K180646Remarks
ASTM D6978-05
Standard Practice
for Assessment of
Resistance of
Medical Gloves to
Permeation by
Chemotherapy
DrugsThe following chemotherapy drugs
and concentration had NO
breakthrough
detected up to 240 minutes:
Azacitidine (25 mg/ml)
Bendamustine HCl (5 mg/ml)
Bleomycin Sulfate (15 mg/ml)
Bortezomib (1 mg/ml)
Busulfan (6 mg/ml)
Capecitabine (26 mg/ml)
Carboplatin (10 mg/ml)
Car-lzomib (2 mg/ml)
Cetuximab (2 mg/ml)
Chloroquine (50 mg/ml)
Cisplatin (1 mg/ml)
Cladribine (1 mg/ml)
Cyclophosphamide (20 mg/ml)
Cyclosporin A (100 mg/ml)
Cytarabine (Cytosine) (100 mg/ml)
Cytovene (Ganciclovir) (10 mg/ml)
Dacarbazine (DTIC) (10 mg/ml)
Dactinomycin (0.5 mg/ml)
Daunorubicin HCl (5 mg/ml)
Decitabine (5 mg/ml)
Docetaxel (10 mg/ml)
Doxorubicin HCl (2 mg/ml)
Epirubicin HCl (Ellence) (2 mg/ml)
Etoposide (Toposar) (20 mg/ml)
Fludarabine (25 mg/ml)
5-Fluorouracil (50 mg/ml)
Fulvestrant (50 mg/ml)
Gemcitabine (38 mg/ml)
Idarubicin (1 mg/ml)
Ifosfamide (50 mg/ml)
Irinotecan HCl (20 mg/ml)
Leuprolide Acetate Salt (5 mg/ml)
Mechlorethamine HCl (1 mg/ml)
Melphalan (5 mg/ml)
Methotrexate (25 mg/ml)
Mitomycin C (0.5 mg/ml)
Mitoxantrone (2 mg/ml)
Oxaliplatin (5 mg/ml)
Paclitaxel (6 mg/ml)
Pemetrexed (25 mg/ml)The following chemotherapy drugs
and concentration had NO
breakthrough
detected up to 240 minutes:
• Cyclophosphamide (20.0 mg/ml) No
breakthrough up to 240 minutes
• Doxorubicin HCl (2.0 mg/ml) No
breakthrough up to 240 minutes
• Etoposide (20.0 mg/ml) No
breakthrough up to 240 minutes
• 5-Fluorouracil (50.0 mg/ml) No
breakthrough up to 240 minutes
• Paclitaxel (Taxol) (6.0 mg/ml) No
breakthrough up to 240 minutes
• Cisplatin (1.0 mg/ml) No
breakthrough up to 240 minutes
• Dacarbazine (10.0 mg/ml) No
breakthrough up to 240 minutes
• Ifosfamide (50.0 mg/ml) No
breakthrough up to 240 minutes
• Mitoxantrone (2.0 mg/ml) No
breakthrough up to 240 minutes
• Vincristine sulfate (1.0 mg/ml) No
breakthrough up to 240 minutes
• Carmustine (3.3 mg/ml) No
breakthrough up to 0.3 minutes
• ThioTEPA (10.0 mg.ml) No
breakthrough up to 30.9 minutes
Warning: Not for Use With:
Carmustine, ThioTEPASimilar
Raltitrexed (0.5 mg/ml)
Retrovir (10 mg/ml)
Rituximab (10 mg/ml)
Temsirolimus (25 mg/ml)
Topotecan HCl (1 mg/ml)
Triclosan (2 mg/ml)
Trisenox (1 mg/ml)
Vinblastine Sulfate (1 mg/ml)
Vincristine (1 mg/ml)
Vinorelbine (10 mg/ml)
Zoledronic Acid (0.8 mg/ml)
The following chemotherapy drugs
and concentration showed
breakthrough detected in less than
60 minutes:
Carmustine (3.3 mg/ml) No
breakthrough up to 0.3 minutes.
Thiotepa (10 mg/ml) No
breakthrough up to 30.9 minutes.
Performance Data for Hazardous Drugs (opioids)
ASTM D6978-05
Standard Practice
for Assessment of
Resistance of
Medical Gloves to
Permeation by
Chemotherapy
DrugsThe following hazardous drugs
(opioids) and concentration had NO
breakthrough detected up to 240
minutes:
Fentanyl Citrate Injection (100
mcg/2 ml)Not TestedDifferent

5

6

7

8

9

Performance DataSame
ASTM D5151-06
Standard Test
Method for
Detection of Holes
in Medical GlovesTesting of the subject device shows
it meets the 2.5% AQL requirement
in the standards for leakage. The
device meets the acceptance
criteria of the standard.Testing of the subject device shows
it meets the 2.5% AQL requirement
in the standards for leakage. The
device meets the acceptance
criteria of the standard.Same
ASTM D6124-06
Standard Test
Method for Residual
Powder on Medical
GlovesResidual powder on the subject
device is an average of 0.4
mg/glove within the powder-free
limit of