K Number
K211096
Device Name
Optiflow Oxygen Kit
Date Cleared
2022-01-28

(290 days)

Product Code
Regulation Number
868.5450
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This product delivers respiratory gases to adult patients. It is intended for use with an MR810 humidifier at flows from 5 to 70 L/min. This product can be used on multiple patients when used with a hydrophobic filter between the product and the patient interface for a maximum of 24 hours after set-up. This product is indicated for the delivery of Nasal High Flow (NHF) by appropriately qualified healthcare professionals under the direction of a physician anesthesiologist in a medical room. Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min. This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist. This product is not intended for apneic ventilation.
Device Description
The Fisher & Paykel (F&P) Optiflow™ Oxygen Kit consists of a dry line, humidification chamber inspiratory tube, and tubing clips. The dryline transfers the respiratory gases from a flow source to the humidification chamber. The humidification chamber provides a reservoir filled to an indicated maximum level with sterile water. As the humiditier heats the water in the chamber, water vapor is formed, which heats and humidifies the respiratory gases delivered from the dryline. The respiratory gas is then transferred to the inspiratory tube. The inspiratory tube (also known as inspiratory limb) electrically heats the respiratory gas utilizing a heater wire to maintain the temperature of the gas. The inspiratory tube delivers the gas through an FDA-cleared filter and interface. The filter and the patient interface are not in the scope of this submission. The tubing clips are attached to the inspiratory tube. They are used to connect the tube to the hospital bed sheet or pillow. The device delivers gas at flow rates between 5 and 70 L/min. The device is to be used by medical professionals on multiple patients over a 24-hour period. Only the Optiflow™ Oxygen Kit is part of this 510(k) submission. The flow source, humidifier, filter and interface are not in the scope of this submission.
More Information

No
The device description and performance studies focus on the mechanical and physical properties of the gas delivery system, with no mention of AI or ML for control, analysis, or prediction.

Yes.
The device delivers respiratory gases for purposes such as Nasal High Flow (NHF), pre-oxygenation, and short-term supplemental oxygenation, all of which are therapeutic interventions.

No

This device is designed to deliver respiratory gases, not to diagnose a medical condition. While it mentions "Qualitative carbon dioxide sampling," this is a minor function secondary to its primary purpose of gas delivery, and it does not perform a comprehensive diagnostic assessment.

No

The device description clearly outlines physical components such as a dry line, humidification chamber, inspiratory tube, and tubing clips, which are hardware. The performance studies also focus on testing these physical components.

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

Here's why:

  • Intended Use: The intended use clearly states that the product "delivers respiratory gases to adult patients." It is used for "delivery of Nasal High Flow (NHF)," "pre-oxygenation and short-term supplemental oxygenation," and allows for "Qualitative carbon dioxide sampling." These are all related to delivering gases to and sampling gases from a patient's respiratory system in vivo (within the living body).
  • Device Description: The device components (dry line, humidification chamber, inspiratory tube, tubing clips) are all designed to facilitate the delivery of heated and humidified respiratory gases to a patient.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. This device does not perform any such tests on bodily samples. The "Qualitative carbon dioxide sampling" mentioned is about sampling the gas being exhaled by the patient, not analyzing a bodily fluid or tissue sample.

Therefore, this device falls under the category of a respiratory support device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

This product delivers respiratory gases to adult patients. It is intended for use with an MR810 humidifier at flows from 5 to 70 L/min. This product can be used on multiple patients when used with a hydrophobic filter between the product and the patient interface for a maximum of 24 hours after set-up.

This product is indicated for the delivery of Nasal High Flow (NHF) by appropriately qualified healthcare professionals under the direction of a physician anesthesiologist in a medical room. Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min.

This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist.

This product is not intended for apneic ventilation.

Product codes

BTT

Device Description

The Fisher & Paykel (F&P) Optiflow™ Oxygen Kit consists of a dry line, humidification chamber inspiratory tube, and tubing clips. The dryline (1) transfers the respiratory gases from a flow source to the humidification chamber. The humidification chamber (2) provides a reservoir filled to an indicated maximum level with sterile water. As the humiditier heats the water in the chamber, water vapor is formed, which heats and humidifies the respiratory gases delivered from the dryline. The respiratory gas is then transferred to the inspiratory tube. The inspiratory tube (3) (also known as inspiratory limb) electrically heats the respiratory gas utilizing a heater wire to maintain the temperature of the gas. The inspiratory tube delivers the gas through an FDA-cleared filter and interface. The filter and the patient interface are not in the scope of this submission. The tubing clips (4) are attached to the inspiratory tube. They are used to connect the tube to the hospital bed sheet or pillow.

The device delivers gas at flow rates between 5 and 70 L/min. The device is to be used by medical professionals on multiple patients over a 24-hour period.

Only the Optiflow™ Oxygen Kit is part of this 510(k) submission. The flow source, humidifier, filter and interface are not in the scope of this submission.

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

adult patients

Intended User / Care Setting

appropriately qualified healthcare professionals under the direction of a physician anesthesiologist in a medical room.
physician anesthesiologist in operating rooms. Hospitals.

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)

Performance testing of the Fisher & Paykel Optiflow™ Oxygen kit was completed to determine that the differences between the subject device and the predicate device do not raise new questions of safety and effectiveness. These tests demonstrate substantial equivalence of the Fisher & Paykel Optiflow™ Oxygen kit to the predicate device.

The following preconditioning was carried out as applicable for each test:

  • Shelf-life testing was performed following accelerated aging conditioning as per ASTM . F1980-16 to demonstrate product requirements continue to be met after 12 months of storage.
  • Transportation testing was performed following transport and storage simulation as per ISTA 2A:2011.
  • . Mechanical strength testing was performed following push, impact, drop, and mold stress relief conditioning as per IEC 60601-1 15.3.2, 15.3.3, 15.3.4, and 15.3.5
  • . Cleaning and low-level disinfection as per the indications for use.

The following additional performance testing has also been completed to confirm the safety and effectiveness of the Optiflow™ Oxygen Kit:

  • Permanent connections test
  • Removable connections test
  • . Gas delivery test
  • . Resistance to flow test

The Optiflow™ Oxygen Kit has been tested to applicable requirements of the following standards:

  • ISO 80601-2-74:2017(E) "Medical electrical equipment, Part 2-74: Particular ● requirements for basic safety and essential performance of respiratory humidifying equipment".
  • . IEC 60601-1-2 4th 2014 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral Standard: Electromagnetic disturbances - Requirements and tests
  • IEC 62366-1:2015 Usability Medical devices - Part 1: Application of usability engineering to medical devices
  • ISO 5356-1:2004 "Anesthetic and Respiratory Equipment- Conical Connectors- Part 1: Cones and Sockets".

Biocompatibility testing:
The biocompatibility evaluation of the Fisher & Paykel Optiflow™ Oxygen Kit was conducted in accordance with the use of international standard ISO 10993-1:2018 Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process; and ISO 18562-1:2017 Biocompatibility evaluation of breathing gas pathways in healthcare applications – Part 1: Evaluation and testing within risk management process.

Key Results: The nonclinical tests demonstrate that the differences between the predicate and subject devices do not raise new questions of safety and effectiveness, and the subject device is substantially equivalent to the legally marketed predicate device.

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.

K162553

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.

K122432

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

§ 868.5450 Respiratory gas humidifier.

(a)
Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes to warm, the breathing gases for administration to a patient. Cascade, gas, heated, and prefilled humidifiers are included in this generic type of device.(b)
Classification. Class II (performance standards).

0

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

January 28, 2022

Fisher &Paykel Healthcare Ltd. Reena Daken Regulatory Affairs Market Manager 15 Maurice Paykel Place, East Tamaki Auckland, 2013 New Zealand

Re: K211096

Trade/Device Name: Optiflow Oxygen Kit Regulation Number: 21 CFR 868.5450 Regulation Name: Respiratory Gas Humidifier Regulatory Class: Class II Product Code: BTT Dated: January 26, 2022 Received: January 28, 2022

Dear Reena Daken:

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.

Brandon Blakely Assistant Director DHT1C: Division of 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

2

Indications for Use

510(k) Number (if known) K211096

Device Name OptiflowTM Oxygen Kit

Indications for Use (Describe)

This product delivers respiratory gases to adult patients. It is intended for use with an MR810 humidifier at flows from 5 to 70 L/min. This product can be used on multiple patients when used with a hydrophobic filter between the product and the patient interface for a maximum of 24 hours after set-up.

This product is indicated for the delivery of Nasal High Flow (NHF) by appropriately qualified healthcare professionals under the direction of a physician anesthesiologist in a medical room. Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min.

This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist.

This product is not intended for apneic ventilation.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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3

5 510(k) Summary

As Required by 21 CFR 807.92 SUBMITTER -

Date prepared26 Jan 2022
Company Name and
AddressFisher & Paykel Healthcare Limited
15 Maurice Paykel Place
East Tamaki
Auckland 2013, New Zealand
Telephone: +64 9 574 0100
Prepared and Submitted
byCarolina Zatarain
Regulatory Affairs Specialist
Contact PersonReena Daken
Regulatory Affairs Manager
Telephone: +64 9 574 0100
Email: reena.daken@fphcare.co.nz

II. DEVICE

Name of DeviceF&P Optiflow™ Oxygen Kit
Common/Usual NameInspiratory tube
Classification NameRespiratory gas humidifier,
21 CFR §868.5450
Regulatory ClassII
Product CodeBTT

4

PREDICATE DEVICE lll.

Predicate Device: ●

  • AirSpiral Heated Breathing tube (K162553) O

● Reference Device:

  • RT380 and RT385 Adult Evaqua 2 Dual Heated Breathing Circuits (K122432) o

IV. DEVICE DESCRIPTION

The Fisher & Paykel (F&P) Optiflow™ Oxygen Kit consists of a dry line, humidification chamber inspiratory tube, and tubing clips. The figure below shows the Optiflow™ Oxygen Kit, as it would be legally marketed in the USA.

Image /page/4/Figure/8 description: The image shows a medical device with four labeled parts. The first part is a dry line, which is a blue, corrugated tube that arches upwards. The second part is a humidification chamber, which is a clear, round container. The third part is a heated inspiratory tube, which is a blue, corrugated tube that is coiled. The fourth part is tubing clips, which are used to hold the heated inspiratory tube in place.

Figure 5-1 Optiflow™ Oxygen Kit

The dryline (1) transfers the respiratory gases from a flow source to the humidification chamber. The humidification chamber (2) provides a reservoir filled to an indicated maximum level with sterile water. As the humiditier heats the water in the chamber, water vapor is formed, which heats and humidifies the respiratory gases delivered from the dryline. The respiratory gas is then transferred to the inspiratory tube. The inspiratory tube (3) (also known as inspiratory limb) electrically heats the respiratory gas utilizing a heater wire to maintain the temperature of the gas. The inspiratory tube delivers the gas through an FDA-cleared filter and interface. The filter and the patient interface are not in the scope of this submission. The tubing clips (4) are attached to the inspiratory tube. They are used to connect the tube to the hospital bed sheet or pillow.

The device delivers gas at flow rates between 5 and 70 L/min. The device is to be used by medical professionals on multiple patients over a 24-hour period.

Only the Optiflow™ Oxygen Kit is part of this 510(k) submission. The flow source, humidifier, filter and interface are not in the scope of this submission.

5

INDICATIONS FOR USE V.

This product delivers respiratory gases to adult patients. It is intended for use with an MR810 humidifier at flows from 5 to 70 L/min. This product can be used on multiple patients when used with a hydrophobic filter between the patient interface for a maximum of 24 hours after set-up.

This product is indicated for the delivery of Nasal High Flow (NHF) by appropriately qualified heather the direction of a physician anesthesiologist in a medical room. Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min.

This product can be used for pre-oxygenation and short-term supplemental oxygenation in operating rooms under the direction of a physician anesthesiologist.

This product is not intended for apneic ventilation.

6

COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE VI.

Table 5-1 compares technological characteristics of the subject device compared to the predicate device.

| Design/technological
characteristic for
comparison | Subject device
Optiflow™ Oxygen Kit | Predicate device
AirSpiral Heated Breathing tube
(K162553) | Comments | |
|----------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|
| Indications for use | This product delivers respiratory gases to
adult patients. It is intended for use with an
MR810 humidifier at flows from 5 to 70 L/min.
This product can be used on
multiple patients when used with a
hydrophobic filter between the product and
the patient interface for a maximum of 24
hours after set-up.
This product is indicated for the delivery of
Nasal High Flow (NHF) by appropriately
qualified healthcare professionals under
the direction of a physician
anesthesiologist in a medical procedure or
surgical room. Qualitative carbon dioxide
sampling can be used at nasal cannula flow
rates from 5 to 50 L/min.
This product can be used for pre-
oxygenation and short-term supplemental
oxygenation (up to 10 minutes) during | The 900PT561 inspiratory tube is for
the delivery of humidified respiratory
gases. For use with AIRVO™ and
AIRVO™ 2 Series humidifiers in
hospitals and long-term care
facilities. For use at flows from 2 to 60
L/min depending on the patient
interface. | Equivalent
Subject and predicate devices have
the same intended use to deliver
humidified respiratory gases.
The indications for the use of the
subject device include multi-patient
use when used with an FDA-cleared
filter and interface for each patient. | |
| Design/technological
characteristic for
comparison | Subject device
Optiflow™ Oxygen Kit | Predicate device
AirSpiral Heated Breathing tube
(K162553) | Comments | |
| | intubation in operating rooms under the
direction of a physician anesthesiologist.
This product is not intended for apneic
ventilation. | | | |
| Operation and safety features | | | | |
| Reusability | Multi-patient use | Single patient use | Indications for use include multi-
patient use. This difference was
addressed using the FDA Guidance
document, "Reprocessing Medical
Devices in Healthcare Care
Settings: Validation Methods and
Labeling." Cleaning and
reprocessing instructions were
validated. | |
| | | | Testing per the guidance document
demonstrates that this difference
does not raise new questions of
safety and effectiveness | |
| Use Duration |