K Number
K241970
Device Name
Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate (XS,S,M,L,XL,XXL)
Date Cleared
2024-08-02

(28 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Powder Free Nitrile Examination Gloves (Blue) , Tested for Use with Chemotherapy Drugs and Fentanyl Citrate 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. The tested chemotherapy drugs are: Carmustine 3.3 mg/ml(3,300 ppm) 27.7 (35.5,27.7,27.7) Cisplatin 1 mg/ml (1,000 ppm) >240min Cyclophosphamide 20 mg/ml (20,000 ppm) >240min Dacarbazine 10mg/ml (10,000 ppm) >240min Doxorubicin HCl 2 mg/ml(2,000 ppm) >240min Etoposide 20 mg/ml (20,000 ppm) >240min Fluorouracil 50mg/ml(50,000 ppm) >240min Gemcitabine HCl 38 mg/ml (38,000 ppm) >240min Ifosfamide 50mg/ml (50,000 ppm) >240min Methotrexate 25mg/ml (25,000 ppm) >240min Mitomycin C 0.5 mg/ml(500 ppm) >240min Mitoxantrone HC1 2 mg/ml (2,000 ppm) >240min Paclitaxel 6 mg/ml (6,000 ppm) >240min Thiotepa 10 mg/ml (10,000 ppm) 59.4(67.5,59.4,65.9) Vincristine Sulfate 1 mg/ml (1,000 ppm) > 240min The tested non-chemotherapy drugs are: Fentanyl Citrate injection 100mcg/2ml >240min Note: Carmustine and Thiotepa have extremely low permeation times of 27.7 and 59.4 minutes respectively. Warning: Do Not Use with Carmustine, Thiotepa
Device Description
The Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate are non-sterile, single use only, disposable examination gloves intended for medical purposes to be worn by examiners to prevent contamination between the examiner. The gloves are blue color, powder free, nitrile gloves. The gloves are offered in six sizes: XS、S、M、L、XL、XXL, packed in a paper box. The proposed gloves are designed and manufactured in accordance with the ASTM D6319-19 standard and are tested for use with chemotherapy drugs and Fentanyl per ASTM D6978-05. The proposed device was modification from the legally marketed (existing) device "Powder free Nitrile Examination Gloves (Blue, Violet Blue, White, Cobalt Blue)"/K202356, manufactured by "KANGLONGDA VIETNAM PROTECTION TECHNOLOGY COMPANY LIMITED", same as the sponsor of this submission. There are two modifications, one is to add a large model XXL, and the other is to add the "Tested for Use with Chemotherapy Drugs and Fentanyl Citrate" indications for use than the legally marketed (existing) device. Testing has been conducted on the proposed device passed as per ASTM D6978-05, ASTM D6319-19, ASTM D5151-19, ASTMD 6124-06. The materials and the manufacturing process technology are the same.
More Information

No
The device is a physical product (examination gloves) and the description focuses on material properties, testing standards, and physical characteristics. There is no mention of software, algorithms, or data processing that would indicate the use of AI/ML.

No.
The device is a glove intended to prevent contamination between a patient and an examiner; it is not designed to treat a disease or condition.

No

Explanation: The device described is a pair of examination gloves intended to prevent contamination between a patient and examiner, not to diagnose a medical condition.

No

The device is a physical product (examination gloves) and not software. The summary describes material properties, physical tests, and intended use as a barrier, not a software function.

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

Here's why:

  • Definition of IVD: An IVD is a medical device used to perform tests on samples such as blood, urine, or tissue to detect diseases, conditions, or infections. These tests are performed in vitro (outside the body).
  • Intended Use: The intended use of this device is "to prevent contamination between patient and examiner" by being worn on the hand or finger. This is a barrier function, not a diagnostic test performed on a sample.
  • Device Description: The device is described as "disposable examination gloves." This aligns with a protective barrier device, not an IVD.
  • Performance Studies: The performance studies conducted focus on physical properties (tensile strength, elongation, watertightness), powder content, and resistance to chemical permeation. These are relevant to the protective function of a glove, not the analytical performance of a diagnostic test.
  • Key Metrics: The key metrics reported (breakthrough time, tensile strength, etc.) are related to the physical and chemical resistance properties of the glove, not diagnostic accuracy metrics like sensitivity, specificity, or AUC.

The fact that the gloves are tested for use with chemotherapy drugs and Fentanyl relates to their protective capability against these substances, not their use in diagnosing a condition.

N/A

Intended Use / Indications for Use

The Powder Free Nitrile Examination Gloves (Blue) , Tested for Use with Chemotherapy Drugs and Fentanyl Citrate 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. The tested chemotherapy drugs are: Carmustine 3.3 mg/ml(3,300 ppm) 27.7 (35.5,27.7,27.7) Cisplatin 1 mg/ml (1,000 ppm) >240min Cyclophosphamide 20 mg/ml (20,000 ppm) >240min Dacarbazine 10mg/ml (10,000 ppm) >240min Doxorubicin HCl 2 mg/ml(2,000 ppm) >240min Etoposide 20 mg/ml (20,000 ppm) >240min Fluorouracil 50mg/ml(50,000 ppm) >240min Gemcitabine HCl 38 mg/ml (38,000 ppm) >240min Ifosfamide 50mg/ml (50,000 ppm) >240min Methotrexate 25mg/ml (25,000 ppm) >240min Mitomycin C 0.5 mg/ml(500 ppm) >240min Mitoxantrone HC1 2 mg/ml (2,000 ppm) >240min Paclitaxel 6 mg/ml (6,000 ppm) >240min Thiotepa 10 mg/ml (10,000 ppm) 59.4(67.5,59.4,65.9) Vincristine Sulfate 1 mg/ml (1,000 ppm) > 240min The tested non-chemotherapy drugs are: Fentanyl Citrate injection 100mcg/2ml >240min Note: Carmustine and Thiotepa have extremely low permeation times of 27.7 and 59.4 minutes respectively. Warning: Do Not Use with Carmustine, Thiotepa

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

LZA, OPJ, ODO, LZC

Device Description

The Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate are non-sterile, single use only, disposable examination gloves intended for medical purposes to be worn by examiners to prevent contamination between the examiner. The gloves are blue color, powder free, nitrile gloves. The gloves are offered in six sizes: XS、S、M、L、XL、XXL, packed in a paper box.

The proposed gloves are designed and manufactured in accordance with the ASTM D6319-19 standard and are tested for use with chemotherapy drugs and Fentanyl per ASTM D6978-05. The proposed device was modification from the legally marketed (existing) device "Powder free Nitrile Examination Gloves (Blue, Violet Blue, White, Cobalt Blue)"/K202356, manufactured by "KANGLONGDA VIETNAM PROTECTION TECHNOLOGY COMPANY LIMITED", same as the sponsor of this submission.

There are two modifications, one is to add a large model XXL, and the other is to add the "Tested for Use with Chemotherapy Drugs and Fentanyl Citrate" indications for use than the legally marketed (existing) device. Testing has been conducted on the proposed device passed as per ASTM D6978-05, ASTM D6319-19, ASTM D5151-19, ASTMD 6124-06.

The materials and the manufacturing process technology are the same.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Hand or finger

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Examiner (medical purposes)

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

Not Found

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

Not Found

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

Non-clinical tests were conducted to verify that the proposed device met all design specifications. The test results demonstrated that the proposed device complies with the following standards:
ISO 10993-10: 2021 Biological Evaluation Of Medical Devices - Part 10: Tests For Skin Sensitization (Results: Under the conditions of the study, not an irritant and not a sensitizer)
ISO 10993-5:2009, Biological evaluation of medical devices - Part 5: Tests for in vitro cytotoxicity. (Results: Under conditions of the study, not cytotoxic)
ASTM D6319-19 Standard Specification for Nitrile Examination Gloves for Medical Application (Physical Dimensions Test: Length and Width passed)
ASTM D6124-06 (Reapproved 2022), Standard Test Method for Residual Powder on Medical Gloves (Powder Content: Meet the requirements of Less than 2mg per glove. Results: Pass)
ASTM D5151-19, Standard Test Method for Detection of Holes in Medical Gloves. (Watertightness Test for Detection of Holes: Results: Pass)
ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs (Results: Meet the requirements of ASTMD 6978-05. Pass)
ASTM D412 (Physical Properties: Tensile Strength and Ultimate Elongation Before Aging and After Aging passed)

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Carmustine: Minimum Breakthrough Detection Time 27.7 (35.5,27.7,27.7) minutes
Cisplatin: Minimum Breakthrough Detection Time >240min
Cyclophosphamide: Minimum Breakthrough Detection Time >240min
Dacarbazine: Minimum Breakthrough Detection Time >240min
Doxorubicin HCl: Minimum Breakthrough Detection Time >240min
Etoposide: Minimum Breakthrough Detection Time >240min
Fluorouracil: Minimum Breakthrough Detection Time >240min
Gemcitabine HCl: Minimum Breakthrough Detection Time >240min
Ifosfamide: Minimum Breakthrough Detection Time >240min
Methotrexate: Minimum Breakthrough Detection Time >240min
Mitomycin C: Minimum Breakthrough Detection Time >240min
Mitoxantrone HCl: Minimum Breakthrough Detection Time >240min
Paclitaxel: Minimum Breakthrough Detection Time >240min
Thiotepa: Minimum Breakthrough Detection Time 59.4(67.5,59.4,65.9) minutes
Vincristine Sulfate: Minimum Breakthrough Detection Time >240min
Fentanyl Citrate injection: Minimum Breakthrough Detection Time >240min

Physical Dimensions:
Length (mm): XS/S/M/L/XL/XXL: ≥230. Pass.
Width(mm): XS: 70±10mm; S: 85±10mm; M: 95±10mm; L: 110±10 mm; XL: 120±10 mm; XXL: 130±10 mm. Pass.
Thickness (mm): Finger: ≥0.05; Palm: ≥0.05. Pass.

Physical Properties (ASTM D412):
Before Aging: Tensile Strength: 14MPa, min (Pass); Ultimate Elongation: 500% min (Pass).
After Aging: Tensile Strength: 14MPa, min (Pass); Ultimate Elongation: 400% min (Pass).

Powder Content (ASTM D6124): Meet the requirements of Less than 2mg per glove (Pass).

Freedom from Holes (ASTM D5151): Be free from holes when tested in accordance with ASTMD5151 (Pass).

Biocompatibility (ISO 10993-10): Under the conditions of the study, not an irritant and not a sensitizer.

Biocompatibility (ISO 10993-5): Under conditions of the study, not cytotoxic.

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.

K202356

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.

K240629

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

§ 880.6250 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 contains the logo of the U.S. Food and Drug Administration (FDA). On the left, there is a seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES-USA" arranged in a circular pattern. To the right of the seal, there is the FDA logo in blue, with the words "U.S. FOOD & DRUG" on top and "ADMINISTRATION" below. The logo is simple and professional, reflecting the FDA's role in regulating food and drugs.

August 2, 2024

Kanglongda Vietnam Protection Technology Company Limited % Ray Wang General Manager Beijing Believe-Med Technology Service Co., Ltd. Rm.912, Building #15, XiYueHui, No.5, YiHe North Rd. FangShan District Beijing, 102401 China

Re: K241970

Trade/Device Name: Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate (XS,S,M,L,XL,XXL) Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LZA, OPJ, ODO, LZC Dated: July 3, 2024 Received: July 5, 2024

Dear Ray Wang:

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 (the 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 available 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

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (OS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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).

2

Sincerely,

Allan Guan -S

For Bifeng Qian, M.D., Ph.D. Assistant Director DHT4C: Division of Infection Control Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

3

Indications for Use

510(k) Number (if known) K241970

Device Name

Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentany! Citrate

Indications for Use (Describe) The Powder Free Nitrile Examination Gloves (Blue) , Tested for Use with Chemotherapy Drugs and Fentanyl Citrate 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. The tested chemotherapy drugs are: Carmustine 3.3 mg/ml(3,300 ppm) 27.7 (35.5,27.7,27.7) Cisplatin 1 mg/ml (1,000 ppm) >240min Cyclophosphamide 20 mg/ml (20,000 ppm) >240min Dacarbazine 10mg/ml (10,000 ppm) >240min Doxorubicin HCl 2 mg/ml(2,000 ppm) >240min Etoposide 20 mg/ml (20,000 ppm) >240min Fluorouracil 50mg/ml(50,000 ppm) >240min Gemcitabine HCl 38 mg/ml (38,000 ppm) >240min Ifosfamide 50mg/ml (50,000 ppm) >240min Methotrexate 25mg/ml (25,000 ppm) >240min Mitomycin C 0.5 mg/ml(500 ppm) >240min Mitoxantrone HC1 2 mg/ml (2,000 ppm) >240min Paclitaxel 6 mg/ml (6,000 ppm) >240min Thiotepa 10 mg/ml (10,000 ppm) 59.4(67.5,59.4,65.9) Vincristine Sulfate 1 mg/ml (1,000 ppm) > 240min The tested non-chemotherapy drugs are: Fentanyl Citrate injection 100mcg/2ml >240min Note: Carmustine and Thiotepa have extremely low permeation times of 27.7 and 59.4 minutes respectively. Warning: Do Not 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

The assigned 510(k) Number: __________________________________________________________________________________________________________________________________________________ K241970

  • Date of Preparation: 07/31/2024 1.
    1. Submitter

KANGLONGDA Vietnam Protection Technology Company Limited

Lot CN 05, Viglacera - Phong Dien Industrial Park, Phong Hoa Commune, Phong Dien District, Thua Thien Hue Province, Vietnam, 49316

Contact Person: Yuxiang Yao Position: Batching Supervisor Tel: +86-13722853299

Email: yaoyuxiang 1212@126.com

    1. Submission Correspondent

Beijing Believe-Med Technology Service Co., Ltd.

Rm.912, Building #15, XiYueHui, No.5, YiHe North Rd., FangShan District, Beijing, China,102401 Contact Person: Ray Wang Position: General Manager Tel: +86-18910677558 Fax: +86-10-56335780 Email: information@believe-med.com

    1. Subject Device Identification
      Trade Name: Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate

Common Name: Medical Examination Glove

Regulatory Information:

Classification: I

Product Code: LZA, LZC, OPJ, QDO

Regulation Number: 21 CFR 880.6250

Review Panel: General Hospital

5

5. Predicate Device Identification

Predicate Device:

510(k) Number: K202356

Product Name: Powder free Nitrile Examination Gloves (Blue, Violet Blue, White, Cobalt Blue)

Manufacturer: Kanglongda Vietnam Protection Technology Company Limited

Regulatory Information:

Classification: I

Product Code: LZA

Regulation Number: 21 CFR 880.6250

Review Panel: General Hospital

Common Name: Nitrile Patient Examination Gloves (Powder Free)

Reference Device:

510(k) Number: K240629

Product Name: Nitrile Disposable Examination Gloves, Tested for Use with Chemotherapy Drugs and Fentanyl

Manufacturer: Xingyu Medical Tech Co., Ltd

Regulatory Information:

Classification: I

Product Code: LZA, LZC, OPJ, QDO

Regulation Number: 21 CFR 880.6250

Review Panel: General Hospital

Common Name: Nitrile Patient Examination Gloves (Powder Free)

Device Description 6.

The Powder Free Nitrile Examination Gloves (Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate are non-sterile, single use only, disposable examination gloves intended for medical purposes to be worn by examiners to prevent contamination between the examiner. The gloves are blue color, powder free, nitrile gloves. The gloves are offered in six sizes: XS、S、M、L、XL、XXL, packed in a paper box.

The proposed gloves are designed and manufactured in accordance with the ASTM D6319-19 standard and are tested for use with chemotherapy drugs and Fentanyl per ASTM D6978-05. The proposed device was

6

modification from the legally marketed (existing) device "Powder free Nitrile Examination Gloves (Blue, White, Cobalt Blue)"/K202356, manufactured by "KANGLONGDA VIETNAM Violet Blue, PROTECTION TECHNOLOGY COMPANY LIMITED", same as the sponsor of this submission.

There are two modifications, one is to add a large model XXL, and the other is to add the "Tested for Use with Chemotherapy Drugs and Fentanyl Citrate" indications for use than the legally marketed (existing) device. Testing has been conducted on the proposed device passed as per ASTM D6978-05, ASTM D6319-19, ASTM D5151-19, ASTMD 6124-06.

The materials and the manufacturing process technology are the same.

We selected K240629 as our reference device and K202356 as our predicate device. Detailed comparison information can be found in the 510k Summary.

  1. Indications For Use

The Powder Free Nitrile Examination Gloves(Blue), Tested for Use with Chemotherapy Drugs and Fentanyl Citrate 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.

| Drugs | Concentration | Minimum Breakthrough
Detection Time |
|------------------------------------|-----------------------|----------------------------------------|
| The tested chemotherapy drugs are: | | |
| Carmustine | 3.3 mg/ml(3,300 ppm) | 27.7
(35.5,27.7,27.7) |
| Cisplatin | 1 mg/ml (1,000 ppm) | >240min |
| Cyclophosphamide | 20 mg/ml (20,000 ppm) | >240min |
| Dacarbazine | 10mg/ml (10,000 ppm) | >240min |
| Doxorubicin HCl | 2 mg/ml(2,000 ppm) | >240min |
| Etoposide | 20 mg/ml (20,000 ppm) | >240min |
| Fluorouracil | 50mg/ml(50,000 ppm) | >240min |
| Gemcitabine HCl | 38 mg/ml (38,000 ppm) | >240min |
| Ifosfamide | 50mg/ml (50,000 ppm) | >240min |
| Methotrexate | 25mg/ml (25,000 ppm) | >240min |
| Mitomycin C | 0.5 mg/ml(500 ppm) | >240min |
| Mitoxantrone HCl | 2 mg/ml (2,000 ppm) | >240min |
| Paclitaxel | 6 mg/ml (6,000 ppm) | >240min |
| Thiotepa | 10 mg/ml (10,000 ppm) | 59.4(67.5,59.4,65.9) |
| Vincristine Sulfate | 1 mg/ml (1,000 ppm) | >240min |

The tested drugs are:

7

The tested non-chemotherapy drugs are:
Fentanyl
injectionCitrate100mcg/2ml>240min

Note: Carmustine and Thiotepa have extremely low permeation times of 27.7 and 59.4 minutes respectively.

Warning: Do Not Use with Carmustine, Thiotepa

8

510k Summary

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| ITEM | 8. Technological Characteristic Comparison Summary
Table 1 Comparison of Technology Characteristics | | | Remark | | |
|----------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------|----------|----------------------------------------|
| Product Code | Proposed Device (K241970)
Powder Free Nitrile Examination
Gloves (Blue), Tested for Use with
Chemotherapy Drugs and Fentanyl
Citrate | Predicate Device(K202356)
Powder free Nitrile Examination Gloves
(Blue, Violet Blue, White, Cobalt Blue) | Reference Device (K240629)
Nitrile Disposable Examination Gloves,
Tested for Use with Chemotherapy Drugs
and Fentanyl | | | |
| Regulation No. | LZA, LZC, OPJ, QDO
21 CFR 880.6250 | LZA
21 CFR 880.6250 | LZA, LZC, OPJ, QDO
21 CFR 880.6250 | SAME | | |
| Class | I | I | I | SAME | | |
| Intended Use | The Powder Free Nitrile Examination
Gloves (Blue), Tested for Use with
Chemotherapy Drugs and Fentanyl
Citrate 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. | The Powder free Nitrile Examination
Gloves (Blue, Violet Blue, White,
Cobalt Blue) is a disposable device
intended for medical purposes that is
worn on the examiner's hands to prevent
contamination between patient and
examiner. | The Nitrile Disposable Examination
Gloves, Tested for Use with
Chemotherapy Drugs and Fentanyl, 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. The tested
chemotherapy drugs are: | SAME
Similar 1 | | |
| | The tested chemotherapy drugs are: | | | | | |
| Drugs | Concentration | | Drugs | Concentration | | Minimum Breakthrough
Detection Time |
| | The tested chemotherapy drugs are: | | | | | |
| Bleomycin sulfate | | | Bleomycin sulfate | (15.0 mg/ml 15,000 ppm) | >240 min | |
| Carboplatine | | | Carboplatine | (10.0 mg/ml 10,000 ppm) | >240 min | |
| Carmustine | | | Carmustine (BCNU) | (3.3mg/ml 3,300-ppm) | 26.7 | |
| Cisplatin | 1mg/ml (1,000ppm) | | Cisplatin | (1.0-mg/ml. 1,000 ppm) | >240 min | |
| Cyclophosphamide | (20.0 mg/ml. 20,000 ppm) | | Cyclophosphamide | (20.0 mg/ml. 20,000 ppm) | >240 min | |
| Cytarabine, (Cytosine) | (100.0 mg/mL 100,000 ppm) | | | | | |
| Dacarbazine | (10.0-mg/mL 10,000 ppm) | | Dacarbazine | 10mg ml (10,000 ppm) | >240 min | |
| Doxorubicin HCL | (2.0-mg/ml 2,000 ppm) | | Doxorubicin HCl | 2mg/ml(2,000 ppm) | >240 min | |
| Etoposide (Toposar)+ | (20.0 mg/mL 20,000 ppm) | | Etoposide | 20mg/ml (20,000 ppm) | >240 min | |
| Fluorouracil (5-Flu) | (50.0-mg/mL-50,000-ppm) | | Fluorouracil | 50mg/ml(50,000ppm) | >240 min | |
| Idarubicin | (1.0-mg/ml 1,000 ppm) | | | | | |
| Gemcitabine HCI | | | Gemcitabine HCI | 38mg/ml (38,000 ppm) | >240 min | |
| Ifosfamide | (50.0 mg/mL 50,000 ppm) | | Ifosfamide | 50mg/ml (50,000 ppm) | >240 min | |
| Mechlorethamine HCL | (1.0 mg/ml 1,000 ppm) | | | | | |
| Methotrexate | (25.0 mg/mL 25,000 ppm) | | Methotrexate | 25mg/ml (25,000 ppm) | >240 min | |
| Mitomycin C | | | Mitomycin C | 0.5 mg/ml(500 ppm) | >240 min | |
| Mitoxantrone HCL | (2.0 mg/ml. 2,000 ppme | | Mitoxantrone HCL | 2 mg/ml (2,000 ppm) | >240 min | |
| Paclitaxel | (6.0 mg/mL 6,000 ppm) | | Paclitaxel | 6 mg/ml (6,000 ppm) | >240 min | |
| Thiotepa | (10.0 mg/mL 10,000 ppm) | | Thiotepa | 10mg/ml (10,000-ppm) | 37.6 | |
| Vincristine Sulfate | (1.0 mg/mL 1,000 ppm | | Vincristine Sulfate | 1 mg ml (1,000ppm) | >240 min | |
| The tested-non-chemotherapy drugs are: | | | The tested non-chemotherapy drugs are: | | | |
| MESNA | (100.0 mg/mL 100,000 ppm) | | | | | |
| Trisenox (Arsenic Trioxide) | (1.0 mg/ml 1,000 ppm) | | | | | |
| Fentanyl Citrate Injection | (100 mcg/2mL)+ | | | | | |
| | | | Note: Carmustine and Thiotep have
extremely low permeation times of 26.7
and 37.6 minutes respectively. | Note: Carmustine and Thiotepa have
extremely low permeation times of 27.7
and 59.4 minutes respectively. | | |

9

510k Summary

| Warning: Do Not Use with Carmustine, Thiotepa | Powder free | Material | Color | OTC use | Sterility | Use | Labeling claim | Size and Dimensions (mm) | Thickness (mm) | Physical
Properties | | Freedom from Holes | Powder Content | Warning: Do Not Use with Carmustine, Thiotepa. | Powder free | Material | Color | OTC use | Sterility | Use | |
|-----------------------------------------------|-------------|----------|-------|---------|-------------|------------|---------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------|--------------------------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------|-------------------------------------|------------------------------------------------|-------------|----------|---------------------------------------|---------|-------------|------------|--|
| | Yes | Nitrile | Blue | Yes | Non-sterile | Single use | Tested for Use with Chemotherapy Drugs and Fentanyl | Length:
Min 230mm for size XS-XXL
Width:
XS:70±10
S: 80±10
M: 95±10
L: 110±10
XL: 120±10
XXL:130±10 | Finger:0.08-0.14±0.01
Palm:0.06-0.10 ±0.01 | Before Aging | After Aging | Be free from holes when tested in accordance with ASTMD5151 | Meet the requirements of ASTM D6124 | | Yes | Nitrile | Blue, Violet Blue, White, Cobalt Blue | Yes | Non-sterile | Single use | |
| | | | | | | | Not Tested for use with Chemotherapy Drugs and Fentanyl | Length:
Min 230mm for size XS-XL
Width:
XS:70±10
S: 80±10
M: 95±10
L: 110±10
XL: 120±10 | Finger:0.08-0.14±0.01
Palm:0.06-0.10 ±0.01 | Tensile Strength: 14MPa, min
Ultimate Elongation:500% min | Tensile Strength: 14MPa, min
Ultimate Elongation:400% min | Be free from holes when tested in accordance with ASTMD5151 | Meet the requirements of ASTM D6124 | | | | | | | | |
| | | | | | | | Tested for Use with Chemotherapy Drugs and Fentanyl | Length:
Min 220mm for size S
Min 230mm for size M-XL
Width:
S: 80±10
M: 95±10
L: 110±10
XL: 120±10 | Finger: ≥0.05; Palm: ≥0.05 | | | | | | | | | | | | |
| | | | | | | | | | | Tensile Strength: 14MPa, min
Ultimate Elongation:500% min | Tensile Strength: 14MPa, min
Ultimate Elongation:400% min | | | | | | | | | | |

10

. Summary
0k
1
U

|

Chemotherapy and non-chemo therapy Drugs Tested with Minimum Breakthrough Detection Time as tested per ASTM D6978NASimilar 2Biocompatibility
Minimum Breakthrough Detection TimeDrugsConcentrationMinimum Breakthrough Detection Time
27.7
(35.5,27.7,27.7)The tested chemotherapy drugs are:
Carmustine3.3 mg/ml(3,300 ppm)>240 minIrritation and Sensitization:Under the conditions of the study, not an irritant and not a sensitizer
>240minCisplatin1 mg/ml (1,000ppm)>240 min
>240minCyclophosphamide20 mg/ml (20,000 ppm)>240 min
>240minDacarbazine10ng/ml (10,000 ppm)>240 min
>240minDoxorubicin HCL2 mg/ml(2,000 ppm)>240 min
>240rainEtoposide20 mag/ml (20,000 ppm)>240 min
>240minFluorouracil50ng/ml (50,000 ppm)>240 min
>240minGemcitabine HCL38mg/ml (38,000 ppm)>240 min
>240minIfosfamide50ng/ml (50,000 ppm)>240 min
>240minMethotrexate25mg/ml (25,000 ppm)>240 min
>240rainMitomycin-C0.5 mg ml(500 ppm)>240 minIrritation and Sensitization:Under the conditions of the study, not an irritant and not a sensitizer
>240minMitoxantrone HCl2mg/ml (2,000 ppm)>240 min
>240rainPaclitaxel6 mag/ml (6,000 ppm)>240 min
59.4(675,59.4.65.9)Thiotepa10 mag/ml (10,000 ppm)37.6
>240rainVincristine Sulfate1 mg/ml (1,000ppm)>240 min
>240minThe tested non-chemotherapy drugs are:
>240minFentanyl Citrate injection100mcg/2ml>240 min
Note: Carmustine and Thiotepa have extremely low permeation times of 27.7 and 59.4 minutes respectively.
Warning: Do Not Use with Carmustine, Thiotepa
Note: Carmustine and Thiotepa have extremely low permeation times of 26.7 and 37.6 minutes respectively.
Warning: Do Not Use with Carmustine, Thiotepa.ISO 10993-10, under the conditions of the study, not an irritant or a sensitizer
ISO 10993-11, under the condition of acute systemic toxicity test, the test article did not show acute systemic toxicity in vivo.
Cytotoxicity:Under conditions of the study, not cytotoxicCytotoxicity:Under conditions of the study, not cytotoxic

11

Similar 1-Indications for use

The proposed device and the reference device have same indications, only minor different drugs and the penetration time of carmustine and thiotepa between the proposed device and the predicate device, which will not raise any new safety or performance.

Different 1-Size and dimension, Thickness

The size and dimension, Thickness of the proposed device is not exactly same as the predicate and reference device. However, the size and dimension, thickness of the proposed device has been covered by ASTM D6319-19. The user can select appropriate model depended on size of user's hand. In addition, its dimension and thickness have been tested and met the requirement of ASTM D6319-19. Therefore, the difference will not affectiveness of the proposed device.

Similar 2-Chemotherapy and non-chemo therapy Drugs

Only minor differences on different drugs and the penetration time of carmustine and thiotepa between the proposed device and the reference device. And met the requirement of ASTM D6978-05. Therefore, the difference will not affect the safety and effectiveness of the proposed device.

  1. Summary of Non-Clinical Testing

Non-clinical tests were conducted to verify that the proposed device met all design specifications. The test results demonstrated that the proposed device complies with the following standards:

ISO 10993-10: 2021 Biological Evaluation Of Medical Devices - Part 10: Tests For Skin Sensitization

ISO 10993-5:2009, Biological evaluation of medical devices - Part 5: Tests for in vitro cytotoxicity.

ASTM D6319-19 Standard Specification for Nitrile Examination Gloves for Medical Application

ASTM D6124-06 (Reapproved 2022), Standard Test Method for Residual Powder on Medical Gloves

ASTM D5151-19, Standard Test Method for Detection of Holes in Medical Gloves.

ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs

Test MethodPurposeAcceptance CriteriaResults
ASTM D6319-19Physical Dimensions TestLength (mm):
XS/S/M/L/XL/XXL: ≥230
Width(mm):
XS: 70±10mm; S: 85±10mm;
M: 95±10mm; L: 110±10 mm;
XL: 120±10 mm
XXL: 130±10 mmPass

Table 2 Summary of non clinical performance testing

12

| | | Thickness (mm):
Finger: ≥0.05; Palm: ≥0.05 | | Pass |
|----------------------|----------------------------------------------------------------------------|--------------------------------------------------------------|----------------------------------|-------------------------------------------------------------------------|
| ASTM D5151-19 | Watertightness Test for Detection of Holes | Be free from holes when tested in accordance with ASTM D5151 | | Pass |
| ASTM D412 | Physical Properties | Before Aging | Tensile Strength:
14MPa, min | Pass |
| | | | Ultimate Elongation:5
00% min | Pass |
| | | After Aging | Tensile Strength:
14MPa, min | Pass |
| | | | Ultimate Elongation:4
00% min | Pass |
| ASTM D6124 | Powder Content | Meet the requirements of Less than 2mg per glove | | Pass |
| ASTMD 6978-05 (2019) | Detect the Permeation time by Chemotherapy Drugs and Fentanyl of the glove | Meet the requirements of ASTMD 6978-05. | | Pass |
| ISO 10993-10 | Irritation and Sensitization | Non-irritating; Non- sensitizer | | Under the conditions of the study, not an irritant and not a sensitizer |
| ISO 10993-5 | Cytotoxicity | Non Cytotoxic | | Under conditions of the study, not cytotoxic |

10. Summary of Clinical Testing Not applicable

11. Conclusions

The conclusions drawn from the nonclinical tests demonstrate that the subject device is as safe, as effective, and performs as well as or better than the legally marketed device, K202356.