K Number
K973734
Device Name
STERILE WATER FOR DEVICE IRRIGATION/ STERILE SALINE FOR DEVICE IRRIGATION
Manufacturer
Date Cleared
1998-02-05

(128 days)

Product Code
Regulation Number
880.6740
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The sterile water and sterile saline are indicated for device irrigation only. The Welcon Sterile Water for Irrigation and Sterile 0.9% Normal Saline for irrigation are indicated for use in device irrigation procedures. The sterile water and saline are not indicated for injection.
Device Description
The Welcon Sterile Water and Sterile 0.9% Normal Saline for Device Irrigation are individual, single-use 4 oz. (120 ml.) cups of fluid intended to be used for irrigation. The individual container consists of a plastic cup with a heat-sealed, adhesive-backed foil lid.
More Information

Not Found

No
The device is sterile water and saline for irrigation, and the summary explicitly states "Mentions AI, DNN, or ML: Not Found".

No.
The device is indicated for device irrigation only and not for injection, implying it is used to irrigate other medical devices, not to treat a patient directly.

No
The device is described as sterile water and saline for device irrigation, with its intended use explicitly stated as "device irrigation only," and not for injection. There is no mention of it being used to diagnose conditions or produce diagnostic information.

No

The device description clearly states it is a physical product (cups of sterile water and saline) and does not mention any software component.

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

Here's why:

  • Intended Use: The intended use is explicitly stated as "device irrigation only" and "for use in device irrigation procedures." This means the sterile water and saline are used to rinse or clean medical devices, not to test or analyze biological samples from the human body.
  • Device Description: The description focuses on the physical container and the fluid itself, intended for external use on devices.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, disease, or condition
    • Using reagents or assays to detect specific substances

The purpose of this device is to facilitate the proper functioning or cleaning of other medical devices, not to provide diagnostic information about a patient.

N/A

Intended Use / Indications for Use

The sterile water and sterile saline are indicated for device irrigation only.

The Welcon Sterile Water for Irrigation and Sterile 0.9% Normal Saline for irrigation are indicated for use in device irrigation procedures. The sterile water and saline are not indicated for injection.

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

79LWD, JOL

Device Description

The Welcon Sterile Water and Sterile 0.9% Normal Saline for Device Irrigation are individual, single-use 4 oz. (120 ml.) cups of fluid intended to be used for irrigation. The individual container consists of a plastic cup with a heat-sealed, adhesive-backed foil lid.

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)

Substantial equivalence for these devices was based solely on design characteristics; no performance or safety data was included in this premarket notification. The materials, performance specifications and essential design characteristics of the Welcon devices are identical to those of the Intermed predicate devices. USP bacterial endotoxin testing was performed to verify that the sterile water and saline solutions conform with USP requirements.

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.

K842166, K842166

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 880.6740 Vacuum-powered body fluid suction apparatus.

(a)
Identification. A vacuum-powered body fluid suction apparatus is a device used to aspirate, remove, or sample body fluids. The device is powered by an external source of vacuum. This generic type of device includes vacuum regulators, vacuum collection bottles, suction catheters and tips, connecting flexible aspirating tubes, rigid suction tips, specimen traps, noninvasive tubing, and suction regulators (with gauge).(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 880.9.

0

K973734

Sterile Water/Saline for

510(k) Summary

Pursuant to 512(i)(3)(A) of the Food, Drug and Cosmetic Act, Welcon, Inc. is required to submit with this Premarket Notification either an "... adequate summary of any information respecting safety and effectiveness or state that information will be made available upon request of any person." Welcon chooses to submit a summary of the safety and cffectiveness information. The summary is as follows:

| Trade Name: | Welcon Sterile Water for Device Irrigation
Welcon Sterile 0.9% Normal Saline for Device Irrigation |
|----------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Owner/Operator: | Welcon, Inc.
99 Hartford Avenue
Providence, RI 02909 |
| Distributed by: | Welcon, Inc.
303 Main Street, Suite 300
Fort Worth, TX 76102 |
| Manufacturing Site: | Intermed, Inc.
15 White Lake Road
Sparta, NJ 07871 |
| Device Generic Name: | Sterile water/sterile saline for device irrigation |
| Classification: | According to Section 513 of the Federal Food, Drug, and
Cosmetic Act, the device classification is Class II, Performance Standard
(79LWD). |
| Predicate Devices: | Sterile Water for Irrigation (Catalog #5575)
Intermed, Inc.
Sparta, New Jersey 07871
K842166
Sterile 0.9% Saline for Irrigation (Catalog #5565)
Intermed, Inc.
Sparta, New Jersey 07871
K842166 |

Product Description:

The Welcon Sterile Water and Sterile 0.9% Normal Saline for Device Irrigation are individual, single-use 4 oz. (120 ml.) cups of fluid intended to be used for irrigation. The individual container consists of a plastic cup with a heat-sealed, adhesive-backed foil lid.

Indications for Use:

The sterile water and sterile saline are indicated for device irrigation only.

1

Safety and Performance:

Substantial equivalence for these devices was based solely on design characteristics; no performance or safety data was included in this premarket notification. The materials, performance specifications and essential design characteristics of the Welcon devices are identical to those of the Intermed predicate devices. USP bacterial endotoxin testing was performed to verify that the sterile water and saline solutions conform with USP requirements.

Conclusion:

Based on the indications for use, tochnological characteristics, and comparison to predicate devices, the Welcon Sterile Water and Sterile 0.9% Normal Saline for Device Irrigation have been shown to be safe and effective for its intended use.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with its wings spread, enclosed within a circle. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES · USA" is arranged around the upper portion of the circle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB - 5 1998

Ms. Pamela Papineau C/O Delphi Medical Device Consulting Welcon, Incorporated 99 Hartford Avenue 02909 Providence, Rhode Island

K973734 Re : Sterile Water for Device Irrigation/Sterile Trade Name: 0.9% Saline for Device Irrigation Requlatory Class: II Product Code: JOL Dated: January 16, 1998 January 20, 1998 Received:

Dear Ms. Papineau:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the device, subject to the general controls provisions The general controls provisions of the Act of the Act. include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and --------------------------------------------------------------------prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major requlations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical General regulation (21 CFR Part 820) and that, Devices: through periodic (QS) inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory In addition, FDA may publish further announcements action. concerning your device in the Federal Reqister. Please note: this response to your premarket notification submission does

3

Page 2 - Ms. Papineau

not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or requlations.

This letter will allow you to begin marketing your device as described in your 510 (k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling requlation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fdf.gov/cdrh/dsmamain.html".

Sincerely yours

Timothy A. Ulatowski

Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radioloqical Health

Enclosure

4

of Page 1 _

510(k) Number (if known):

Sterile Water for Irrigation/Sterile 0.9% Normal Saline for Device Name: Device Irrigation

Indications for Use:

The Welcon Sterile Water for Irrigation and Sterile 0.9% Normal Saline for irrigation are indicated for use in device irrigation procedures. The sterile water and saline are not indicated for injection.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER - - - -PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Aner Nariani for PLC

(Division Sie Division of Den and Gene sral He 510(k) Number

Prescription Use (Per 21 CFR 801.109)

OR

Over-the -Counter Use ________________________________________________________________________________________________________________________________________________________

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