BI-PHASIC INFILTRATOR

K012044 · Reliance Medical Corp. · FRN · Aug 28, 2001 · General Hospital

Device Facts

• Record ID: K012044
• Device Name: BI-PHASIC INFILTRATOR
• Applicant: Reliance Medical Corp.
• Product Code: FRN · General Hospital
• Decision Date: Aug 28, 2001
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5725
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

General surgical fluid irrigation and infiltration.

Device Story

Bi-Phasic Infiltrator is a surgical device designed for fluid irrigation and infiltration. It functions by delivering fluids to a surgical site to assist in procedures. Used in clinical settings by surgeons or trained medical staff. The device facilitates fluid management during surgery, potentially improving procedural efficiency and patient outcomes by maintaining site hydration or delivering necessary irrigation solutions.

Clinical Evidence

No clinical data provided; substantial equivalence based on device description and intended use.

Technological Characteristics

Device designed for fluid irrigation and infiltration. Specific materials, energy sources, and software details are not described in the provided documentation.

Indications for Use

Indicated for general surgical fluid irrigation and infiltration in patients requiring such procedures.

Regulatory Classification

Identification

An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.

Submission Summary (Full Text)

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AUG 2 8 2001

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Robert W. Nicks Managing Director Beliance Medical Corporation 730 Independent Avenue Grand Junction, Colorado 81505

K012044 Re : Bi-Phasic Infiltrator Trade/Device Name: 880.5725 Requlation Number: Regulatory Class: II Product Code: FRN Dated: April 2, 2001 Received: June 29, 2001

Dear Mr. Nicks:

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 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). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions aqainst 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. ਚੇ substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP requlation may result in requlatory In addition, FDA may publish further announcements action. concerning your device in the Federal Register. Please note:

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Page 2 - Mr. Nicks

this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic emroduct 312 or on 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 acberroom in your tial equivalence of your device to a legally marketed predicate device results in a classification for your markets 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 [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers International and Consumer Assistance at its toll-free number [phone] or [phone] or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

Timothy A. Ulatowski

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

Enclosure

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K012044 510(k) Number (if known):_

Bi-Phasic Infiltrator Device Name:_

Indications For Use:

The Reliance Medical Bi-Phasic Infiltrator indication for use is: General surgical fluid irrigation and infiltration.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Retara Ciccerite

(Division Sign-Off) Division of Dental, Infection Control, and General Hospital Devices 510(k) Number_4012044

Prescription Use_ (Per 21 CFR 801.109) OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)

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