EXCEL PRIMARY SOLUTION SET

K031500 · Exelint Intl. Co. · FPA · Jul 25, 2003 · General Hospital

Device Facts

• Record ID: K031500
• Device Name: EXCEL PRIMARY SOLUTION SET
• Applicant: Exelint Intl. Co.
• Product Code: FPA · General Hospital
• Decision Date: Jul 25, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5440
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

This Primary Solution set is used for infusion of I.V. solutions and/or medication to a patient intrayenously. This safety feature may aid in the prevention of needle stick injury.

Device Story

Exel Primary Solution Set is an intravascular administration set designed for delivery of IV fluids and medications. Device incorporates safety features to mitigate risk of needle stick injuries during clinical use. Operated by healthcare professionals in clinical settings to facilitate controlled fluid/medication delivery. Device functions as a conduit between fluid source and patient venous access site.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Intravascular administration set; Class II device (21 CFR 880.5400); includes safety mechanism for needle stick prevention.

Indications for Use

Indicated for patients requiring intravenous infusion of solutions or medications.

Regulatory Classification

Identification

An intravascular administration set is a device used to administer fluids from a container to a patient's vascular system through a needle or catheter inserted into a vein. The device may include the needle or catheter, tubing, a flow regulator, a drip chamber, an infusion line filter, an I.V. set stopcock, fluid delivery tubing, connectors between parts of the set, a side tube with a cap to serve as an injection site, and a hollow spike to penetrate and connect the tubing to an I.V. bag or other infusion fluid container.

Special Controls

*Classification.* Class II (special controls). The special control for pharmacy compounding systems within this classification is the FDA guidance document entitled “Class II Special Controls Guidance Document: Pharmacy Compounding Systems; Final Guidance for Industry and FDA Reviewers.” Pharmacy compounding systems classified within the intravascular administration set are exempt from the premarket notification procedures in subpart E of this part and subject to the limitations in § 880.9.

Submission Summary (Full Text)

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Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 2 5 2003

Mr. Armand Hamid Director Exelint International Company 5840 West Centinela Avenue Los Angeles, California 90045

Re: K031500

Trade/Device Name: Exel Primary Solution Set Regulation Number: 880.5400 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: May 1, 2003 Received: May 13, 2003

Dear Mr. Hamid:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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.

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Page 2 - Mr. Hamid

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 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 regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act 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,

for Herk

Šusan Runner, DDDS, MA Interim Director Division of Anesthesiology, General Hospital Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Attachment 1 A

Page 1 of _1

510(k) Number (if known) K031500

Device Name: EXEL Primary Solution Set

Indications For Use:

This Primary Solution set is used for infusion of I.V. solutions and/or medication to a patient intrayenously. This safety feature may aid in the prevention of needle stick injury.

Patricia Curente

(Division Sign-Off) Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K031506

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109) OR

Over -The-Counter Use

(Optional Format 1-2-96)