SUBCUTANEOUS NEEDLE INFUSION SET

K082818 · Marcal Medical, Inc. · FPA · Dec 23, 2008 · General Hospital

Device Facts

• Record ID: K082818
• Device Name: SUBCUTANEOUS NEEDLE INFUSION SET
• Applicant: Marcal Medical, Inc.
• Product Code: FPA · General Hospital
• Decision Date: Dec 23, 2008
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5440
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Subcutaneous Infusion Set is designed specifically for the delivery of medication to the subcutaneous tissue

Device Story

Subcutaneous Needle Infusion Set facilitates medication delivery to subcutaneous tissue. Device consists of sterile kit containing infusion set and adhesive dressing. Features include luer lock connector, 90-degree needle mounted to butterfly stabilizer, and available in single, bifurcated, trifurcated, and quadfurcated configurations. Intended for single use. Operated by clinicians or patients to administer subcutaneous medications; stabilizer and adhesive dressing secure needle placement. Benefits include reduced trauma and improved patient compliance through dedicated infusion set design.

Clinical Evidence

Bench testing only.

Technological Characteristics

Sterile, single-use infusion set. Components include luer lock, 90-degree needle, butterfly stabilizer, and adhesive dressing. Configurations: single, bifurcated, trifurcated, and quadfurcated. No electronic or software components.

Indications for Use

Indicated for the delivery of medication to the subcutaneous tissue in patients requiring subcutaneous infusion therapy.

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.

Predicate Devices

• Evans Sub-Q, Model MC4206 (K020530)
• Intravascular Administration Set (K891072)

Submission Summary (Full Text)

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K082818

page 1 of

# 510(K) SUMMARY (as required by 807.92(c))

DEC 2 3 2008

| Regulatory Correspondent | AJW Technology Consultants Inc<br>962 Allegro Lane<br>Apollo Beach, FL 33572<br>[e-mail] |
|--------------------------|----------------------------------------------------------------------------------------------------|
| Submitter of 510(k): | Marcal Medical, Inc.<br>1114 Benfield Blvd, Suite H<br>Millersville, MD 21108<br>USA |
| | Phone: [phone]<br>Fax: [phone] |
| Contact Person: | Candace Keaton |
| Date of Summary: | 6/17/08 |
| Trade/Proprietary Name: | Subcutaneous Needle Infusion Set |
| Classification Name: | Set Administrative Intravascular |
| Product Code: | FPA |

#### Intended Use:

The Subcutaneous Infusion Set is designed specifically for the delivery of medication to the subcutaneous tissue

#### Device Description:

The subcutaneous needle infusion set consists of a sterile packaged kit including the infusion set and an adhesive dressing to hold the device in place. The unique Single, Bifurcated, Trifurcated, and Quadfurcated for the Sub-Q have a luer lock at one end and a 90 degree needle mounted to a butterfly stabilizer at the other end. The sets are convenient to use, associated with less trauma, and offer an opportunity to improve compliance cost-effectively through the use of a dedicated infusion set. The device is for single use only.

## Predicate Device:

K020530 - Evans Medical, Inc - Evans Sub-Q, Model MC4206 K891072 - Multi-Med, Inc - Intravascular Administration Set.

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K\$\phi\$82818 page 2 of 2

## Substantial Equivelance:

The Marcal Medical Subcutancous Needle Infusion Set meets all established acceptance criteria for performance testing and design verification testing. The components of the Sub-Q Set are substantially equivalent to the predicate device presented in this 510k.

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## DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three stripes forming its wing and body. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle.

#### Public Health Service

DEC 2 3 2008

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Marcal Medical, Incorporated C/O Mr. Arthur Ward President AJW Technology Consultants Incorporated 962 Allegro Lane Apollo Beach, Florida 33572

Re: K082818

Trade/Device Name: Subcutaneous Needle Infusion Set Regulation Number: 21 CFR 880,5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: September 17, 2008 Received: September 30, 2008

Dear Mr. Ward:

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. Ward

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 Center for Devices and Radiological Health's (CDRH's) Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. 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/industry/support/index.html.

Sincerely yours.

Chris S. Liem, Ph.D.

Chiu S. Lin. Ph. D Division 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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K082818

## Indications for Use

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: Subcutaneous Needle Infusion Set

Indications for Use:

The Subcutaneous Infusion Set is designed specifically for the delivery of medication to the subcutaneous tissue

Prescription Use X (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Anthong 2. Ownt

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

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510(k) Number: 482818

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