SWABCAP

K083508 · Excelsior Medical Corp. · QBP · Apr 28, 2009 · General Hospital

Device Facts

• Record ID: K083508
• Device Name: SWABCAP
• Applicant: Excelsior Medical Corp.
• Product Code: QBP · General Hospital
• Decision Date: Apr 28, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5440
• Device Class: Class 2

Intended Use

SwabCap™ is intended for use on swab-able luer access valves as a disinfecting cleaner prior to line access and to act as a physical barrier to contamination between line accesses. SwabCap™ will disinfect the valve five (5) minutes after application and act as a physical barrier to contamination for up to ninety-six (96) hours under normal conditions if not removed.

Device Story

SwabCap is a single-use, sterile cap containing 70% isopropyl alcohol; designed to fit securely onto swab-able luer access valves. Device functions as a disinfecting cleaner and physical barrier; disinfection occurs 5 minutes after application; barrier protection lasts up to 96 hours. Used in clinical settings by healthcare providers to maintain sterility of intravenous access points between line accesses. Benefits include reduced risk of contamination and associated bloodstream infections. Device is latex-free, preservative-free, and DEHP-free.

Clinical Evidence

Bench testing only. No clinical data provided.

Technological Characteristics

Cap containing 70% isopropyl alcohol; sterile; latex-free; preservative-free; DEHP-free. Sterilization via gamma irradiation. Single-use, passive mechanical barrier design.

Indications for Use

Indicated for use on swab-able luer access valves as a disinfecting cleaner and physical barrier to contamination for patients requiring intravenous line access.

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

• Effectiv™ Cap (K080579)
• Curos Port Protector (K080466)
• Alcohol Prep Pad (Unknown)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left, and the FDA logo on the right. The FDA logo is in blue and includes the acronym "FDA" followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in a stacked format.

Excelsior Medical Corp. Roshana Ahmed Manager c/o CanReg, Incorporated 4 Innovation Drive Dundas, On, L2H 7P3 Canada

March 11, 2022

Re: K083508

Trade/Device Name: Swabcap Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: Class II Product Code: QBP

Dear Roshana Ahmed:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated April 28, 2009 and the correction letter dated March 6, 2019. Specifically, FDA is updating this SE Letter because FDA has better categorized your device technology under regulation 880.5440.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact Payal Patel, OHT3: Office of GastroRenal, Ob-Gyn, General Hospital and Urology Devices, 240-402-6029, Payal.Patel(@fda.hhs.gov.

Sincerely,

P

Payal Patel Assistant Director for General Hospital Devices DHT3C: Division of Drug Delivery and General Hospital Devices and Human Factors OHT3: Office of GastroRenal, Ob-Gyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

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Image /page/1/Picture/0 description: The image shows the logo of the U.S. Food & Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the agency's name on the right. The symbol is a stylized representation of a caduceus, a traditional symbol of medicine. The agency's name is written in bold, sans-serif font, with "U.S. FOOD & DRUG" on the top line and "ADMINISTRATION" on the bottom line.

March 6, 2019

Excelsior Medical Corp. Roshana Ahmed Manager 4 Innovation Drive Dundas. Ontario. L2H 7P3 Canada

Re: K083508 Trade/Device Name: SwabCapTM Regulatory Class: Unclassified Product Code: QBP Dated: November 24, 2008 Received: November 26, 2008

#### Dear Roshana Ahmed:

This letter corrects our substantially equivalent letter of April 28, 2009.

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 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. 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 located 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.

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

U.S. Food & Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 www.fda.gov

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#### K083508 - Roshana Ahmed

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 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable. the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803). please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Geeta K. Pamidimukkala -S

for Tina Kiang, Ph.D. Acting Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K083508

Excelsior Medical Corporation Traditional 510(k)

SwabCap™

## Indications for Use

| 510(k) Number: | K083508 |
|---------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Device Name: | SwabCap ^TM |
| Indication for Use: | SwabCap ^TM is intended for use on swab-able luer access valves as a disinfecting cleaner prior to line access and to act as a physical barrier to contamination between line accesses. |
| | SwabCap ^TM will disinfect the valve five (5) minutes after application and act as a physical barrier to contamination for up to |

ninety-six (96) hours under normal conditions if not removed.

Prescription Use _ X (21 CFR Part 801 Subpart D) And/Or

Over the Counter Use (21 CFR Part 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

H. Ol
for

Division Sign-Off . Office of Device Evaluation

510(k)

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

KO83508 510(k) Number: __

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# 510(k) Summary of Safety and Effectiveness

| Manufacture Name: | Excelsior Medical Corporation |
|------------------------------|-------------------------------------|
| Contact Name: | John Linfante |
| Title | VP Regulatory and Quality Assurance |
| Postal Address: | 1933 Heck Avenue |
| | Neptune, NJ 07753 |
| Phone Number: | 732-643-6088 |
| Fax: | 732-776-7600 |
| Date: | February 12, 2009 |
| Device Proprietary Names: | SwabCap™ |
| Device Common or Usual Name: | Alcohol pad |
| Classification Name: | Pad, Alcohol, Device Disinfectant |
| Classification Code | LKB |
| Classification Panel | General Hospital |
| Regulation Number | N/A |

#### Predicate Device:

Substantial equivalence is claimed to the following devices as related to intended use and design characteristics:

- Effectiv™ Cap, Hospira, Inc., K080579 .
- . Curos Port Protector, Ivera Medical, K080466
- Alcohol Prep Pad, Professional Disposables Inc. 510(k) Number: Unknown .

#### Description of the Device

The SwabCap™ is designed to securely fit on swab-able luer access valves. The cap contains 70% isopropyl alcohol. The product is intended for single-use and is provided sterile, latex free, preservative free and DEHP free.

#### Intended Use of the Device

SwabCap" is intended for use on swab-able luer access valves as a disinfecting cleaner prior to line access and to act as a physical barrier to contamination between line accesses.

SwabCap" will disinfect the valve five (5) minutes after application and act as a physical barrier to contamination for up to ninety-six (96) hours under normal conditions if not removed.

#### Substantial Equivalence

The SwabCap " is similar to the predicate devices based on the intended use, design, technology, antimicrobial agent and performance.

#### Conclusion

Based on the information provided in this 510(k) premarket notification, the SwabCap" is substantially equivalent in terms of safety and effectiveness to the predicate devices identified above.

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K083505
2 of 3

SwabCap™

### Section J - Substantial Equivalence

Table J-1 compares the SwabCap™ to the predicate devices.

| 510(k) Number | K083508 | K080579 | K080466 | Unknown |
|------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Device Name | SwabCap™ | Effectiv™ Cap | Curos™ Port<br>Protector | Alcohol Prep<br>Pad |
| Manufacturer | Excelsior<br>Medical Corp. | Hospira, Inc. | Ivera Medical<br>Corporation | Professional<br>Disposables Inc. |
| Intended Use | SwabCap™ is<br>intended for use<br>on swab-able<br>luer access<br>valves as a<br>disinfecting<br>cleaner prior to<br>line access and<br>to act as a<br>physical barrier<br>to contamination<br>between line<br>accesses. | The Effectiv™<br>Cap is a device<br>containing 70%<br>IPA. When left<br>in place for 5 to<br>10 minutes the<br>cap<br>decontaminates<br>the injection<br>port; thereafter<br>the cap provides<br>a physical barrier<br>during intended<br>use. | The Curos™ Port<br>Protector is a<br>device<br>containing 70%<br>Isopropyl<br>alcohol. When<br>left in<br>place for 5 to 15<br>minutes the<br>Curos™ Port<br>Protector<br>decontaminates<br>the injection<br>port; thereafter<br>the Curos™ Port<br>Protector<br>provides a<br>physical barrier<br>during the<br>intended use. | For topical<br>cleansing prior<br>to injections or<br>venipuncture.<br>Each soft pad is<br>saturated with<br>70% isopropyl<br>alcohol.<br><br>For professional<br>and hospital use. |
| Additional<br>Claims | DEHP, Latex<br>and Preservative<br>Free | DEHP and Latex<br>Free | unknown | unknown |
| Antimicrobial<br>Agent | 70% Isopropyl<br>Alcohol | 70% Isopropyl<br>Alcohol | 70% Isopropyl<br>Alcohol | 70% Isopropyl<br>Alcohol |
| Sterilization | Gamma<br>Irradiated | Unknown | Non-sterile | Gamma<br>irradiated |
| Packaging | Individually<br>wrapped with<br>peel off foil lid | Individually<br>wrapped with<br>peel off foil lid | Individually<br>wrapped. | Individually<br>packaged in<br>packets. |

Table J-1: Comparison to Predicates for SwabCap"

349

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Image /page/6/Picture/1 description: The image shows the word "SwabCap" in a stylized font, with the letters slightly spaced apart. Above the word "SwabCap", there are two lines of text that appear to be handwritten. The first line of text is "K08352", and the second line of text is "3df3".

#### Discussion:

The SwabCap™ device is similar to the predicate devices in terms of intended use, design and material characteristics.

### Conclusion:

It is concluded that the SwabCap™ device is substantially equivalent to the predicate devices.

i