ORION II CT CVC

K113622 · Health Line International Corporation (Hlic) · FOZ · May 18, 2012 · General Hospital

Device Facts

• Record ID: K113622
• Device Name: ORION II CT CVC
• Applicant: Health Line International Corporation (Hlic)
• Product Code: FOZ · General Hospital
• Decision Date: May 18, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5200
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The ORION™ II CT CVC is intended to be used by medical professionals for short-term access to the central venous system for infusion, intravenous therapy, blood sampling and for power injection of contrast media. All ORION™ II CT CVC products have a maximum · recommended infusion rating of 5 ml/sec.

Device Story

ORION™ II CT CVC is a central venous catheter family for infusion, intravenous therapy, blood sampling, and power injection of contrast media. Device consists of radiopaque polyurethane tubing with kink-resistant, tapered design and injection-molded polyurethane hub with Luer lock fittings. Available in 16G single lumen, 5Fr/7Fr dual lumen, and 7Fr triple lumen configurations (13-30 cm lengths). Used by medical professionals in clinical settings for short-term (less than 30 days) central venous access. Catheters withstand power injection of contrast media at 5 ml/sec (max 300 psi). Device is supplied sterile and non-pyrogenic. Healthcare providers use the device to deliver fluids/medications or draw blood; power injection capability allows for diagnostic imaging procedures. Benefits include reliable central venous access for therapy and imaging.

Clinical Evidence

Bench testing only. No clinical data provided. Performance testing included design verification to confirm mechanical integrity, biocompatibility (ISO 10993), and sterilization validation (ISO 11135-1:2007). Testing confirmed the device withstands power injection at 5 ml/sec and 300 psi.

Technological Characteristics

Materials: Radiopaque polyurethane. Design: Kink-resistant, tapered catheter with injection-molded hub and Luer lock fittings. Configurations: 16G single, 5Fr/7Fr dual, 7Fr triple lumen. Energy: None (passive). Sterilization: Ethylene Oxide (ISO 11135-1:2007). Biocompatibility: ISO 10993 compliant. Connectivity: None.

Indications for Use

Indicated for short-term (less than 30 days) access to the central venous system for intravenous administration of fluids, medications, blood products, and/or nutritional therapy solutions when prescribed. Blood sampling and power injection of contrast media may also be conducted.

Regulatory Classification

Identification

An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term use (less than 30 days) to sample blood, monitor blood pressure, or administer fluids intravenously. The device may be constructed of metal, rubber, plastic, or a combination of these materials.

Predicate Devices

• SYNERGY™ CT PICC (K101329)

Submission Summary (Full Text)

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K113622

Page 15 of 144

Health Line International Corporation

510(k) Premarket Notification Submission: ORION™ II CT CVC

# MAY 1 8 2012

# 510(k) SUMMARY OF SAFETY AND EFFECTIVENESS (21 CFR 807.92) for ORION™ II CT CVC

### SUBMITTER:

Health Line International Corporation 803 N. 1250 W. - STE 1 Centerville, Utah 84014

### ESTABLISHMENT REGISTRATION NUMBER: 3006097687

#### CONTACT:

Nola L. Benstog QA/RA Director Telephone: [phone] Fax: [phone] Email: [e-mail]

### DATE PREPARED:

November 30, 2011

### NAME OF MEDICAL DEVICE:

Proprietary Name: Regulation Name: Common/Usual Name: ORION™ II CT CVC Intravascular Catheter Central Venous Catheter (CVC), single, double and triple lumen

#### DEVICE CLASSIFICATION:

Classification Panel: Regulatory Class: Product Code: Regulation Number:

General Hospital Class II FOZ 21 CFR 880.5200

#### PREDICATE DEVICE:

Proprietary Name: Regulation Name: Common/Usual Name: Classification Panel: Regulatory Class: Product Code: Regulation Number:

#### SYNERGY™ CT PICC (K101329)

Percutaneous, Implanted, Long-term Intravascular Catheter Catheter, Intravascular, Therapeutic, Long Term General Hospital Class II । ਹਵ 21 CFR 880.5970

#### CONFIDENTIAL

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### DEVICE DESCRIPTION:

The ORION™ II CT CVC is a family of central venous catheters designed to perform infusion, intravenous therapy, blood sampling and also power injection of contrast media studies, The catheters, made of radiopaque polyurethane tubing, are inserted in a central vein. Each ORION™ II CT CVC has a kink resistant, gradual tapered catheter design. The ORION™ II CT CVC kit includes a catheter and introduction components. The catheter is supplied sterile and non-pyrogenic in a variety of kit configurations.

The ORION™ II CT CVC is indicated for dwell times shorter than 30 days. The ORION™ II CT CVC catheter assemblies have been tested to withstand power injection of worst-case viscosity injection media at 5 ml/sec with a maximum power injector pressure of 300 psi.

The ORION™ II CT CVC product line has catheters in 16 G single lumen, 5 Fr and 7 Fr dual lumen and 7 Fr triple lumen. Catheters range from approximately 13-30 cm long. The catheters are attached to an injection-molded polyurethane hub that has extension legs with Luer lock fittings for access attachment. All ORION™ II CT CVC products have a maximum recommended infusion rating is 5 ml/sec. The maximum pressure or pounds per square inch (psi) of the power injector utilized should not exceed 300 psi.

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#### INTENDED USE:

The ORION™ II CT CVC is intended to be used by medical professionals for short-term access to the central venous system for infusion, intravenous therapy, blood sampling and for power injection of contrast media. All ORION™ II CT CVC products have a maximum · recommended infusion rating of 5 ml/sec.

### INDICATIONS FOR USE:

The ORION™ II CT CVC is indicated for short term (less than 30 days) access to the central venous system for intravenous administration of fluids, medications, blood products, and/or nutritional therapy solutions when prescribed. Blood sampling and power injection of contrast media may also be conducted with the ORION™ III CT CVC.

## TECHNOLOGICAL COMPARISON TO PREDICATE DEVICES:

New device is compared to Marketed Device? Yes. It is compared to a legally marketed predicate.

Does the new device have the same indication statements? Yes, with the exception of the insertion site and the removal of the long term access indication. Additionally, the ORION™ II CT CVC indications contain solutions detail for the CVC device.

Do the differences alter the intended therapeutic/diagnostic/etc. effect (i.e. deciding may consider impact on safety and effectiveness)? No.

Does the new device have the same technological characteristics, e.g. design, material, etc.? Yes. The CVC device of this submission, the ORION™ II CT CVC, is identical to that of (K101329), SYNERGY™ CT PICC, with the exception of the length. In fact, the ORION™ II CT CVC and the SYNERGY™ CT PICC are manufactured by the same company, Health Line International Corporation, the submitter of this submission. The basic fundamental scientific technology of the device has not changed. There may be minor variations in the contents of the introduction kit components.

Could the new characteristics affect safety or effectiveness? No.

Do the new characteristics raise new types of safety and effectiveness questions? No. There are no new types of safety and effectiveness questions.

Do accepted scientific methods exist for assessing effects of the new characteristics? Yes.

CONFIDENTIAL

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Health Line International Corporation 510(k) Premarket Notification Submission: ORION™ II CT CVC

The FDA's Guidance on Premarket Notification [510(k)] Submission for Short-Term and Long-Term Intravascular Catheters, dated 3/16/95 was used to determine the appropriate methods for evaluating the device's performance.

Sterilization requirements of ISO 11135-1:2007, Sterilization of Health Care Products – Ethylene Oxide – Part 1: Requirements for Development, Validation and Routine Control of a Sterilization Process for Medical Devices.

Biocompatibility requirements according to of ISO-10993, Biological Evaluation of Medical Devices Part 1: Evaluation and Testing. Test profiles for externally communicating, bloodcontacting, prolonged contact devices will be met.

These and other standards were used to determine the appropriate methods for evaluating the device's performance.

Are performance data available to assess effects of new characteristics? Yes. Verification testing was performed according to protocols based on the above-referenced guidance document recommendations and additional standards.

Do performance data demonstrate equivalence? Yes. Performance data gathered in design verification testing demonstrated that the ORION™ II CT CVC is substantially equivalent to the noted predicate device.

#### CONCLUSION

The ORION™ II CT CVC met all established acceptance criteria for performance testing and design verification testing. This testing demonstrated that the ORION™ II CT CVC is safe and effective for its intended use, and based on FDA's decision tree is substantially equivalent to the following predicate device: SYNERGY™ CT PICC (K101329).

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## DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/4/Picture/1 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal features a stylized caduceus-like symbol with three intertwined lines, representing health and medicine. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged in a circular pattern around the symbol.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Ms. Nola Benstog OA/RA Director Health Line International Corporation 803 North 1250 West, Suite 1 Centerville, Utah 84014

MAY 1 8 2012

Re: K113622

Trade/Device Name: ORION™ II CT CVC Regulation Number: 21 CFR 880.5200 Regulation Name: Catheter, Intravascular, Therapeutic, Short Term Regulatory Class: Class II Product Code: FOZ Dated: April 24, 2012 Received: April 25, 2012

Dear Ms. Benstog:

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. 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.

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### Page 2- Ms. Benstog

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices /ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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 the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours.

Antion D. anan

Anthony D. Watson, B.S., M.S., M.B.A. 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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Page 13 of 144

Health Line International Corporation Health Line Tricer Hiter Hitscion Submission: ORION™ II CT CVC

### Indications For Use

510(k) Number (if known):

Device Name: ORION™ II CT CVC

Indications For Use:

The ORION™ II CT CVC is indicated for short term (less than 30 days) access to the central The ORION" II CT CVC In Indicated for short confinent medications, blood products, and/or
venous system for intravenous administration of fluids, medication of venous system for intravellous auministruction of hands sampling and power injection of
nutritional therapy solutions when prescribed. Onloary II CT CVC nutritional therapy solutions and the ORION™ II CT CVC.
contrast media may also be conducted with the ORION™ III CT CVC.

Prescription Use _ × (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 IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Rld Clyn 5/17/12

I Vision Sion-Off) ·sion of Anesthesiology, General Hospital lection Control, Dental Davices

510(k) Number: K113622