F&P Optiflow Nasal Oxygen Cannula with CO2 Sampling

K201723 · Fisher & Paykel Healthcare, Ltd. · BTT · Mar 16, 2021 · Anesthesiology

Device Facts

• Record ID: K201723
• Device Name: F&P Optiflow Nasal Oxygen Cannula with CO2 Sampling
• Applicant: Fisher & Paykel Healthcare, Ltd.
• Product Code: BTT · Anesthesiology
• Decision Date: Mar 16, 2021
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 868.5450
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

This product is a single-patient-use device that delivers respiratory gases to adult patients in hospitals and long-term care facilities. This product is indicated for the delivery of Nasal High Flow (NHF) and Low Flow Oxygen to spontaneously breathing patients by appropriately qualified healthcare professionals. Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min in operating and procedure rooms. This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist. This product is not intended for apneic ventilation.

Device Story

Interface delivers respiratory gases to adult patients; connects to humidification systems or flow meters via ISO 5356-1 connectors. Features integrated CO2 sampling component for connection to external CO2 sampling lines and analyzers. Designed with specific tube/manifold geometry to reduce turbulent flow. Used in hospitals and long-term care facilities by healthcare professionals. Provides respiratory gas delivery and qualitative CO2 monitoring; assists in pre-oxygenation and short-term oxygenation during intubation. Benefits include combined gas delivery and monitoring capability in a single patient interface.

Clinical Evidence

No clinical data relied upon. Substantial equivalence demonstrated via bench testing, including shelf-life (ASTM F1980-16), transportation (ISTA 2A:2011), leak testing, flow resistance, and mechanical strength testing. Biocompatibility evaluated per ISO 10993-1 and ISO 18562-1. Usability testing conducted for CO2 sampling feature.

Technological Characteristics

Nasal cannula interface with integrated CO2 sampling port. Materials evaluated per ISO 10993-1 and ISO 18562-1. Connectors: 22 mm male ISO 5356-1 taper and Luer lock (ISO 594-2). Flow range: 5-70 L/min. Non-sterile, single-patient use. Mechanical design optimized for reduced turbulent flow.

Indications for Use

Indicated for adult patients in hospitals and long-term care facilities requiring Nasal High Flow (NHF) or Low Flow Oxygen. Suitable for spontaneously breathing patients. CO2 sampling indicated for use at flow rates 5-50 L/min in operating/procedure rooms. Indicated for pre-oxygenation and short-term supplemental oxygenation (up to 10 min) during intubation under physician anesthesiologist direction. Contraindicated for apneic ventilation.

Regulatory Classification

Identification

A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes to warm, the breathing gases for administration to a patient. Cascade, gas, heated, and prefilled humidifiers are included in this generic type of device.

Predicate Devices

• F&P Optiflow™+ Nasal Cannula (K162553)

Reference Devices

• Westmed Gas Sampling Cannula with O2 Delivery (K162343)

Submission Summary (Full Text)

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March 16, 2021

Fisher & Paykel Healthcare Ltd. Reena Daken Senior Regulatory Affairs Specialist 15 Maurice Paykel Place, East Tamaki Auckland, 2013 New Zealand

Re: K201723

Trade/Device Name: F&P Optiflow Nasal Oxygen Cannula with CO2 Sampling Regulation Number: 21 CFR 868.5450 Regulation Name: Respiratory Gas Humidifier Regulatory Class: Class II Product Code: BTT Dated: February 12, 2021 Received: February 16, 2021

Dear Reena Daken:

We have reviewed vour 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. 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

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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 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/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance)and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Todd Courtney Assistant Director DHT1C: Division of ENT. Sleep Disordered Breathing, Respiratory and Anesthesia Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K201723

### Device Name

F&P Optiflow Nasal Oxygen Cannula with CO2 Sampling

Indications for Use (Describe)

This product is a single-patient-use device that delivers respiratory gases to adult patients in hospitals and long-term care facilities.

This product is indicated for the delivery of Nasal High Flow (NHF) and Low Flow Oxygen to spontaneously breathing patients by appropriately qualified healthcare professionals.

Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min in operating and procedure rooms.

This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist.

This product is not intended for apneic ventilation.

Type of Use (Select one or both, as applicable)

| <div> <span> <b> ☑ Prescription Use (Part 21 CFR 801 Subpart D) </b> </span> </div> |
|-----------------------------------------------------------------------------------------------------------|
| <div> <span> ☐ Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |

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# 510(k) Summary

As Required by 21 CFR 807.92(c)

#### l. SUBMITTER

| Company Name and Address | Fisher & Paykel Healthcare Limited<br>15 Maurice Paykel Place<br>East Tamaki<br>Auckland 2013, New Zealand<br>Telephone: [phone] |
|---------------------------|-----------------------------------------------------------------------------------------------------------------------------------------|
| Prepared and Submitted by | Amelia Ortiz Rios<br>Senior Regulatory Affairs Specialist |
| Contact Person | Reena Daken<br>Regulatory Affairs Market Manager<br>Telephone: [phone]<br>Email: [e-mail] |
| Date Prepared | 16 March 2021 |

#### II. DEVICE

| Name of Device | F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling |
|---------------------|------------------------------------------------------|
| Common/Usual Name | Nasal Cannula |
| Classification Name | Respiratory gas humidifier |
| Regulatory Class | Class II (21 CFR §868.5450) |
| Product Code | BTT |

#### PREDICATE DEVICE lll.

- Predicate device: ●
- K162553 F&P Optiflow™+ Nasal Cannula o
- . Reference device:
- K162343 Westmed Gas Sampling Cannula with O2 Delivery o

#### IV. DEVICE DESCRIPTION

The F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling is a medical device intended to deliver respiratory gases to the patient and provide a sample of the patient's exhaled respiratory gases through the CO2 sampling accessory to a CO2 sampling line and CO2 analyzer. The device is offered in three sizes being small (S), medium (M) and large (L). The F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling is a prescription only device, provided in a non-sterile state.

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## Principle of Operation

The subject device is an interface which delivers respiratory gases to the patient from a humidification system or a flow meter. The internal diameter of the tube and the geometry of the manifold, gas path connector and nasal prongs have been designed to reduce turbulent flow, allowing it to deliver respiratory gas at both low and high flows.

The F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling may be connected to breathing circuits and a humidifier or it may also be used with a flow meter, such as, the Compensated Thorpe Tube Flowmeter. the Nasal Oxygen Cannula may be connected to breathing circuits through a male medical taper connector as per ISO 5356-1:2015 'Anaesthetic and respiratory equipment – Conical connectors - Part 1: Cones and sockets'.

The nasal cannula delivers respiratory gases from the inspiratory tube to the patient. The nasal cannula is fitted onto the patient and attached to the inspiratory tube using the above connector. The CO2 sampling component connects to a commercially available carbon dioxide sampling line (not included with this product) and is fitted on the patient to sample exhaled gas from either the nares, or mouth.

#### INDICATIONS FOR USE V.

This product is a single-patient-use device that delivers respiratory gases to adult patients in hospitals and long-term care facilities.

This product is indicated for the delivery of Nasal High Flow (NHF) and Low Flow Oxygen to spontaneously breathing patients by appropriately qualified healthcare professionals.

Qualitative carbon dioxide sampling can be used at nasal cannula flow rates from 5 to 50 L/min in operating and procedure rooms.

This product can be used for pre-oxygenation and short-term supplemental oxygenation (up to 10 minutes) during intubation in operating rooms under the direction of a physician anesthesiologist.

This product is not intended for apneic ventilation.

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#### COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE VI.

| Design/technological | Subject device | Predicate device | Rationale for Substantial Equivalence |
|----------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| characteristic for | F& P Optiflow™ Nasal Oxygen | F&P Optiflow™+ Nasal Cannula | |
| comparison | Cannula with CO2 Sampling | | |
| Indications for Use | This product is a single-patient-use<br>device that delivers respiratory gases to<br>adult patients in hospitals and long-term<br>care facilities.<br>This product is indicated for the delivery<br>of Nasal High Flow (NHF) and Low Flow<br>Oxygen to spontaneously breathing<br>patients by appropriately qualified<br>healthcare professionals.<br>Qualitative carbon dioxide sampling can<br>be used at nasal cannula flow rates from<br>5 to 50 L/min in operating and procedure<br>rooms.<br>This product can be used for pre-<br>oxygenation and short-term<br>supplemental oxygenation (up to 10<br>minutes) during intubation in operating<br>rooms under the direction of a physician<br>anesthesiologist.<br>This product is not intended for apneic<br>ventilation. | Nasal cannula patient interface for<br>delivery of humidified respiratory gases. | Equivalent<br>The intended uses are equivalent.<br>The subject and predicate devices are both<br>intended to deliver high flow humidified<br>respiratory gases.<br>The subject device has a carbon dioxide<br>sampling functionality which is supported<br>through performance testing as per the<br>reference device, K162343. |
| Availability | Prescription use.<br>(Part 21 CFR 801 Subpart D) | Prescription use.<br>(Part 21 CFR 801 Subpart D) | Identical. |
| Patient Population | Adult patients. | Mainly adult patients. | Equivalent.<br>Patient population for the subject device is a<br>subset of the patient population of the predicate<br>device. |
| Operating<br>Environment | Hospitals and long term care facilities. | Hospitals and long term care facilities. | Identical. |
| Reusability and<br>Duration of Use | Single patient use only for a maximum<br>period of 24 hours. | Single patient use only,<br>< 14 days hospital<br><br>Single patient reusable,<br>< 30 days home | Equivalent. |
| Sizes | AA030S<br>AA030M<br>AA030L | OPT942 Small<br>OPT944 Medium<br>OPT946 Large | Identical. |
| Specifications | | | |
| Ambient Operating<br>Temperature | 18 – 26 °C | 18 – 28 °C | Equivalent<br>The operating temperature range is within that of<br>the predicate device. |
| System<br>Specifications | When assembled with 22 mm heated<br>inspiratory tube and chamber and a<br>compatible F&P humidifier: | MR850 Humidifier in invasive mode, RT<br>series kit with 22 mm heated inspiratory<br>tube and chamber. | Equivalent<br>The subject device is intended for use with a<br>larger flow range. |
| | Flow Range:<br>AA030S(Small) 5-70L/min<br>AA030M(Medium) 5-70L/min<br>AA030L(Large) 5-70L/min | Flow Range:<br>OPT942 (Small) 10 - 60L/min<br>OPT944 (Medium) 10 - 60 L/min<br>OPT946 (Large) 10 - 60 L/min | |
| Shelf Life | 18 months | Shelf-life not claimed on labelling | The subject device claims an 18-month shelf life. |
| Storage Temperature | -10°C to +50°C | -10°C to +50°C | Identical |
| Sterility | Device not provided sterile | Device not provided sterile | Identical |
| Disposal | Dispose of product safely in accordance<br>with standard hospital procedure. | Disposal not defined. | Disposal information defined for subject device<br>in the User Instruction. |
| Nasal Cannula Function and Design | | | |
| 22 mm Male ISO<br>Taper Connector | Included. | Included. | Identical. |
| Proprietary F&P<br>Connector | Included. | Included. | Identical. |
| CO2 Sampling tube's<br>Luer connection | Included | Not Included | CO2 Sampling feature is only present in the<br>subject device and not available in the predicate<br>device.<br>The sampling functionality is equivalent to that of<br>the reference device, K162343. |

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#### PERFORMANCE DATA VII.

# Non-Clinical Performance Data

Performance testing of the F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling was completed to determine that the differences between the subject device and the predicate device do not raise new questions of safety or effectiveness. These tests demonstrate substantial equivalence of the F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling to the predicate device.

- . Shelf life testing was performed following accelerated aging conditioning as per ASTM F1980-16 to demonstrate product requirements continue to be met after 18 months of storage.
- . Transportation testing was performed following transportation to ISTA 2A:2011 Packaged-Products 150 lbs (68 kgs) or Less.
- . The following additional performance testing has also been completed to confirm the safety and effectiveness of the Optiflow™ Nasal Oxygen Cannula with CO2 Sampling:
- Nasal Cannula Leak Test O
- O CO2 Sampling Tube Leak Test
- Resistance to flow of the CO2 Sampling Tube O
- Resistance to flow during compression of the CO2 Sampling Tube o
- Testing was performed to ensure functional requirements were met after transport, o storage, and simulated use conditioning.
- O Strength testing of CO2 Sampling Tube's permanent connections after transport, storage, and simulated use conditioning.
- Testing to validate the device's CO2 Sampling functionality O

Usability testing conducted on the use of the CO2 Sampling feature and the warnings and directions for use related to the CO2 Sampling feature only.

The Optiflow™ Nasal Oxygen Cannula with CO2 Sampling has been tested to applicable requirements of the following standards:

- ISO 594-2. "Conical fitting with 6% (Luer) taper for syringes, needles and certain other . medical equipment- Part 2: Lock fittings".
- ISO 5356-1:2004 "Anesthetic and Respiratory Equipment- Conical Connectors- Part 1: Cones ● and Sockets".
- ISO 5361:2012 "Anesthetic and Respiratory Equipment-Tracheal tubes and connectors" ●
- ISO 10993-1 Fifth Edition 2018-08 "Biological Evaluation of Medical Devices Part 1: . Evaluation and Testing Within a Risk Management Process".
- . ISO 18562-1 First Edition 2017-03, "Biocompatibility evaluation of breathing gas pathways in healthcare applications- Part 1: Evaluation and testing within a risk management process".

# Clinical Performance Data

Clinical performance data has not been relied upon in this marketing submission to demonstrate substantial equivalence between the subject and predicate devices.

#### CONCLUSIONS VIII.

The comparison of features, performance data and intended use demonstrate that the F&P Optiflow™ Nasal Oxygen Cannula with CO2 Sampling is substantially equivalent to the predicate, Optiflow™ + Nasal Cannula, (K162553).