MODEL 350G GAS CONSERVER

K090421 · Inspired Technologies, Inc. · NFB · May 29, 2009 · Anesthesiology

Device Facts

• Record ID: K090421
• Device Name: MODEL 350G GAS CONSERVER
• Applicant: Inspired Technologies, Inc.
• Product Code: NFB · Anesthesiology
• Decision Date: May 29, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 868.5905
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Inspired Technologies 350G Gas Conserver is intended as a delivery device for medial-grade oxygen from high-pressure oxygen cylinders. This is an ambulatory device, which allows patients to ambulate longer than they would with a continuous flow regulator on the same cylinder. The 350G Gas Conserver is intended to be used in the hospital, healthcare facilities, or home care environments.

Device Story

The 350G Gas Conserver is an ambulatory oxygen delivery device for high-pressure cylinders. It features an integral pressure regulator (CGA 870 style) reducing cylinder pressure to 19-25 psig. The device uses a pressure switch to sense inhalation (vacuum range 0.03 to -0.200 cm H2O) and a microprocessor-controlled algorithm (SmartDose™) to trigger pulsed oxygen delivery at the start of inhalation. It includes a continuous flow override (2 LPM) for low-battery scenarios. Operated by clinicians or patients in hospitals, clinics, or homes, the device provides visual status indicators for battery and valve activation. It is powered by 4 AA batteries and stores data on an SD card. By conserving oxygen, it extends cylinder use time, facilitating patient ambulation.

Clinical Evidence

Bench testing only. Testing included low battery voltage, battery life, reverse polarity, pressure regulator verification, high/low temperature storage and operation, cleaning verification, and IPX1 drip-proof verification. Compliance with FCC CFR 47 Parts 15B/18, Industry Canada, BS EN 55011:2007, and IEC 60601-1 standards was demonstrated.

Technological Characteristics

Integral high-pressure regulator; pressure switch (0.03 to -0.200 cm H2O); microprocessor-controlled dosing valves; 4 AA battery power; SD card data storage; IPX1 rated; software-driven dosing algorithm.

Indications for Use

Indicated for patients on oxygen requiring ambulatory delivery of medical-grade oxygen from high-pressure cylinders in hospital, healthcare, or home environments.

Regulatory Classification

Identification

A noncontinuous ventilator (intermittent positive pressure breathing-IPPB) is a device intended to deliver intermittently an aerosol to a patient's lungs or to assist a patient's breathing.

Predicate Devices

• Sunrise PD 1000 (K020329)
• Inspired Technologies VIAspire Model 300P LOX portable (K072011)
• Essex Hi Pressure OCD (K024023)

Submission Summary (Full Text)

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#### Non-Confidential Summary of Safety and Effectiveness

Page 1 of 2 16-Feb-09

K.O904Al

| Inspired Technologies, Inc.<br>1061 Main Street - #24<br>N. Huntingdon, PA 15642 | Tel - 724-861-5510<br>Fax - 724-861-5530 |
|----------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------|
| Official Contact: | Rick Confer - Director RA/QA |
| Proprietary or Trade Name: | Model 350G Gas Conserver |
| Usual Name: | Conserver, oxygen |
| Classification Name: | Noncontinuous ventilator (IPPB)<br>NFB - 868.5905 |
| Predicate Devices: | Sunrise PD 1000 - K020329<br>Inspired Technologies VIAspire Model 300P LOX portable -<br>K072011<br>Essex - Hi Pressure OCD - K024023 |

#### Device Description:

The Inspired Technologies Model 350G Gas Conserver is designed to extend the use time of oxygen cylinders. It contains an integral pressure regulator with CGA 870 style yoke. The pressure regulator reduces the cylinder pressure to 19 - 25 psig. While the device is normally operated in the conserving mode, there is a continuous flow over-ride switch that allows 2 LPM of oxygen to bypass all valves for delivery to the patient. This continuous flow mode is typically used in the event of low or no battery power. In the conserving mode, the 350G Gas Conserver delivers oxygen to the patient by sensing inhalation via a pressure switch and opening one, two or both control valves for a specified period of time as determined by the microprocessor control algorithm. In the conserving mode, the device uses SmartDose™ technology to accomplish the oxygen savings. SmartDose™ senses the start of inhalation and releases a short "pulsed" dose at the very beginning of the inhalation cycle. The 350G Gas Conserver intended to be used by trained clinicians in the hospital, clinical or home care environments.

#### Indications for Use:

The Inspired Technologies 350G Gas Conserver is intended as a delivery device for medial-grade oxygen from high-pressure oxygen cylinders. This is an ambulatory device, which allows patients to ambulate longer than they would with a continuous flow regulator on the same cylinder. The 350G Gas Conserver is intended to be used in the hospital, healthcare facilities, or home care environments.

#### Patient Population:

Patients on oxygen

#### Environment of Use:

Hospital, healthcare facilities, or home care environments.

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## Non-Confidential Summary of Safety and Effectiveness Page 2 of 2 16-Feb-09

| Features | Model 350G Gas Conserver |
|----------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Software driven | Yes |
| Components | Integral high pressure regulator<br>Dosing device and algorithm<br>Valves |
| Pressure reduction from high<br>pressure cylinders | Yes |
| Dosing algorithm | 16.0 cc/lpm x setting value ( i.e. 16x 1=16, 16 x 2 =32 etc) at<br>1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 5.0, and 6.0 Lpm flow settings<br>Sport mode 1 is setting value + 16 cc<br>Sport Mode 2 is setting value +32 cc/lpm |
| Back up mode flow rate | Continuous flow in back-up mode of 2 Lpm |
| Powered and duration | 4 "AA" batteries |
| Status indicators | Battery Status<br>Patient setting-valve activation |
| Breath sensing | Pressure switch range (vacuum) 0.03 to -0.200 cm H2O |
| Dosing | Up to 35 BPM at maximum settings (5) |
| Alarms | Visual battery low alert<br>No audible alarms |
| Data Storage | SD card used for storage of data |

To demonstrate safety and efficacy we performed the following tests according to the following standards:

FCC CFR 47 Parts 15B and 18 Industry Canada BS EN 55011:2007 IEC 60601-1 Bench and performance testing for: Low battery voltage tests Battery Life Battery reverse polarity Pressure regulator verification Storage at high and low temperatures Operation at high and low temperatures Cleaning verification IPX1 -Drip proof verification

## Differences Between Other Legally Marketed Predicate Devices:

The proposed device is viewed as substantially equivalent to the predicate devices, Sunrise - PD 1000 - K020329, Inspired Technologies - VIAspire LOX Portable - K072011, and Essex - Hi Pressure OCD - K024023

There are no significant differences that affect the safety or effectiveness of the intended device as compared to the predicate devices.

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Image /page/2/Picture/1 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal features a stylized eagle with its wings spread, facing to the right. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" are arranged in a circular pattern around the eagle. The text is in all capital letters and is evenly spaced around the circle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

# MAY 2 9 2009

Inspired Technologies, Incorporated C/O Mr. Paul E. Dryden President ProMedic, Incorporated 24301 Woodsage Drive Bonita Springs, Florida 34134-2958

Re: K090421

Trade/Device Name: 350G Gas Conserver Regulation Number: 21 CFR 868.5905 Regulation Name: Noncontinuous Ventilator Regulatory Class: II Product Code: NFB Dated: May 15, 2009 Received: May 18, 2009

Dear Mr. Dryden:

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 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. Dryden

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 (OS) 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/cdrh/comp/ 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/cdrh/mdr/ 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/cdrh/industry/support/index.html.

Sincerely yours,

Susan Renores

Susan Runner, D.D.S., MA Acting 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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### Indications for Use Statement

Page 1 of 1

510(k) Number:

Ko 1042 (To be assigned)

Device Name:

350G Gas Conserver

Indications for Use:

The Inspired Technologies 350G Gas Conserver is intended as a delivery device for medial-grade oxygen from high-pressure oxygen cylinders. This is an ambulatory device, which allows patients to ambulate longer than they would with a continuous flow regulator on the same cylinder.

The 350G Gas Conserver is intended to be used in the hospital, healthcare facilities, or home care environments.

Prescription Use XX (Part 21 CFR 801 Subpart D)

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)

Schuler

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

510(k) Number: k090421