SURSHIELD SAFETY WINGED BLOOD COLLECTION SET

{0}------------------------------------------------ # MAY 3 0 2003 Ko3/279 TERUMO MEDICAL PRODUCTS - HANGZHOU CHINA SURSHIELD™ SAFETY BLOOD COLLECTION SET Section II - Summary and Certification # SUMMARY OF SAFETY AND EFFECTIVENESS INFORMATION PERTAINING TO SUBSTANTIAL EQUIVALENCE ### DEVICE NAME ### Proprietary Name SURSHIELD™ Safety Winged Blood Collection Set ### Classification Name Tubes, vials, systems, serum separators, blood collection (75JKA) 21CFR. Section 862.1675 Classification: Class II Intravascular Administration Set (80FPA) 21CFR. Section 880.5440 Classification: Class II #### Common Name Blood specimen collection device and Intravascular Administration Set ### INTENDED USE The TERUMO® SURSHIELD™ SAFETY WINGED BLOOD COLLECTION SET is a winged blood collection needle intended for venipuncture to collect blood specimens from patients. The TERUMO® SURSHIELD™ SAFETY WINGED BLOOD COLLECTION SET is also indicated for intravenous administration of fluids after removing the attached luer adapter from the blood collection set connector and attaching a syringe, or other compatible/appropriate device. This device may be used for any patient population with consideration given to patient size, appropriateness for the solution being infused, and duration of therapy. Additionally, after withdraw of the needle from the patient's vein, the attached needle safety shield can be manually activated to cover the needle immediately after use to minimize risk of accidental needlestick. {1}------------------------------------------------ ## DESCRIPTION The Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou, China is a sterile, single-use device consisting of a needle attached to a winged type hub, tubing, female connector with a multi-sample luer adapter attached for blood collection. A hinged shield cover is attached to the wing just below the needle-to-wing junction. The shield cover can be turned 180 degrees on the hinge. As the needle is removed from the patient's vessel, the user's finger actively pushes the shield cover until it latches onto needle using a one- or two- handed technique. The shield cover is designed to allow the user's finger to remain behind the needle point so that the risk of needle stick injury is minimized. The shield cover is transparent for easy confirmation of the needle held in it. ## SUBSTANTIAL EQUIVALENCE The Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou, China is substantially equivalent to the Surshield Safety Winged Blood Collection set manufactured by Terumo Corporation in Kofu, Japan and cleared under K013164. # PRINCIPLE OF OPERATION/TECHNOLOGY Both devices are operated manually. ## MATERIALS The materials used in the Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou, China are the same as the predicate devices, which do not raise any new issues of safety or effectiveness. {2}------------------------------------------------ ## SPECIFICATIONS | Cannula gauge | Color code | Product code | Winged type hub | Cannula length | Tube Length | |---------------|------------|--------------|-----------------|----------------|-------------| | 19G | Cream | MN*SVS19B30 | C type | 3/4"(19mm) | 300mm | | 21G | Green | MN*SVS21B30 | C type | 3/4"(19mm) | 300mm | | 23G | Light blue | MN*SVS23B30 | C type | 3/4"(19mm) | 300mm | | | | MN*SVS23B18 | C type | 3/4" (19mm) | 180mm | | 25G | Orange | MN*SVS25B30 | C type | 3/4"(19mm) | 300mm | | | | MN*SVS25B18 | C type | 3/4"(19mm) | 180mm | ## PERFORMANCE The following tests were performed on the Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou, China: - Shield cover/Needle Locking Strength ● - Break strength of the shield cover joint ● - Force to lock the needle in the shield cover (Force to activate safety feature) . - Puncture Resistance of Shield Cover - Flow Rate - Wing to Tubing Connection Strength - . Tubing to Connector Connection Strength - Needle to Wing Connection Strength - Needle Penetration Resistance - Wing Needle Protector Fit - Leak Test - Blockage Test - Connection Strength of Winged Infusion Set and Luer Adaptor Joint - Valve Protector Fit ● {3}------------------------------------------------ Additionally, a risk analysis was conducted and no new issues were identified since the Surshield China device is the same as the cleared Surshield Kofu. None of the data raises any new issues of safety and effectiveness. The Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou. China is substantially equivalent to the Surshield Safety Winged Blood Collection set manufactured by Terumo Corporation in Kofu, Japan and cleared under K013164. ## ADDITIONAL SAFETY INFORMATION The sterilization conditions are validated according to EN550 to provide a Sterility Assurance Level (SAL) of 10-9. Ethylene Oxide residual levels resulting from EtO sterilization will not exceed the maximum residue levels proposed for Part 821 of Title 21 in the Federal Register Notice issued June 23, 1978, and indicated as follows: | Ethylene Oxide | 25 ppm | |-----------------------|--------| | Ethylene Chlorohydrin | 25 ppm | The device's blood contacting materials were tested in accordance with the tests recommended in the FDA General Program Memorandum #G95-1 (5/1/95): Use of International Standard ISO-10993, "Biological Evaluation of Medical Devices Part-1: Evaluation and Testing. Results of the testing demonstrate that the blood contacting materials are biocompatible. ### CONCLUSION The Surshield Safety Winged Blood Collection Set manufactured by Terumo Medical Products in Hangzhou, China is substantially equivalent to the Surshield Safety Winged Blood Collection set manufactured by Terumo Corporation in Kofu, Japan and cleared under K013164 with respect to intended use, design, technology/principles of operation, materials and performance. Differences between the devices do not raise any new issues of safety or effectiveness. Date Prepared: 04/18/03 - Prepared by: Kazuhito Inoue Regulatory Affairs Specialist 125 Blue Ball Rd Elkton, MD 21921 Phone: 1-800-283-7866 Ex. 7001 · Fax: (410) 398-6079 {4}------------------------------------------------ Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around a symbol. The symbol consists of three stylized human profiles facing right, stacked on top of each other, with flowing lines suggesting hair or clothing. MAY 3 0 2003 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 *Terumo Medical Products Hangzhou Company C/O Mr. Kazuhito Inoue Regulatory Affairs Specialist Terumo Medical Corporation 125 Blue Ball Road Elkton, Maryland 21921 Re: K031279 Trade/Device Name: SURSHIELD™ Safety Winged Blood Collection Set Regulation Number: 21 CFR 880.5440 Regulation Name: Intravascular Administration Set Regulatory Class: II Product Code: FPA Dated: April 21, 2003 Received: April 22, 2003 Dear Mr. Inoue: 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. 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 {5}------------------------------------------------ Page 2 - Mr. Inoue 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 Office of Compliance at (301) 594-4618. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html Sincerely yours, Susan Burnes Susan Runner, DDS, MA Interim Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {6}------------------------------------------------ Ko3/279 ### 510(k) Number (if known): SURSHIELD™ SAFETY WINGED BLOOD COLLECTION SET Device Name: #### Indications For Use: The TERUMO® SURSHIELD™ SAFETY WINGED BLOOD COLLECTION SET is a winged blood collection needle intended for venipuncture to collect blood specimens from patients. The TERUMO® SURSHIELD™ SAFETY WINGED BLOOD COLLECTION SET is also indicated for intravenous administration of fluids after removing the attached luer adapter from the blood collection set connector and attaching a syringe, or other compatible/appropriate device. This device may be used for any patient population with consideration given to patient size, appropriateness for the solution being infused, and duration of therapy. Additionally, after withdraw of the needle from the patient's vein, the attached needle safety shield can be manually activated to cover the needle immediately after use to minimize risk of accidental needlestick. (PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Prescription Use (Per 21 CFR 801.109) OR Over-The-Counter Use Patricia Cucentiz (Optional Format 1-2-96) vision Sian-Off vision of Anesthesiology, General Hospital, Infection Control, Dental Devices 510(k) Number: