K Number
K013123
Device Name
EMS PULMONARY FUNCTION TESTING FILTER
Date Cleared
2002-03-14

(176 days)

Product Code
Regulation Number
868.1840
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For use with pulmonary function testing. To filter air between the patient's exhaled air and the testing equipment. Single patient use.
Device Description
The EMS PFT Filter is acompact, electrostatic filter with various end-fitting adaptable to various pulmonary function testing circuits. It has 75 ml deadspace and resistance of 07. cm H2O at 720 Ipm per ATS spirometry or 0.5 cm I-120 @ 60 lpm. There are various connectors to allow connection to various PFT equipment. Single patient use.
More Information

No
The summary describes a physical filter for pulmonary function testing and does not mention any software, algorithms, or data processing that would indicate the use of AI or ML.

No
The primary function of this device is to filter air between a patient's exhaled breath and testing equipment, which is a protective and hygienic function for the equipment and subsequent users, not to directly treat a medical condition or restore health.

No
The device is described as a filter for use with pulmonary function testing equipment, designed to filter air between the patient's exhaled air and the testing equipment. Its purpose is to prevent cross-contamination by filtering bacteria and viruses, not to diagnose a medical condition.

No

The device description clearly describes a physical filter with specific dimensions, materials (electrostatic filter), and physical connectors, indicating it is a hardware device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to "filter air between the patient's exhaled air and the testing equipment" during pulmonary function testing. This is a physical barrier and filtration function, not a diagnostic test performed in vitro (outside the body) on a sample.
  • Device Description: The description focuses on the physical characteristics of the filter (electrostatic, deadspace, resistance, connectors) and its filtration capabilities (bacterial and viral filtration). It does not describe a test that analyzes a biological sample to diagnose a condition.
  • Lack of IVD Characteristics: There is no mention of analyzing a biological sample (like blood, urine, or tissue), reagents, or a diagnostic assay.

The device is a component used with a diagnostic test (pulmonary function testing equipment), but it is not the diagnostic test itself. It serves a protective and hygienic function for the equipment and potentially the patient.

N/A

Intended Use / Indications for Use

For use with pulmonary function testing. To filter air between the patient's exhaled air and the testing equipment. Single patient use.

Product codes

BZG

Device Description

The EMS PFT Filter is a compact, electrostatic filter with various end-fitting adaptable to various pulmonary function testing circuits. It has 75 ml deadspace and resistance of 07. cm H2O at 720 Ipm per ATS spirometry or 0.5 cm I-120 @ 60 lpm. There are various connectors to allow connection to various PFT equipment. Single patient use.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Hospital, Sub-acute Institutions

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

Pulmonary Data Services - KoKo – K934475

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc)

Not Found

§ 868.1840 Diagnostic spirometer.

(a)
Identification. A diagnostic spirometer is a device used in pulmonary function testing to measure the volume of gas moving in or out of a patient's lungs.(b)
Classification. Class II (performance standards).

0

Premarket Notification 510(k)

Section 2 - Certifications and Summaries

MAR 1 4 2002

EMS PFT Filtcr

1013123

Engincered Medical Systems, Inc. 2055 Executive Dr. Indianapolis, IN 46241

Non-Confidential Summary of Safety and Effectiveness

Page i of 2 March 7, 2002

EMSTel (317) 246-5500
2055 Executive Dr.Fax (317) 246-5501
Indianapolis, IN 46241
Official Contact:Bonnic Holly - Quality Manager
Proprietary or Trade Name:EMS Pulmonary Function Testing Filter
Common/Usual Name:PFT filter
Classification Name:Filter, Bacterial, Breathing Circuit
Predicate Devices:Pulmonary Data Services - KoKo – K934475

Device Description:

The EMS PFT Filter is acompact, electrostatic filter with various end-fitting adaptable to various pulmonary function testing circuits. It has 75 ml deadspace and resistance of 07. cm H2O at 720 Ipm per ATS spirometry or 0.5 cm I-120 @ 60 lpm. There are various connectors to allow connection to various PFT equipment. Single patient use.

Intended Use:
Indicated Use --For use with pulmonary function testing. To filter
air between the patient's exhaled air and the testing
equipment. Single patient use.
Environment of Use --Hospital, Sub-acute Institutions

1

Non-Confidential Summary of Safety and Effectiveness

Page 2 of 2

March 7, 2002

Comparison to Predicate Devices:

| | EMS Proposed device
Filter - Model # 5813 | Predicate PDS KoKo
K934475 |
|---------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------|-------------------------------|
| Attribute | | |
| Intended use | For use with pulmonary function
testing. To filter
air between the patient's exhaled
air and the testing
equipment | Same |
| Intended for single patient | Yes | Yes |
| Prescription | Yes | Yes |
| Intended population | Any patient | Same |
| Intended Environment of Use | Hospital, sub-acute | Same |
| Can be used with several
different PFT machines | Yes | Yes |
| Design Features | | |
| Compact housing | Yes | Yes |
| Various end-fittings | Yes | Yes |
| Dead Space (ml) | 75 ml | 60 ml |
| Resistance to flow at 720 lpm
per ATS standard for
spirometry | 0.7 cm H2O |