K Number
K014169
Device Name
WATER PURIFICATION COMPONENTS FOR HEMODIALYSIS
Date Cleared
2002-02-06

(49 days)

Product Code
Regulation Number
876.5665
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Carbon Filters and Water Softeners are intended to be used as components of a water purification system to remove organic and inorganic substances from water that is used to dilute dialysis concentrate to form dialysate and to produce purified water for other purposes such as dialyzer reprocessing and equipment rinse and disinfection
Device Description
The BJJ&A water purification components utilize no new water purification techniques, carbon filtration and water softening. The predicate device system we are claiming SE to, utilizes the exact same water purification principles. The following is a comparison summary of the BJJ&A water treatment components and the predicate device. BJJ&A and U.S. Filter both utilize a water softener made of materials, which are "NSF" and/or FDA approved. U.S. Filters' softener is installed with a single regeneration tank and electrically interlocked to shut down the RO unit operation during the softener regeneration cycle. BJJ&A softeners are installed in a single regeneration tank configuration such as USF or in a duplex-twin alternating fashion to provide softened water to the system 24 hours a day. While one regeneration tank is in a regeneration cycle the other regeneration tank is on line providing soft water to the system. This will prevent the possibility of softener regeneration or a salt dump into the water purification system during a patient shift. This also eliminates the need to shut down the RO unit for softener regeneration. Carbon filtration is utilized by both BJJ&A and U.S. Filter to filter out chlorine and chloramines from the water. BJJ&A uses carbon filter made from materials, which are FDA or NSF approved. Both companies use two carbon filters in a series configuration with test ports installed after each filter. A minimum total contact time of 10 empty bed contact time minutes are incorporated into both designs as recommended by the FDA for chlorine and chloramine removal. Both BJJ&A and U.S. Filter recommended the chlorine and chloramine levels be checked before each patient shift. Hard plumbed bypass piping of the carbon tanks is not allowed on either component. Both components will utilize an activated carbon with an Iodine number of 900 or greater. Both BJJ&A and U.S. Filter uses in line carbon regeneration filters. U.S. Filter uses a single carbon filter in its single patient dialysis system. BIJ&A always uses a dual carbon filter in series in every dialysis water system installed, including single patient systems. BJJ&A and U.S. Filter incorporate emergency equipment bypass lines and valving that are clearly labeled and tagged. Instructions for usage will be included with the water components and staff in-service will be provided to the clinic/customer by BJJ&A. The use of dead legged bypass piping will be avoided. Carbon filters will not have hard plumbed bypass lines. U.S. Filter emergency equipment bypass utilizes a dry bypass technique. This method uses breakable unions and isolation valves at the end of each bypass line so that stagnant water will not be present in the line in the event of an emergency bypass condition. BJJ&A emergency equipment bypass is a wt bypass method. In this method the bypass valve is installed with no more than one half pipe a diameter length in this methou the bypass valve to avoid water stagnation. The use of dead leg bypass piping is unacceptable. BJJ&A water distribution piping will be configured with no dead legs longer than 6 pipe diameters. U.S. Filter installs sanitization/sanitant introduction valve(s) or introduction port must be incorporated to allow chemical injection of sanitants to allow sanitization of the RO must be incorporated to anow chemical injoined in connections or through the top of the storage system and storage and the the sites for sanitant introduction BJJ&A avoids having any additional deadleg bypass valving installed into the original piping system and this further avoids water stagnation.
More Information

Not Found

No
The device description focuses solely on traditional water purification techniques (carbon filtration and water softening) and mechanical design differences compared to the predicate device. There is no mention of AI, ML, or any computational analysis of data for decision-making or control.

No.
Explanation: The device is a water purification system component for dialysis, not a therapeutic device. It processes water used in medical procedures, but does not directly treat patients.

No

This device is a water purification system component for dialysis, designed to remove substances from water. It does not diagnose medical conditions.

No

The device description clearly details physical components like carbon filters, water softeners, tanks, piping, and valves, indicating it is a hardware-based system for water purification.

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

Here's why:

  • Intended Use: The intended use is to purify water for use in dialysis and other related equipment processes. This is a water treatment system, not a device used to examine specimens derived from the human body.
  • Device Description: The description focuses on the physical components and processes of water purification (carbon filtration, water softening). It does not mention any components or functions related to analyzing biological samples.
  • Lack of IVD Characteristics: The text does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological specimens (blood, urine, tissue, etc.)
    • Providing diagnostic information about a patient's health
    • Using reagents or assays
    • Measuring analytes in a sample

The device is clearly intended to prepare water for use in a medical procedure (dialysis) and related equipment, which falls under the category of medical devices, but not specifically IVDs.

N/A

Intended Use / Indications for Use

Carbon Filters and Water Softeners are intended to be used as components of a water purification system to remove organic and inorganic substances from water that is used to dilute dialysis concentrate to form dialysate and to produce purified water for other purposes such as dialyzer reprocessing and equipment rinse and disinfection

Product codes (comma separated list FDA assigned to the subject device)

78 FIP

Device Description

Note: In this summary the word "component" refers to an individual part of a water treatment system. Example : the water softener or the carbon filter. The word system refers to the water purification plant as a whole. Example: the water softener, carbon filter, reverse osmosis, storage tank, ultrafiltration, ultraviolet sterilizer, and pumping systems. We are claiming substantial equivance to components
Bob J. Johnson & Assoc., Inc. (BJJ&A) is applying for a 510(k) premarket notification for our "Water Purification Components for Hemodialysis". The following is a summary of our submission document. The regulatory classification is class II CFR 876.5665(a), Product Code 78 FIP. The device we are claiming substantial equivalence to is marketed by U.S. Filter. The registration number for this device is K980182, U.S. Filter Water. Purification System. Regulatory Class: II, 21 CFR 876.5665/Procode: 78 FIP.
The BJJ&A water purification system for hemodialysis will be used with a hemodialysis system. The Water purification system will remove organic and inorganic substances and microbial contaminants from water used to dilute dialysate, bicarbonate, acetate and sterilant for dialyzer reprocessing. The purified water will also be used in the equipment disinfection process, equipment rinsing and any other application the clinic/customer deems appropriate. This system will meet all the requirements put forth by the United States Food and Drug Administration (FDA) and the Association for the Advancement of Medical Instrumentation (AAMI) and any other laws that may apply.
The BJJ&A water purification components utilize no new water purification techniques, carbon filtration and water softening. The predicate device system we are claiming SE to, utilizes the exact same water purification principles. The following is a comparison summary of the BJJ&A water treatment components and the predicate device.
BJJ&A and U.S. Filter both utilize a water softener made of materials, which are "NSF" and/or FDA approved. U.S. Filters' softener is installed with a single regeneration tank and electrically interlocked to shut down the RO unit operation during the softener regeneration cvcle. BJJ&A softeners are installed in a single regeneration tank configuration such as USF or in a duplex-twin alternating fashion to provide softened water to the system 24 hours a day. While one regeneration tank is in a regeneration cycle the other regeneration tank is on line providing soft water to the system. This will prevent the possibility of softener regeneration or a salt dump into the water purification system during a patient shift. This also eliminates the need to shut down the RO unit for softener regeneration. Information is available in the "purposes and operation" summary.
Carbon filtration is utilized by both BJJ&A and U.S. Filter to filter out chlorine and chloramines from the water. BJJ&A uses carbon filter made from materials, which are FDA or NSF approved. Both companies use two carbon filters in a series configuration with test ports installed after each filter. A minimum total contact time of 10 empty bed contact time minutes are incorporated into both designs as recommended by the FDA for chlorine and chloramine removal. Both BJJ&A and U.S. Filter recommended the chlorine and chloramine levels be checked before each patient shift. Hard plumbed bypass piping of the carbon tanks is not allowed on either component. Both components will utilize an activated carbon with an Iodine number of 900 or greater. Both BJJ&A and U.S. Filter uses in line carbon regeneration filters. U.S. Filter uses a single carbon filter in its single patient dialysis system. BIJ&A always uses a dual carbon filter in series in every dialysis water system installed, including single patient systems.
BJJ&A and U.S. Filter incorporate emergency equipment bypass lines and valving that are clearly labeled and tagged. Instructions for usage will be included with the water components and staff in-service will be provided to the clinic/customer by BJJ&A. The use of dead legged bypass piping will be avoided. Carbon filters will not have hard plumbed bypass lines. U.S. Filter emergency equipment bypass utilizes a dry bypass technique. This method uses breakable unions and isolation valves at the end of each bypass line so that stagnant water will not be present in the line in the event of an emergency bypass condition. BJJ&A emergency equipment bypass is a wt bypass method. In this method the bypass valve is installed with no more than one half pipe a diameter length in this methou the bypass valve to avoid water stagnation. The use of dead leg bypass piping is unacceptable.
BJJ&A water distribution piping will be configured with no dead legs longer than 6 pipe diameters. U.S. Filter installs sanitization/sanitant introduction valve(s) or introduction port must be incorporated to allow chemical injection of sanitants to allow sanitization of the RO must be incorporated to anow chemical injoined in connections or through the top of the storage system and storage and the the sites for sanitant introduction BJJ&A avoids having any additional deadleg bypass valving installed into the original piping system and this further avoids water stagnation.
Included in this document is labeling that is applied to the components of the water purification metuded in this doodinis. AAMI water purification standards are also included With an actual water quality analysis and Total Organic Carbon analysis from existing water with an actual water quality dialysis. Dimensional drawings and product specification sheets pullincation components for analysis vith owner's manuals for each of the components models.
In summary, the BJJ&A water purification components and the U.S. Filter predicate device In summary, the Discore water parinother. The core water purification components and tomponents are very bithe same. The differences are in the application of the bypass econnology are exactly the differences in these two systems are derived from the fact BJJ&A is in a constant attempt to provide the best water quality and safest possible system to the public.
Note: The Renal Care Facilities will supply their own reverse osmosis system, ultra-filtration rack, DI, and storage tanks. BJJ&A will only be providing the water softener systems and carbon systems.

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

Not Found

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): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K980182

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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

§ 876.5665 Water purification system for hemodialysis.

(a)
Identification. A water purification system for hemodialysis is a device that is intended for use with a hemodialysis system and that is intended to remove organic and inorganic substances and microbial contaminants from water used to dilute dialysate concentrate to form dialysate. This generic type of device may include a water softener, sediment filter, carbon filter, and water distillation system.(b)
Classification. Class II (special controls). The device, when it is a water purification subsystem disinfectant, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

Image /page/0/Picture/0 description: The image shows a logo for "BJJ&A Total Water Treatment Bob J. Johnson & Associates, Inc." The logo includes a star on the left, followed by the text "BJJ&A" and a series of wavy lines. Below the wavy lines is the text "Total Water Treatment" and "Bob J. Johnson & Associates, Inc."

FEB 0 6 2002

K014169 Page 1 of 3

San Antonio Office

7715 Mainland Suite 115 San Antonio, Texas 78250 (210) 684-7638 (210) 681-1339 Fax

Corporate Office

1313 FM 1960 E. Houston, Texas 77073 (281) 443-2225 (281) 443-6831 Fax

Dallas Office

2619 Farrington Street as. Texas 75207 (-- +) 631-4316 (214) 631-4657 Fax

San Angelo Office

7433 Billo Dr. San Angelo, Tx. 76901 (915)482-2202

Lubbock Office

516 84th Street Lubbock, Texas 79404 (806) 745-7933 (806) 745-8631 Fax

Harlingen Office

Federico Vaquera (956)778-2099 (956)642-3355 Fax

PREMARKET NOTIFICATION 510(k) SUMMARY

November 30, 2001

Bob J. Johnson & Assoc., Inc. 7715 Mainland Dr. #115 San Antonio, Texas 78250 Robert Snyder

Ph: (210)684-7638
Fax: (210)681-1339

WATER PURIFICATION COMPONENTS FOR HEMODIAL YSIS Regulatory Classification: Class II CFR 876.5665(a)

Product Code: 78 FIP

Note: In this summary the word "component" refers to an individual part of a water treatment system. Example : the water softener or the carbon filter. The word system refers to the water purification plant as a whole. Example: the water softener, carbon filter, reverse osmosis, storage tank, ultrafiltration, ultraviolet sterilizer, and pumping systems. We are claiming substantial equivance to components

Bob J. Johnson & Assoc., Inc. (BJJ&A) is applying for a 510(k) premarket notification for our "Water Purification Components for Hemodialysis". The following is a summary of our submission document. The regulatory classification is class II CFR 876.5665(a), Product Code 78 FIP. The device we are claiming substantial equivalence to is marketed by U.S. Filter. The registration number for this device is K980182, U.S. Filter Water. Purification System. Regulatory Class: II, 21 CFR 876.5665/Procode: 78 FIP.

The BJJ&A water purification system for hemodialysis will be used with a hemodialysis system. The Water purification system will remove organic and inorganic substances and microbial contaminants from water used to dilute dialysate, bicarbonate, acetate and sterilant for dialyzer reprocessing.

1

K014169
Page 2 of 3

Page 2 of 3

The purified water will also be used in the equipment disinfection process, equipment rinsing and any other application the clinic/customer deems appropriate. This system will meet all the requirements put forth by the United States Food and Drug Administration (FDA) and the Association for the Advancement of Medical Instrumentation (AAMI) and any other laws that may apply.

The BJJ&A water purification components utilize no new water purification techniques, carbon filtration and water softening. The predicate device system we are claiming SE to, utilizes the exact same water purification principles. The following is a comparison summary of the BJJ&A water treatment components and the predicate device.

BJJ&A and U.S. Filter both utilize a water softener made of materials, which are "NSF" and/or FDA approved. U.S. Filters' softener is installed with a single regeneration tank and electrically interlocked to shut down the RO unit operation during the softener regeneration cvcle. BJJ&A softeners are installed in a single regeneration tank configuration such as USF or in a duplex-twin alternating fashion to provide softened water to the system 24 hours a day. While one regeneration tank is in a regeneration cycle the other regeneration tank is on line providing soft water to the system. This will prevent the possibility of softener regeneration or a salt dump into the water purification system during a patient shift. This also eliminates the need to shut down the RO unit for softener regeneration. Information is available in the "purposes and operation" summary.

Carbon filtration is utilized by both BJJ&A and U.S. Filter to filter out chlorine and chloramines from the water. BJJ&A uses carbon filter made from materials, which are FDA or NSF approved. Both companies use two carbon filters in a series configuration with test ports installed after each filter. A minimum total contact time of 10 empty bed contact time minutes are incorporated into both designs as recommended by the FDA for chlorine and chloramine removal. Both BJJ&A and U.S. Filter recommended the chlorine and chloramine levels be checked before each patient shift. Hard plumbed bypass piping of the carbon tanks is not allowed on either component. Both components will utilize an activated carbon with an Iodine number of 900 or greater. Both BJJ&A and U.S. Filter uses in line carbon regeneration filters. U.S. Filter uses a single carbon filter in its single patient dialysis system. BIJ&A always uses a dual carbon filter in series in every dialysis water system installed, including single patient systems.

BJJ&A and U.S. Filter incorporate emergency equipment bypass lines and valving that are clearly labeled and tagged. Instructions for usage will be included with the water components and staff in-service will be provided to the clinic/customer by BJJ&A. The use of dead legged bypass piping will be avoided. Carbon filters will not have hard plumbed bypass lines. U.S. Filter emergency equipment bypass utilizes a dry bypass technique. This method uses breakable unions and isolation valves at the end of each bypass line so that stagnant water will not be present in the line in the event of an emergency bypass condition. BJJ&A emergency equipment bypass is a wt bypass method.

2

K014169
Page 3 of 3

Page 3 of 3

In this method the bypass valve is installed with no more than one half pipe a diameter length in this methou the bypass valve to avoid water stagnation. The use of dead leg bypass piping is unacceptable.

BJJ&A water distribution piping will be configured with no dead legs longer than 6 pipe diameters. U.S. Filter installs sanitization/sanitant introduction valve(s) or introduction port must be incorporated to allow chemical injection of sanitants to allow sanitization of the RO must be incorporated to anow chemical injoined in connections or through the top of the storage system and storage and the the sites for sanitant introduction BJJ&A avoids having any additional deadleg bypass valving installed into the original piping system and this further avoids water stagnation.

Included in this document is labeling that is applied to the components of the water purification metuded in this doodinis. AAMI water purification standards are also included

With an actual water quality analysis and Total Organic Carbon analysis from existing water with an actual water quality dialysis. Dimensional drawings and product specification sheets pullincation components for analysis vith owner's manuals for each of the components models.

In summary, the BJJ&A water purification components and the U.S. Filter predicate device In summary, the Discore water parinother. The core water purification components and tomponents are very bithe same. The differences are in the application of the bypass econnology are exactly the differences in these two systems are derived from the fact BJJ&A is in a constant attempt to provide the best water quality and safest possible system to the public.

Note: The Renal Care Facilities will supply their own reverse osmosis system, ultra-filtration rack, DI, and storage tanks. BJJ&A will only be providing the water softener systems and carbon systems.

3

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of a caduceus, which is a symbol of medicine and health. The caduceus consists of a staff with two snakes coiled around it and a pair of wings at the top.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 0 6 2002

Mr. Robert Snyder Regional Manager, South Texas Territory Bob J. Johnson & Assoc., Inc. 7715 Mainland Dr., #115 SAN ANTONIO TX 78250

Re: K014169 Trade/Device Name: Water Purification Components for Hemodialysis Regulation Number: 21 CFR §876.5665 Regulation Name: Water purification system for hemodialysis Regulatory Class: II Product Code: 78 FIP Dated: November 30, 2001 Received: December 19, 2001

Dear Mr. Snyder:

We have reviewed your Section 510(k) premarket notification of intent to market the indication We have reviewed your Section JTQ(x) premained is substantially equivalent (for the indications referenced above and nave decemblicate devices marketed predicate devices marketed in interstate for use stated in the enclosure) to regary manated provice Amendments, or to
commerce prior to May 28, 1976, the enactment date of the Federal Food Drug commerce prior to May 20, 1970, the charge with the provisions of the Federal Food, Drug, devices that have been recuire approval of a premarket approval application (PMA).
and Cosmetic Act (Act) that do not require approval of a premarket approval ions of the Act and Cosmetic Act (Act) that do not require approvial controls provisions of the Act. The
You may, therefore, market the device, subject to the general resigned reservation, You may, therefore, market the device, subject to use gentrements for annual registration, listing of the and general controls provisions of the Fectiver requires against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), ( if your device is classified (Sec above) moved regulations affecting your device can be
it may be subject to additional controls. Existing major regulations affecting FDA ma it may be subject to additional controls. L'Aisang major sogo to 898. In addition, FDA may found in the Code of Pederal Regareering your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination are not mean Please be advised that IDA 3 issualled of a based on a suith other requirements of the Act
es and that FDA has made a decemination administered by other Federal agencies. You must of any Federal statutes and regulations administration of the limited to: registration and listing comply with all the Act STequirements, mouth, good manufacturing practice requirements as set
(21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice due d (21 CFR Part 807), labelling (21 CFR Pair 800); government (200); and if applicable, the electronic
forth in the quality systems (QS) regulation (21 CFR 1000 1050 forth in the quality systems (QS) regulations (SE-SE-SE) of the Act); 21 CFR 1000-1050.
product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

4

This letter will allow you to begin marketing your device as described in your 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 one of the following numbers, based on the regulation number at the top of this letter:

8xx.1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained 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,

Nancy C Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Indications for Use K014169

Carbon Filters and Water Softeners are intended to be used as components of a water purification system to remove organic and inorganic substances from water that is used to dilute dialysis concentrate to form dialysate and to produce purified water for other purposes such as dialyzer reprocessing and equipment rinse and disinfection

BOB J. JOHNSON & ASSOCIATES, INC.
1313 FM 1960 Ε.
HOUSTON, TX 77073
281-443-2225
1-800-341-2225

Prescription Use
(Per 21 CFR 801.109)

(Division Sign Off)
Division of Reproductive Abdominal,
and Rad
510(k) NumberK01416