K Number
K014282
Device Name
BACSTOP FILTER,BACSTOP FILTER/HME
Manufacturer
Date Cleared
2002-06-26

(181 days)

Product Code
Regulation Number
868.5260
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For use with ventilators, anesthesia machines, and open flow systems where filtration of inspired and / or expired gases is desired and to add and retain moisture in the circuit as required. For patients with a tidal volume 150-500 ml (pediatrics) and >250 ml (adults). Single patient use. Duration of use up to 24 hours.
Device Description
The Munktell Bacstop Filter and Filter / HME are available in multiple sizes and incorporate standard 15 / 22 mm connectors with a gas sampling luer port. The depth filter uses electrostatic media for filtration and a foam media for the HME media.
More Information

No
The summary describes a passive filter and HME device with no mention of computational analysis, learning, or adaptive capabilities.

No.
This device functions as a filter and heat/moisture exchanger for respiratory circuits, primarily protecting patients and equipment from microbes and providing humidification, which are supportive functions rather than direct therapeutic interventions for a disease or condition. While essential for patient comfort and safety during ventilation, it does not treat a medical condition itself.

No

Explanation: The device description states its purpose is for filtration and moisture retention in ventilator and anesthesia circuits, not for diagnosing any medical condition.

No

The device description clearly describes a physical filter and filter/HME with specific materials and 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 clearly states the device is for use with ventilators, anesthesia machines, and open flow systems to filter and humidify inspired and expired gases. This is a function related to respiratory support and gas management, not the in vitro examination of specimens derived from the human body.
  • Device Description: The description details a filter and filter/HME (Heat and Moisture Exchanger) with connectors and media for filtration and humidification. This aligns with a respiratory accessory, not a device used for diagnostic testing of biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting specific analytes, or providing diagnostic information based on in vitro testing.

IVD devices are specifically designed to perform tests on samples taken from the body to diagnose diseases, monitor health, or determine treatment. This device's function is entirely focused on managing the gases breathed by a patient during respiratory support.

N/A

Intended Use / Indications for Use

For use with ventilators, anesthesia machines, and open flow systems where filtration of inspired and / or expired gases is desired and to add and retain moisture in the circuit as required. For pediatric patients with tidal volumes 150-500 ml and adult patients with tidal volumes >250 ml. Duration of use up to 24 hours. Single patient use.

Product codes

CAH

Device Description

The Munktell Bacstop Filter and Filter / HME are available in multiple sizes and incorporate standard 15 / 22 mm connectors with a gas sampling luer port. The depth filter uses electrostatic media for filtration and a foam media for the HME media.

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

pediatric patients with tidal volumes 150-500 ml and adult patients with tidal volumes >250 ml.

Intended User / Care Setting

Home, Hospital, Sub-acute Institutions, Emergency Services

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.)

Bacterial filtration - BFE - Nelson Lab. 99.999%
Viral filtration - VFE - Nelson Lab. 99.99+%
Humidification output (mg H2O/l) 31 mg H2O /L at TV of 1000 ml - adult 32 mg H2O /L at TV of 250 ml - pediatric

Predicate Device(s)

K881657, K945359, K941381, K941536

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5260 Breathing circuit bacterial filter.

(a)
Identification. A breathing circuit bacterial filter is a device that is intended to remove microbiological and particulate matter from the gases in the breathing circuit.(b)
Classification. Class II (performance standards).

0

K0142f2

Munktell Filter AB Box 300 S 790 20, Grycksbo, Sweden

Non-Confidential Summary of Safety and Effectiveness

Page 1 of 2 April 18, 2002

| Munktell Filter AB
Box 300
S 790 20 Grycksbo, Sweden | Tel - 011 (46) 23-683-80
Fax - 011 (46) 23-401-15 |
|------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Official Contact: | Gustav Kyrk - Managing Director |
| Proprietary or Trade Name: | Bacstop, Bacstop Mini, Bacstop Humini |
| Common/Usual Name: | Bacterial / Viral Filter and Heat and Moisture Exchanger |
| Classification Name: | Filter, Bacterial, Breathing Circuit |
| Predicate Devices: | Gibeck - Humid-Vent Filter - K881657
Hudson RCI (Artema) Aqua +FH - K945359
Mallinckrodt - Hygroboy and Hygrobac - K941381
Mallinckrodt - Barrierbac and Barrierbac "S" - K941536 |

Device Description: 100 100 100 100 11 11 11 11 11 11 11 11 11 11 13 13 13

The Munktell Bacstop Filter and Filter / HME are available in multiple sizes and incorporate standard 15 / 22 mm connectors with a gas sampling luer port. The depth filter uses electrostatic media for filtration and a foam media for the HME media.

Intended Use:
Indicated Use --For use with ventilators, anesthesia machines, and open flow systems where filtration of inspired and / or expired gases is desired and to add and retain moisture in the circuit as required.
For pediatric patients with tidal volumes 150-500 ml and adult patients with tidal volumes >250 ml. Duration of use up to 24 hours. Single patient use.
Environment of Use --Home, Hospital, Sub-acute Institutions, Emergency Services

1

Non-Confidential Summary of Safety and Effectiveness Page 2 of 2 April 18, 2002

General Technical Characteristics

AttributeMunktell - Proposed devices
Indications for use - To filter inspired and / or
expired gases and add and retain moistureSame
Intended for single patient, up to 24 hoursYes
PrescriptionYes
Intended populationAny patient, including adults and pediatrics
Intended Environment of UseHome, Hospital, Sub-acute Institutions,
Emergency Services
Placement in various locations in circuitYes
Design
Gas sampling portYes
Standard 15/22 mm connectorsYes
Dead Space (ml)23 to 85 ml
Resistance to flow250 ml - adult
Materials
Housing polystyreneYes
Filter mediaElectrostatic polypropylene
HME mediaFoam
Performance Standards
None under Section 514Yes
ISO 5356-1 Conical 15/22Yes
ISO 594-2 Luer FittingsYes
ISO 9360- HME moisture outputYes

Differences between Other Legally Marketed Predicate Devices

The data within the submission demonstrates that the proposed devices when compared to the predicate devices are safe and effective and are substantially equivalent to the predicate devices.

2

Image /page/2/Picture/0 description: The image shows the seal of the Department of Health & Human Services USA. The seal features a stylized image of an eagle with three heads in profile, facing right. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" are arranged in a circular pattern around the eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 2 6 2002

Munktell Filter AB c/o Mr. Paul Dryden ProMedic, Inc. 6329 W. Waterview Court McCordsville, IN 46055-9501

Re: K014282

Munktell Bacstop Filter and Filter/HME, Model # 321 201, 321 202, 321 203, 321 204 Adults, Model # 321 209, 321 210 Pediatric Regulation Number: 868.5260 Regulation Name: Breathing Circuit Filter Regulatory Class: II (two) Product Code: CAH Dated: April 2, 2002 Received: April 3, 2002

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. Iisting 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.

3

Page 2 - Mr. Paul 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); 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.

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 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4648. 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" (21CFR 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,

Donna-Bea Tillman, Ph.D. Acting Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for UsePage 1 of 1
510(k) Number:K014282
Device Name:Bacstop Filter and Filter / HME
Intended Use:For use with ventilators, anesthesia machines, and open flow
systems where filtration of inspired and / or expired gases is
desired and to add and retain moisture in the circuit as required.

For patients with a tidal volume 150-500 ml (pediatrics) and

250 ml (adults).

Single patient use. Duration of use up to 24 hours. |

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division of Cardiovascular & Respiratory Devices
510(k) Number K01428

Prescription Use (Per CFR 801.109)

or

Over-the-counter use _________________________________________________________________________________________________________________________________________________________