K Number
K031150
Device Name
HEMOBAG, MODEL HBBSD2000
Date Cleared
2003-06-23

(74 days)

Product Code
Regulation Number
870.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The HEMOBAG™ is a blood circulating storage reservoir designed to collect anticoagulated whole blood salvaged from extracorporeal circuits after the patient has been disconnected from the circuit. When used in connection with the TS3 Tubing Set and a commercially available hemoconcentrator, the HEMOBAG™ serves as a reservoir for circulating and hemoconcentrating blood in a closed circuit recovery loop.
Device Description
The HEMOBAG™ Blood Salvage Device is a storage reservoir for blood that can be held, circulated and hemoconcentrated. It is designed for use in salvaging anticoagulated whole blood from extracorporeal circuits. When used in conjunction with a TS3 Tubing Set and a commercially available hemoconcentrator, the HEMOBAG™ serves as a hemoconcentrating reservoir for use in a closed circuit recovery loop for removal of excess plasma water and low molecular weight solutes. The richly concentrated, anticoaqulated, autologous whole blood is then quickly made available to the patient for gravity transfusion. The HEMOBAG™ is designed with a universal (1/4" – 3/8″) stepped connector on the arterial infusion port to allow lines of varying sizes to be attached to the bag. The inlet and outlet ports of the bag are designed with quick connect/disconnect ¼" connectors to mate with the TS3 Tubing set for fluid delivery to and from the hemoconcentrator. The HEMOBAG™ is equipped with a needleless port for ease of access. The HEMOBAG™ has been designed with a spike port to facilitate gravity transfusion. A baffle has been positioned inside the bag to allow the blood from the hemoconcentrator to enter the bag and circulate toward the top of the bag and down again to the outlet port allowing proper mixing and flow during hemoconcentration.
More Information

DTN

Not Found

No
The summary describes a passive blood storage and circulation device with no mention of computational analysis, algorithms, or learning capabilities.

Yes.
The device collect and processes autologous blood for gravity transfusion back to the patient. This directly treats a patient's medical condition by returning blood.

No

The HEMOBAG™ is described as a "blood circulating storage reservoir" designed to collect, circulate, and hemoconcentrate blood. Its purpose is to prepare concentrated, autologous whole blood for reinfusion, not to diagnose a condition or disease.

No

The device description clearly details a physical blood storage reservoir with specific ports, connectors, and internal components (baffle), indicating it is a hardware device. There is no mention of software as a component or the primary function.

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

Here's why:

  • Intended Use: The intended use is to collect, store, circulate, and hemoconcentrate blood salvaged from extracorporeal circuits for reinfusion into the patient. This is a process performed on the patient's blood outside the body, but the purpose is therapeutic (returning the blood to the patient), not diagnostic (analyzing the blood to provide information about a patient's health).
  • Device Description: The description focuses on the physical characteristics of the bag and its function in a closed circuit for blood processing. It does not mention any components or functions related to analyzing or testing the blood for diagnostic purposes.
  • Performance Studies: The performance studies focus on the safety and effectiveness of the device in terms of blood handling (cellular damage, hemolysis) and its ability to function as a reservoir and facilitate circulation and hemoconcentration. These are performance characteristics relevant to a blood processing device, not a diagnostic device.
  • Key Metrics: The key metrics measured (hematocrit, platelet depletion, etc.) are related to the impact of the device on the blood during processing, not diagnostic measurements of the blood's composition or properties for the purpose of diagnosing a condition.

IVD devices are specifically designed to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnostic, monitoring, or compatibility purposes. The HEMOBAG™'s function is to process and return blood to the patient, which falls under the category of a therapeutic or blood processing device, not an IVD.

N/A

Intended Use / Indications for Use

The HEMOBAG™ Blood Salvage Device is a storage reservoir for blood that can be held, circulated and hemoconcentrated. It is designed for use in salvaging anticoagulated whole blood from extracorporeal circuits. When used in conjunction with a TS3 Tubing Set and a commercially available hemoconcentrator, the HEMOBAG™ serves as a hemoconcentrating reservoir for use in a closed circuit recovery loop for removal of excess plasma water and low molecular weight solutes. The richly concentrated, anticoaqulated, autologous whole blood is then quickly made available to the patient for gravity transfusion.

Product codes

DTN

Device Description

The HEMOBAG™ is designed with a universal (1/4" – 3/8″) stepped connector on the arterial infusion port to allow lines of varying sizes to be attached to the bag. The inlet and outlet ports of the bag are designed with quick connect/disconnect ¼" connectors to mate with the TS3 Tubing set for fluid delivery to and from the hemoconcentrator. The HEMOBAG™ is equipped with a needleless port for ease of access. The HEMOBAG™ has been designed with a spike port to facilitate gravity transfusion. A baffle has been positioned inside the bag to allow the blood from the hemoconcentrator to enter the bag and circulate toward the top of the bag and down again to the outlet port allowing proper mixing and flow during hemoconcentration.

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

SAFETY TESTING: The sterile HEMOBAG™ was subjected to biological evaluation (biocompatibility testing) using the guidelines provided in ANSI/AAMI/ISO 10993, Vol. 4 for limited exposure medical devices that have contact with circulating blood. The device successfully passed all of these tests.
The HEMOBAG™ was evaluated to determine whether or not it introduced more trauma to the blood than the predicate device. The evaluation was done by determining the cellular depletion and hemolysis of anticoaqulated bovine whole blood that had been circulated through the HEMOBAG™ at a rate of approximately 1.2 liters per minute for a 1-hour period. An identical evaluation was performed on the anticoagulated bovine whole blood that had been circulated through the predicate device in the same manner. The results of these tests proved that the difference between the amount of cellular damage noted in the blood that had been circulated through the HEMOBAG™ and that which had been circulated through the predicate device was statistically insignificant. Cellular damage was measured by change in hematocrit, platelet depletion, white blood cell count, plasma free hemoglobin and calculated % hemolysis. Blood in the test circuits was evaluated and found to have demonstrated acceptable hematological parameters during the test period. Since the test parameters used represent a scenario that is far worse than parameters that will be seen in proper clinical use, this device is considered safe with respect to cellular damage and hemolysis when used under abnormal stressful conditions.

EFFECTIVENESS: The function and purpose of this device is to accommodate and hold up to 2000ml of anticoagulated whole blood salvaged from an extracorporeal circuit after the patient has been removed. The device also functions as a reservoir for the same blood as it is hemoconcentrated by ultrafiltration for ultimate gravity transfusion to the patient. The HEMOBAG™ has been designed using materials and processes that will allow the flexible bag to hold up to 2000ml of fluid circulating at a rate of 300 – 500ml per minute for a period of approximately 10 – 15 minutes. The functionality of the HEMOBAG™ was successfully tested by overfilling the bag with warm water by 10 -- 20% and allowing the bag to hang for a period of 2 hours and then water to circulate through the bag at a rate of 2000 ml per minute for a period of 2 hours. Since the test parameters used represent a scenario far worse than those seen in clinical use, the device is considered effective with respect to its ability to serve as a reservoir for holding, circulating and hemoconcentrating up to 2000ml of anticoagulated whole blood. The rounded corners and baffle inside the bag allow mixing and proper flow of the blood through the HEMOBAG™ during hemoconcentration.

Key Metrics

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.4400 Cardiopulmonary bypass blood reservoir.

(a)
Identification. A cardiopulmonary bypass blood reservoir is a device used in conjunction with short-term extracorporeal circulation devices to hold a reserve supply of blood in the bypass circulation.(b)
Classification. Class II (special controls), except that a reservoir that contains a defoamer or filter is classified into the same class as the defoamer or filter. The device, when it is a cardiopulmonary bypass blood reservoir that does not contain defoamers or blood filters, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

0

JUN 2 3 2003

K 031150

510(k) SUMMARY

The HEMOBAG™ Blood Salvage Device is a storage reservoir for blood that can be held, circulated and hemoconcentrated. It is designed for use in salvaging anticoagulated whole blood from extracorporeal circuits. When used in conjunction with a TS3 Tubing Set and a commercially available hemoconcentrator, the HEMOBAG™ serves as a hemoconcentrating reservoir for use in a closed circuit recovery loop for removal of excess plasma water and low molecular weight solutes. The richly concentrated, anticoaqulated, autologous whole blood is then quickly made available to the patient for gravity transfusion.

The HEMOBAG™ is designed with a universal (1/4" – 3/8″) stepped connector on the arterial infusion port to allow lines of varying sizes to be attached to the bag. The inlet and outlet ports of the bag are designed with quick connect/disconnect ¼" connectors to mate with the TS3 Tubing set for fluid delivery to and from the hemoconcentrator. The HEMOBAG™ is equipped with a needleless port for ease of access. The HEMOBAG™ has been designed with a spike port to facilitate gravity transfusion. A baffle has been positioned inside the bag to allow the blood from the hemoconcentrator to enter the bag and circulate toward the top of the bag and down again to the outlet port allowing proper mixing and flow during hemoconcentration.

SAFETY TESTING

The sterile HEMOBAG™ was subjected to biological evaluation (biocompatibility testing) using the guidelines provided in ANSI/AAMI/ISO 10993, Vol. 4 for limited exposure medical devices that have contact with circulating blood. The device successfully passed all of these tests.

The HEMOBAG™ was evaluated to determine whether or not it introduced more trauma to the blood than the predicate device. The evaluation was done by determining the cellular depletion and hemolysis of anticoaqulated bovine whole blood that had been circulated through the HEMOBAG™ at a rate of approximately 1.2 liters per minute for a 1-hour period. An identical evaluation was performed on the anticoagulated bovine whole blood that had been circulated through the predicate device in the same manner. The results of these tests proved that the difference between the amount of cellular damage noted in the blood that had been circulated through the HEMOBAG™ and that which had been circulated through the predicate device was statistically insignificant. Cellular damage was measured by change in hematocrit, platelet depletion, white blood cell count, plasma free hemoglobin and calculated % hemolysis. Blood in the test circuits was evaluated and found to have demonstrated acceptable hematological parameters during the test period. Since the test parameters used represent a scenario that is far worse than parameters that will be seen in proper clinical use, this device is considered safe with respect to cellular damage and hemolysis when used under abnormal stressful conditions.

EFFECTIVENESS

The function and purpose of this device is to accommodate and hold up to 2000ml of anticoagulated whole blood salvaged from an extracorporeal circuit after the patient has been removed. The device also functions as a reservoir for the same blood as it is hemoconcentrated by ultrafiltration for ultimate gravity transfusion to the patient. The HEMOBAG™ has been designed using materials and processes that will allow the flexible bag to hold up to 2000ml of fluid circulating at a rate of 300 – 500ml per minute for a period of approximately 10 – 15 minutes. The functionality of the HEMOBAG™ was successfully tested by overfilling the bag with warm water by 10 -- 20% and allowing the bag to hang for a period of 2 hours and then water to circulate through the bag at a rate of 2000 ml per minute for a period of 2 hours. Since the test parameters used represent a scenario far worse than those seen in clinical use, the device is considered effective with respect to its ability to serve as a reservoir for holding, circulating and hemoconcentrating up to 2000ml of anticoagulated whole blood. The rounded corners and baffle inside the bag allow mixing and proper flow of the blood through the HEMOBAG™ during hemoconcentration.

APPENDIX D

1

Image /page/1/Picture/1 description: The image shows a logo with a circular border containing text, though the text is too blurry to read. Inside the circle is a stylized symbol consisting of three curved lines that resemble a bird in flight or a flowing design. The logo is black and white and appears to be a seal or emblem of some kind.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 2 3 2003

Global Blood Resources, LLC Mr. Keith Samolyk, CCP President & CEO 998 Windsor Avenue Windsor, CT 06096

Re: K031150

Trade/Device Name: HEMOBAGTM Regulation Number: 21 CFR 870.4400 Regulation Name: Blood Reservoir Regulatory Class: Class II (two) Product Code: DTN Dated: April 7, 2003 Received: April 10, 2003

Dear Mr. Samolyk:

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.

2

Page 2 - Keith A. Samolyk, CCP.

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), please contact the Office of Compliance at (301) 594-4646. 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) you may obtain. 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.

Afgealngpl

for

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

JUN 2 3 2003

INTENDED USE

The HEMOBAG™ is a blood circulating storage reservoir designed to collect anticoagulated whole blood salvaged from extracorporeal circuits after the patient has been disconnected from the circuit. When used in connection with the TS3 Tubing Set and a commercially available hemoconcentrator, the HEMOBAG™ serves as a reservoir for circulating and hemoconcentrating blood in a closed circuit recovery loop.

C. Wyndham for B. Zuckerman

ivision of Cardiovascular Devices

KO31150 510(k) Number