K Number
K031323
Device Name
DBT, DYNAMIC BUBBLE TRAP
Manufacturer
Date Cleared
2003-08-01

(98 days)

Product Code
Regulation Number
870.4260
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The DBT™ is indicated for use in cardiopulmonary bypass procedures for the removal of gaseous microemboli.
Device Description
The DBT™, Dynamic Bubble Trap is a sterile device with a non-pyrogenic fluid pathway. It is intended for single use only, in the arterial line of an extracorporeal circuit during cardiopulmonary bypass procedures. It is designed to remove gaseous microemboli from the arterial line of a cardiopulmonary bypass circuit.
More Information

Not Found

No
The summary describes a mechanical device for removing microemboli and does not mention any AI or ML components or capabilities.

Yes
The device is used in cardiopulmonary bypass procedures to remove gaseous microemboli, which directly impacts the patient's physiological state during the procedure, classifying it as a therapeutic device.

No
The device is described as being for the "removal of gaseous microemboli," which is a treatment function, not a diagnostic one. It removes a problem rather than analyzing or detecting it for diagnosis.

No

The device description clearly states it is a "sterile device with a non-pyrogenic fluid pathway" and is intended for use "in the arterial line of an extracorporeal circuit". This indicates a physical, hardware-based medical device, not a software-only one.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, treatment, or prevention of disease.
  • Device Function: The DBT™ is described as a device used in cardiopulmonary bypass procedures to remove gaseous microemboli from the arterial line of an extracorporeal circuit. This is a mechanical process performed on blood outside the body during a surgical procedure.
  • Lack of Diagnostic Purpose: The intended use and device description do not mention any analysis of biological specimens for diagnostic purposes. Its function is purely therapeutic/supportive during a medical procedure.

Therefore, the DBT™ falls under the category of a medical device used in a surgical procedure, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The DBT™ is indicated for use in cardiopulmonary bypass procedures for the removal of gaseous microemboli.

Product codes

DTM

Device Description

The DBT™, Dynamic Bubble Trap is a sterile device with a non-pyrogenic fluid pathway. It is intended for single use only, in the arterial line of an extracorporeal circuit during cardiopulmonary bypass procedures. It is designed to remove gaseous microemboli from the arterial line of a cardiopulmonary bypass circuit.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Arterial line of an extracorporeal circuit

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)

Testing was performed in accordance with the Guidance Performance Data: for Cardiopulmonary Bypass Arterial Line Blood Filter 510(k) Submissions, dated November 29, 2000. The recommended special controls have been applied to minimize all identified potential risks to health. Bench testing demonstrates that the device has been designed to minimize the identified potential risks to a patient's health. Based upon the performance studies and the proposed Conclusion: device labeling, the DBT™, Dynamic Bubble Trap, is substantially equivalent to the identified predicate devices in terms of intended use, safety, and effectiveness.

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

Not Found

Predicate Device(s)

Pall EC Plus Filter (K834380)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.4260 Cardiopulmonary bypass arterial line blood filter.

(a)
Identification. A cardiopulmonary bypass arterial line blood filter is a device used as part of a gas exchange (oxygenator) system to filter nonbiologic particles and emboli (blood clots or pieces of foreign material flowing in the bloodstream which will obstruct circulation by blocking a vessel) out of the blood. It is used in the arterial return line.(b)
Classification. Class II (special controls). The special control for this device is the FDA guidance document entitled “Guidance for Cardiopulmonary Bypass Arterial Line Blood Filter 510(k) Submissions.”

0

510(k) SUMMARY - DYNAMIC BUBBLE TRAP

Submitter Name:Convergenza AG
Submitter Address:St. Markusgasse 16
FL 9490 Vaduz
Principality of Liechtenstein
Contact Person:Christie DeWitt
Phone/Fax Number:(239) 992-3163
Date Prepared:April 25, 2003
Device Trade Name:DBT™, Dynamic Bubble Trap
Device Common Name:Arterial Filter
Classification Name:Cardiopulmonary Bypass Arterial Line Blood Filter
21 CFR §870.4260; Class II
Predicate Devices:Pall EC Plus Filter (K834380)
Device Description:The DBT™, Dynamic Bubble Trap is a sterile device with
a non-pyrogenic fluid pathway. It is intended for single
use only, in the arterial line of an extracorporeal circuit
during cardiopulmonary bypass procedures. It is
designed to remove gaseous microemboli from the
arterial line of a cardiopulmonary bypass circuit.
Intended Use:The DBT™ is indicated for use in cardiopulmonary
bypass procedures for the removal of gaseous
microemboli.
Device Technological
Characteristics:The DBT™ is tubular with 3/8-inch barbed inlet and
outlet ports. Within the tube there is a diffuser chamber
and a site for collecting microbubbles, which is
connected to the recirculation line. Inside the diffuser
chamber there is a tightly integrated three-channel
spiral. As blood passes through the spiral, it is
converted into a rotating stream. The resulting
centripetal forces direct gaseous microemboli to the
center of the flow line. The collection site, which is
situated in the center of the distal end of the tube,
diverts the central blood flow line and returns it together
with all collected microbubbles to the cardiotomy

1

Testing was performed in accordance with the Guidance Performance Data: for Cardiopulmonary Bypass Arterial Line Blood Filter 510(k) Submissions, dated November 29, 2000. The recommended special controls have been applied to minimize all identified potential risks to health. Bench testing demonstrates that the device has been designed to minimize the identified potential risks to a patient's health. Based upon the performance studies and the proposed Conclusion:

device labeling, the DBT™, Dynamic Bubble Trap, is substantially equivalent to the identified predicate devices in terms of intended use, safety, and effectiveness.

2

Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles an eagle or bird-like figure, composed of three curved lines. The seal is black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Convergenza AG c/o Ms. Christine B. DeWitt DeWitt Group International 3625 Woodlake Drive Bonita Springs, FL 34134

Re: K031323

DBT™, Dynamic Bubble Trap Regulation Number: 870.4260 Regulation Name: Cardiopulmonary Bypass Arterial Line Blood Filter Regulatory Class: Class II (two) Product Code: DTM Dated: April 24, 2003 Received: April 25, 2003

Dear Ms. DeWitt:

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.

AUG = 1 2003

3

Page 2 - Ms. Christine B. DeWitt

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 (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) 594-4646. 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,

N. Robertson M.P.

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

Enclosure

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510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: DBT™, Dynamic Bubble Trap _______________________________________________________________________________________________________________________________________

Indications for Use:

The DBT™ is indicated for use in cardiopulmonary bypass procedures for the removal of gaseous microemboli.

(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)X OROver-The-Counter Use
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(Division Sign-Off)

(Optional Format 1-2-96) Division of Cardiovascular Devices

510(k) NumberK031323
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