K Number
K040229
Date Cleared
2004-03-19

(46 days)

Product Code
Regulation Number
870.1130
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The A&D LifeSource UB-328 digital blood pressure monitor is intended for use by adults for measuring the systolic and diastolic blood pressure and pulse rate.
Measure blood pressure (systolic and diastolic) and pulse rate.

Device Description

The A&D LifeSource UB-328 digital blood pressure monitor is intended for use by adults for measuring the systolic and diastolic blood pressure and pulse rate. UB-328 uses an inflated cuff which is wrapped around the upper wrist. The cuff is inflated automatically by the air pump. The systolic and diastolic blood pressures are determined by oscillometric method. The deflation rate is controlled by a preset mechanical valve at a constant rate. The pressure of the cuff is completely released automatically at the end of the measurement. At the same time, the measurements are displayed on the LCD display for one minute. After one minute without operation, UB-328 turns off automatically. UB-328 measures blood pressure and pulse rate even when an irregular heartbeat occurs.

AI/ML Overview

Here's a breakdown of the acceptance criteria and study information for the A&D LifeSource UB-328 Digital Blood Pressure Monitor, based on the provided document:

1. Table of Acceptance Criteria and Reported Device Performance

The provided document refers to the AAMI SP-10 standard. The device's performance is reported as "Conformed" for all applicable sections of this standard. While the document lists sections of SP-10 that were tested, specific quantitative acceptance criteria and their corresponding reported device performance values are not explicitly detailed in this summary. Instead, a qualitative "Conformed" status is given for each test.

SP-10 Section #Section TitleAcceptance Criteria (Implied by standard)Reported Device Performance
4.1.1General(Standard requirements)Conformed
4.1.2.1Device labeling(Standard requirements)Conformed
4.1.2.2Outer container(Standard requirements)Conformed
4.1.3Information manual(Standard requirements)Conformed
4.1.4.1Component replacement(Standard requirements)Conformed
4.1.4.2Power system labeling(Standard requirements)Conformed
4.1.4.3Labeling for battery-powered devices(Standard requirements)Conformed
4.2.1Storage conditions(Standard requirements)Conformed
4.2.2Operating conditions(Standard requirements)Conformed
4.2.3Vibration and shock(Standard requirements)Conformed
4.2.4.1Voltage range(Standard requirements)Conformed
4.2.4.2Life(Standard requirements)Conformed
4.3.1.1Maximum cuff pressure(Standard requirements)Conformed
4.3.1.2Cuff deflation(Standard requirements)Conformed
4.3.2Electrical safety(Standard requirements)Conformed
4.3.3Conductive components(Standard requirements)Conformed
4.4.1Pressure indicator accuracy(Standard requirements)Conformed
4.4.2Overall system efficacy(Standard requirements)Conformed
4.4.2.1Auscultatory method as the reference standard(Standard requirements)Conformed
4.4.2.2Intra-arterial method as the reference standard(Standard requirements)Not applicable
4.4.3Battery-powered devices(Standard requirements)Conformed
4.5Requirements for devices with manual inflation systems(Standard requirements)Conformed

Note: The AAMI SP-10 standard typically defines specific accuracy requirements for blood pressure monitors (e.g., mean difference and standard deviation between the device and a reference method). However, this 510(k) summary only states "Conformed" rather than providing the numerical results for these key performance metrics.

2. Sample Size Used for the Test Set and Data Provenance

The document indicates that the device "meets NIST/AAMI SP-10 standard and FDA guidance 'Non-invasive Blood Pressure (NIBP) Monitor Guidance'." However, it explicitly states: "UB-328 is not clinically tested." This implies that the testing was based on laboratory and engineering evaluations rather than a clinical study with a human test set. Therefore, information regarding "sample size used for the test set," "country of origin of the data," and whether it was "retrospective or prospective" is not applicable as there was no disclosed human clinical test set.

The basis for equivalence is that the device "uses the identical software codes and pressure detection related hardware as the predicate devices to determine systolic, diastolic, and pulse rate."

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

Since the device was not clinically tested and relied on equivalence to predicate devices and adherence to engineering standards (AAMI SP-10), there is no mention of experts establishing ground truth for a clinical test set. The AAMI SP-10 standard itself would detail requirements for reference measurements, likely involving trained technicians for auscultatory methods in clinical trials, but these details are not provided here for this specific device's evaluation.

4. Adjudication Method for the Test Set

Not applicable, as no human clinical test set with adjudicated ground truth is described.

5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This device is a digital blood pressure monitor, not an AI-assisted diagnostic imaging device with human readers.

6. If a Standalone (i.e. algorithm only without human-in-the loop performance) was done

Yes, in a sense. The testing performed was for the device itself (algorithm + hardware) to meet engineering and performance standards (AAMI SP-10) without human interpretation in a diagnostic context. The document confirms it "is not clinically tested," meaning it was evaluated as a standalone product adhering to technical standards.

7. The Type of Ground Truth Used (expert consensus, pathology, outcomes data, etc.)

For the technical tests conducted according to AAMI SP-10 (e.g., pressure indicator accuracy, overall system efficacy using auscultatory method as reference), the implied ground truth would be:

  • Engineering Reference Standards: For many of the technical sections (e.g., voltage range, storage conditions, cuff pressure).
  • Auscultatory Method: Specifically mentioned as the "reference standard" for "Overall system efficacy" (Section 4.4.2.1), which is the standard clinical method for validating automated blood pressure devices.

8. The Sample Size for the Training Set

Not applicable. This device does not appear to use a machine learning or AI model that requires a "training set" in the typical sense. Its performance relies on fixed algorithms and hardware, which are compared against established standards.

9. How the Ground Truth for the Training Set was Established

Not applicable, as there is no mention of a machine learning model or a training set.

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MAR 1 9 2004

K040229/S1
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Attachment (D) 510(k) Summary

DATE PREPARED 1.

July 29, 2003

2. SPONSOR INFORMATION

A&D Engineering, Inc. Mr. Jerry Wang 1555 McCandless Drive, Milpitas, CA 95035 Tel: 408-518-5113 Fax: 408-635-2313 Email: jwang(@andmedical.com

3. DEVICE NAME

Proprietary Name:A&D LifeSource UB-328 Digital Blood Pressure Monitor
Common/Usual Name:Blood Pressure Monitor
Classification name:Non-invasive blood pressure measurement System21 CFR 870-1130, Class II, 74DXN.

DEVICE DESCRIPTION AND INTENDED USE 4.

The A&D LifeSource UB-328 digital blood pressure monitor is intended for use by adults for measuring the systolic and diastolic blood pressure and pulse rate.

PREDICATE DEVCIE ਨ.

It is substantially equivalent to the following three devices: A&D UB-401, FDA 510(k) K002115. Issued on July 25, 2000

A&D UA-787, FDA 510(k) K012472. Issued on Feb. 15, 2002

TECHNOLOGICAL CHARACTERISTECS 6.

UB-328 uses an inflated cuff which is wrapped around the upper wrist. The cuff is inflated automatically by the air pump. The systolic and diastolic blood pressures are

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K040229/51
page 2 of 2

determined by oscillometric method. The deflation rate is controlled by a preset mechanical valve at a constant rate. The pressure of the cuff is completely released automatically at the end of the measurement. At the same time, the measurements are displayed on the LCD display for one minute. After one minute without operation, UB-328 turns off automatically. UB-328 measures blood pressure and pulse rate even when an irregular heartbeat occurs.

DEVICE TESTING 7.

A&D LifeSource UB-328 digital blood pressure monitor meets NIST/AAMI SP-10 standard and FDA guidance 'Non-invasive Blood Pressure (NIBP) Monitor Guidance". Please refer to the table below for the list of AAMI SP-10 tests. UB-328 is not clinically tested. It uses the identical software codes and pressure detection related hardware as the predicate devices to determine systolic, diastolic, and pulse rate.

SP-10Section #Section TitleTest Results &Comments
4.1.1GeneralConformed
4.1.2.1Device labelingConformed
4.1.2.2Outer containerConformed
4.1.3Information manualConformed
4.1.4.1Component replacementConformed
4.1.4.2Power system labelingConformed
4.1.4.3Labeling for battery-powered devicesConformed
4.2.1Storage conditionsConformed
4.2.2Operating conditionsConformed
4.2.3Vibration and shockConformed
4.2.4.1Voltage rangeConformed
4.2.4.2LifeConformed
4.3.1.1Maximum cuff pressureConformed
4.3.1.2Cuff deflationConformed
4.3.2Electrical safetyConformed
4.3.3Conductive componentsConformed
4.4.1Pressure indicator accuracyConformed
4.4.2Overall system efficacyConformed
4.4.2.1Auscultatory method as the reference standardConformed
4.4.2.2Intra-aeterial method as the reference standardNot applicable
4.4.3Battery-powered devicesConformed
4.5Requirements for devices with manual inflation systemsConformed

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Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAR 1 9 2004

A&D Engineering, Inc. c/o Mr. Jerry Wang Director of Engineering & QA 1555 McCandless Drive Milpitas, CA 95035

K040229 Re:

Trade Name: A&D Lifesource UB-328 Digital Blood Pressure Monitor Regulation Number: 21 CFR 870.1130 Regulation Name: Noninvasive Blood Pressure Measurement System Regulatory Class: II (two) Product Code: 74 DXN Dated: January 30, 2004 Reccived: February 02, 2004

Dear Mr. Wang:

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.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complics with other requirements of the Act

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Page 2 -- Mr. Jerry Wang

or any Federal statutes and regulations administered by other Federal agencies. You must or any I catales and 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 Of It Fat 8017; accems (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. product thankled on begin marketing your device as described in your Section 510(k) I mis letter will and in yourse of substantial equivalence of your device to a legally promance notifications of caresults 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 11 you abon office of Compliance at (301) 594-4648. 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 other general minimational and Consumer Assistance at its toll-frec number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Ashley B. Beane

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

Director

Enclosure

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Indications for Use

510(k) Number (if known):__K040229

Device Name: _A&D Medical LifeSource UB-328 Digital Blood Pressure Monitor

Indications For Use:

Measure blood pressure (systolic and diastolic) and pulse rate.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use __ (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Ashley B. Evans

510(K) Number K040229 (SM. IQ

Page 1 of -

§ 870.1130 Noninvasive blood pressure measurement system.

(a)
Identification. A noninvasive blood pressure measurement system is a device that provides a signal from which systolic, diastolic, mean, or any combination of the three pressures can be derived through the use of tranducers placed on the surface of the body.(b)
Classification. Class II (performance standards).