K Number
K040802
Device Name
HEMOSONIC 200HEMODYNAMIC MONITOR
Manufacturer
Date Cleared
2004-04-28

(30 days)

Product Code
Regulation Number
862.3700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The HemoSonic™ 200 can be used to observe, diagnose, evaluate, and monitor at-risk patients from 15 to 150 kg by providing hemodynamic information for determining therapeutic actions and maintaining cardiovascular stability.
Device Description
The probe jacket contains the acoustic gel into which the ultrasound crystals are placed. It consists of a plug rod, tip cap, hub, body, acoustic gel and tip.
More Information

Not Found

No
The summary does not mention AI, ML, deep learning, or any related terms, nor does it describe any features or performance metrics typically associated with AI/ML-powered devices. The focus is on the physical components and basic performance testing.

No.
The device provides hemodynamic information for determining therapeutic actions and maintaining cardiovascular stability, but it does not perform the therapeutic actions itself. It is a diagnostic and monitoring device.

Yes
The "Intended Use / Indications for Use" section explicitly states that the device "can be used to observe, diagnose, evaluate, and monitor at-risk patients." The word "diagnose" directly indicates it is a diagnostic device.

No

The device description explicitly mentions physical components like a "probe jacket," "plug rod," "tip cap," "hub," "body," "acoustic gel," and "tip," indicating it is a hardware device.

Based on the provided information, the HemoSonic™ 200 is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use describes the device as being used to "observe, diagnose, evaluate, and monitor at-risk patients... by providing hemodynamic information". This is a description of a device used in vivo (within the living body) to gather physiological data directly from the patient.
  • Device Description: The description mentions a "probe jacket" containing "acoustic gel" and "ultrasound crystals". This is consistent with an ultrasound probe designed for direct contact with the patient's body.
  • Lack of IVD Characteristics: IVD devices are typically used to examine specimens (like blood, urine, tissue) outside the body to diagnose or monitor conditions. The provided information does not mention any analysis of biological specimens.

Therefore, the HemoSonic™ 200 is a device used for in vivo monitoring of hemodynamic parameters, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The HemoSonic™ 200 can be used to observe, diagnose, evaluate, and monitor at-risk patients from 15 to 150 kg by providing hemodynamic information for determining therapeutic actions and maintaining cardiovascular stability.

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

DPN

Device Description

The probe jacket contains the acoustic gel into which the ultrasound crystals are placed. It consists of a plug rod, tip cap, hub, body, acoustic gel and tip.

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)

Tests were performed to demonstrate substantial equivalence in the following areas:
• tensile strength,
• acoustic properties,
• simulated insertion, and
• biocompatibility.
The results of the laboratory tests demonstrate that the device is as safe and effective as the legally marketed predicate devices.

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.

K031153

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

§ 862.3700 Propoxyphene test system.

(a)
Identification. A propoxyphene test system is a device intended to measure propoxyphene, a pain-relieving drug, in serum, plasma, and urine. Measurements obtained by this device are used in the diagnosis and treatment of propoxyphene use or overdose or in monitoring levels of propoxyphene to ensure appropriate therapy.(b)
Classification. Class II (special controls). A propoxyphene test system is not exempt if it is intended for any use other than employment or insurance testing or is intended for Federal drug testing programs. The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9, provided the test system is intended for employment and insurance testing and includes a statement in the labeling that the device is intended solely for use in employment and insurance testing, and does not include devices intended for Federal drug testing programs (e.g., programs run by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Transportation (DOT), and the U.S. military).

0

K040802

APR 2 8 2004

510(k) Summary
Submitter:ARROW International, Inc.
2400 Bernville Road
Reading, PA 19605-9607 USA
Contact person:William G. McLain
Manager, Regulatory Affairs
Phone: 610-378-0131, ext. 3323
Fax: 610-478-3188
Email: bill.mclain@arrowintl.com
Date summary prepared:March 26, 2004
Device trade name:Probe Jacket for the HemoSonic™ 200 Hemodynamic Monitor.
Device common name:Sheath, Jacket or Sheath Jacket.
Device classification
name:FED; 21 CFR Part 876.1500; Sheath, for Endoscope
Legally marketed
devices to which the
device is substantially
equivalent:The predicate device is the jacket used in Arrow International, the
HemoSonic™ 200 Hemodynamic Monitor cleared under K031153.
Description of the
device:The probe jacket contains the acoustic gel into which the ultrasound
crystals are placed. It consists of a plug rod, tip cap, hub, body,
acoustic gel and tip.
Intended use of the
device:The probe jacket is an accessory to the HemoSonic™ 200
Hemodynamic Monitor.
Technological
characteristics:The proposed device has the same technological characteristics as
the predicate device(s).
Performance tests:Tests were performed to demonstrate substantial equivalence in the
following areas:
• tensile strength,
• acoustic properties,
• simulated insertion, and
• biocompatibility.
Conclusions:The results of the laboratory tests demonstrate that the device is as
safe and effective as the legally marketed predicate devices.

.

1

Image /page/1/Picture/1 description: The image is a black and white seal for the Department of Health & Human Services - USA. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the top half of the circle. In the center of the seal is an image of a stylized bird with three wing segments and a tail.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR 2 8 2004

Arrow International, Inc. c/o Mr. William G. McLain Manager, Regulatory Affairs 2400 Bernville Road Reading, PA 19605

Re: K040802

HemoSonic™M 200 Hemodynamic Monitor Regulation Number: 21 CFR 870.2100 Regulation Name: Cardiovascular Blood Flowmeter Regulatory Class: Class II (two) Product Code: ' DPN Dated: March 26, 2004 Received: March 29, 2004

Dear Mr. McLain:

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.

2

Page 2 - Mr. William G. McLain

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. 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,

Donna R. Vicinel

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

Enclosure

3

Indications for Use

510(k) Number (if known): ¥ 04 0 80 2

Device Name: HemoSonic™ 200 Hemodynamic Monitor

Indications For Use:

The HemoSonic™ 200 can be used to observe, diagnose, evaluate, and monitor at-risk patients from 15 to 150 kg by providing hemodynamic information for determining therapeutic actions and maintaining cardiovascular stability.

Prescription Use _X

AND/OR

Over-The-Counter Use

. . . . . . . .

(Part 21 CFR 801 Subpart D)

(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)

Dona R. La due

(Division Sign-Off) Division of Cardiovascular Devices

510(k) Number K040802