K Number
K053054
Device Name
THROMBIX 3X3 HEMOSTATIC PAD
Date Cleared
2005-11-23

(23 days)

Product Code
Regulation Number
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Thrombix 3X3 pad is applied topically and is indicated as a trauma dressing for temporary control of moderate to severely bleeding wounds and for the control of surface bleeding from vascular access sites and percutaneous catheters or tubes.
Device Description
The Thrombix 3x3 hemostatic pad consists of a lyophilized pad containing thrombin, sodium carboxymethylcellulose, and calcium chloride in a non-woven gauze.
More Information

Not Found

No
The device description and performance studies focus on the chemical and physical properties of a hemostatic pad, with no mention of AI or ML.

No.
The device is a hemostatic pad used for temporary control of bleeding from wounds and vascular access sites, which is a short-term, acute care application, not a therapeutic treatment for a disease or condition.

No
The device is described as a "trauma dressing" for "temporary control of moderate to severely bleeding wounds," which indicates a therapeutic rather than diagnostic function. It is used to stop bleeding, not to identify or measure a medical condition.

No

The device description clearly states it is a "lyophilized pad containing thrombin, sodium carboxymethylcellulose, and calcium chloride in a non-woven gauze," indicating a physical, hardware-based medical device.

Based on the provided information, the Thrombix 3X3 pad is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states it is applied topically to control bleeding wounds and surface bleeding from vascular access sites. This is a direct application to the body for therapeutic purposes.
  • Device Description: The description details a pad containing substances that interact with blood in situ (on the body) to promote clotting.
  • Lack of IVD Characteristics: IVDs are used to examine specimens (like blood, urine, tissue) outside the body to provide information for diagnosis, monitoring, or screening. The Thrombix 3X3 pad does not perform this function.

Therefore, the Thrombix 3X3 pad is a hemostatic device used for topical application, not an in vitro diagnostic.

N/A

Intended Use / Indications for Use

The Thrombix 3X3 pad is applied topically and is indicated as a trauma dressing for temporary control of moderate to severely bleeding wounds and for the control of surface bleeding from vascular access sites and percutaneous catheters or tubes.

Product codes

QSX, FRO

Device Description

The Thrombix 3x3 hemostatic pad consists of a lyophilized pad containing thrombin, sodium carboxymethylcellulose, and calcium chloride in a non-woven gauze.

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 conducted included assessment of the potlife of the pad after addition of up to 10 mls of saline.

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

Not Found

Predicate Device(s)

K040510, K050511

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

N/A

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: on the left, there is a symbol representing the Department of Health & Human Services USA, and on the right, there is the text "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue. The FDA logo is a symbol of the agency's mission to protect and promote public health through the regulation and supervision of food safety, tobacco, pharmaceuticals, medical devices, and other related products.

February 10, 2023

Vascular Solutions, Inc. Linda Busklein Senior Regulatory Affairs Associate 6464 Sycamore Court Minneapolis, Minnesota 55369

Re: K053054

Trade/Device Name: Thrombix 3x3 hemostatic pad Regulatory Class: Unclassified Product Code: QSX

Dear Linda Busklein:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated November 23, 2005. Specifically, FDA is updating this SE Letter because FDA has better categorized your device technology under product code QSX.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact Julie Morabito, OHT4: Office of Surgical and Infection Control Devices, 240-402-3839, Julie.Morabito@fda.hhs.gov.

Sincerely,

Julie A. Morabito -S

Julie Morabito, Ph.D. Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

1

Image /page/1/Picture/1 description: The image shows the seal of the Department of Health and Human Services (HHS) of the United States. The seal features a stylized eagle with its wings spread, symbolizing protection and service. The words "DEPARTMENT OF HEALTH AND HUMAN SERVICES. USA" are arranged in a circular pattern around the eagle, indicating the department's name and national affiliation. The seal is simple and monochromatic.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 2 3 2005

Linda Busklein Senior Regulatory Affairs Associate Vascular Solutions, Inc. 6464 Sycamore Court Minneapolis, Minnesota 55369

Re: K053054

Trade/Device Name: Thrombix 3x3 hemostatic pad Regulatory Class: Unclassified Product Code: FRO Dated: October 28, 2005 Received: November 4, 2005

Dear Ms. Busklein:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your becamed the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for ass black in the May 28, 1976, the enactment date of the Medical Device Amendments, or to connineroo price to 1125 2011 devices that have been require approval of a premarket approval application (PMA). and Cosmetic Plov (10) 110, 100 (10) 100 ) 100 ) 100 general controls provisions of the Act. The I ou may, dierely mains 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 may or subject to 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 complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must or any reath 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.

2

Page 2- Linda Busklein

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 (240) 276-0115. 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/industry/support/index.html.

Sincerely yours,

Barbara Buchner

Mark N. Melkerson Acting Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Indications for Use Statement

510(k) Number:

KUS3054

Device Name:

Thrombix 3x3 hemostatic pad

Indications for Use:

The Thrombix 3X3 pad is applied topically and is indicated as a trauma dressing for temporary control of moderate to severely bleeding wounds and for the control of surface bleeding from vascular access sites and percutaneous catheters or tubes.

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

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Harbare Buchm
(Division Sign-Off)

Division of General, Restorative, and Neurological Devices

Page 1 of __

510(k) Number K053054

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K053054

page 1/1

NOV 2 3 2005

510(K) SUMMARY

Common/Usual Name:Topical Hemostatic
Product Trade Name:Thrombix 3x3 hemostatic pad
Classification Name:Unclassified, Product Code FRO
Manufacturer:Vascular Solutions, Inc.
6464 Sycamore Court
Minneapolis, Minnesota 55369
Establishment Registration:2134812
Contact:Linda Busklein
Sr. Regulatory Affairs Associate
(763) 656-4349 phone
(763) 656-4250 fax
Performance Standards:No performance standards have been developed under
section 514 for this device.
Device Description:The Thrombix 3x3 hemostatic pad consists of a lyophilized
pad containing thrombin, sodium carboxymethylcellulose,
and calcium chloride in a non-woven gauze.
Intended Use:The Thrombix 3X3 pad is applied topically and is indicated
as a trauma dressing for temporary control of moderate to
severely bleeding wounds and for the control of surface
bleeding from vascular access sites and percutaneous
catheters or tubes.
Summary of Non-Clinical Testing:Tests conducted included assessment of the potlife of the
pad after addition of up to 10 mls of saline.
Predicate Devices:D-Stat Dry 3x3 hemostatic pad (K040510)
ThrombiGel thrombin/gelatin foam hemostat (K050511)
Conclusions:The Thrombix 3x3 hemostatic pad is substantially
equivalent to the currently marketed D-Stat Dry 3x3
hemostatic pad and the ThrombiGel thrombin/gelatin foam
hemostat, based on a comparison of the indications for use
and the technological characteristics of the device.

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