K Number
K061367
Device Name
BLUESKY VISTA WOUND VACUUM SYSTEM, MODEL 100.0500
Date Cleared
2006-08-10

(86 days)

Product Code
Regulation Number
878.4780
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The BlueSky VISTA™ Wound Vacuum System is indicated for patients who would benefit from a suction device particularly as the device may promote wound healing.
Device Description
The product is a portable suction pump that may promote wound healing when used with accessory wound sealing kits.
More Information

Not Found

No
The summary describes a standard wound vacuum system and does not mention any AI or ML capabilities.

Yes
The device is indicated for patients who would benefit from a suction device, particularly as it may promote wound healing, which is a therapeutic effect.

No
The provided text does not state that the device is used for diagnosis. It is described as a "suction device" that "may promote wound healing." The "Intended Use / Indications for Use" section focuses on its therapeutic function for wound healing rather than diagnostic capabilities.

No

The device description explicitly states it is a "portable suction pump," which is a hardware component, not software only.

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

Here's why:

  • Intended Use/Indications for Use: The description clearly states the device is a "suction device" used to "promote wound healing." This is a therapeutic application, not a diagnostic one.
  • Device Description: It's described as a "portable suction pump" used with "accessory wound sealing kits." This aligns with a wound care device, not a device that analyzes biological samples.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, disease, or condition based on sample analysis.
    • Using reagents or assays.

The device's function is to apply suction to a wound, which is a physical intervention aimed at promoting healing, not a diagnostic test.

N/A

Intended Use / Indications for Use

The BlueSky VISTA™ Wound Vacuum System is indicated for patients who would benefit from a suction device particularly as the device may promote wound healing.

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

BTA, OMP

Device Description

The product is a portable suction pump that may promote wound healing when used with accessory wound sealing kits.

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)

Performance testing and device comparison demonstrates that the subject device is substantially equivalent to the predicate device, and is safe and effective for the intended use.

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.

K042134, K052456

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

§ 878.4780 Powered suction pump.

(a)
Identification. A powered suction pump is a portable, AC-powered or compressed air-powered device intended to be used to remove infectious materials from wounds or fluids from a patient's airway or respiratory support system. The device may be used during surgery in the operating room or at the patient's bedside. The device may include a microbial filter.(b)
Classification. Class II.

0

K061367

510(k) Summary

AUG 1 0 2006

General Information
Submitters Name/Address:BlueSky Medical Group, Inc.
5924 Balfour Ct., Suite 102
Carlsbad, CA 92008
Establishment Registration Number:2032666
Contact Person:Jasper Benke
Phone Number:(760) 603-8130
Date Prepared:May 1, 2006
Device Description
Trade Name:BlueSky VISTA™ Wound Vacuum
System
Generic/Common Name:Suction Pump and Accessories
Classification Name:Powered Suction Pump (21 CFR
878.4780, Product Code BTA)

Predicate Device Information

Versatile 1™ Wound Vacuum System cleared originally in K042134 (November 15, 2004) and amended in K052456 (November 4, 2005).

Product Description

The product is a portable suction pump that may promote wound healing when used with accessory wound sealing kits.

Intended Use

The BlueSky VISTA™ Wound Vacuum System is indicated for patients who would benefit from a suction device particularly as the device may promote wound healing.

Substantial Equivalence

In establishing substantial equivalence to the predicate device, BlueSky Medical evaluated the indications for use, materials, technology, product specifications, and energy requirements of the system. Performance testing has been completed to demonstrate the safe and effective use of the BlueSky VISTA™ Wound Vacuum System for the intended use.

Summary of Safety and Effectiveness

Performance testing and device comparison demonstrates that the subject device is substantially equivalent to the predicate device, and is safe and effective for the intended use.

1

Image /page/1/Picture/1 description: The image contains the words "Public Health Service" in bold, black font. The words are stacked on top of each other, with "Public Health" on the top line and "Service" on the bottom line. The text appears to be extracted from a document or sign.

Image /page/1/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle or bird-like symbol with three curved lines forming its body and wing. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the symbol.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR - 7 2009

Smith & Nephew, Inc. % Ms. Laura Krejci 970 Lake Carillon Drive, Suite 110 St. Petersburg, Florida 33716

Re: K061367

Trade/Device Name: BlueSky VISTA™ Wound Vacuum System Regulation Number: 21 CFR 878.4780 Regulation Name: Powered Suction Pump Regulatory Class: II Product Code: OMP Dated: June 15, 2006 Received: June 19, 2006

Dear Ms. Krejci:

This letter corrects our substantially equivalent letter of August 10, 2006.

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 (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 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 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

2

Page 2 - Ms. Laura Krejci

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 continue 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). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at (240) 276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at (240) 276-3464. 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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours.

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

Enclosure

3

Indications for Use

K061367 510(k) Number:

BlueSky VISTA™ Wound Vacuum System Device Name:

Indications for Use:

The BlueSky VISTA™ Wound Vacuum System is indicated for patients who would benefit from a suction device particularly as the device may promote wound healing.

Prescription Use X (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)

Hulu Leven
(Division Sign-Off)

Division of General, Restorative, Page 1 of _ and Neurological Devices

510(k) Number K04367