K Number
K061974
Device Name
GEM PREMIER 4000 WITH IQM, MODEL 4000; GEM CVP 1 AND 2 WITH CO-OX; GEM CVP 3 AND 4 HEMATOCRIT
Date Cleared
2006-09-15

(65 days)

Regulation Number
862.1120
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2, pO2, Na+, K+, Cl-, Ca++, glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity. Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iQM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls. As part of this program, GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartridge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.
Device Description
The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2 pO2, Na . K , CI , Ca * , glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity. Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iOM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls. As part of this program, GEM CVP 1 and 2 (Calibration Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartidge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.
More Information

Not Found

No
The description of "Intelligent Quality Management (iQM)" focuses on automated process control, error detection, and correction based on predefined criteria and calibration, which are typical features of traditional automated systems and do not inherently indicate the use of AI or ML. There is no mention of learning from data, adaptive algorithms, or other characteristics commonly associated with AI/ML.

No
This device is an analytical instrument that measures various parameters in whole blood samples, aiding in diagnosis. It does not provide any treatment or therapy.

Yes

The "Intended Use / Indications for Use" section explicitly states that the parameters measured by the device "aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity." This indicates its role in the diagnostic process.

No

The device description clearly states it is a "portable critical care system" and an "instrument" that performs quantitative measurements of blood parameters. This indicates a physical hardware component is central to the device's function, not just software.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Analyzes biological samples: The device analyzes "whole blood samples."
  • Provides quantitative measurements: It provides "quantitative measurements of pH, pCO2, pO2, Na+, K+, Cl-, Ca++, glucose, lactate, hematocrit and CO-Oximetry."
  • Aids in diagnosis: The parameters measured "aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity."
  • Used in a clinical setting: The intended use specifies it's for use "at the point of health care delivery in a clinical setting and in a central laboratory."

These characteristics align with the definition of an In Vitro Diagnostic device, which is used to examine specimens derived from the human body to provide information for the diagnosis, prevention, or treatment of disease or for the assessment of health.

N/A

Intended Use / Indications for Use

The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2, pO2, Nat, K+, Cl , Ca+, glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity.

Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iQM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls.

As part of this program, GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartridge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.

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

CHL, JGS, CEM, JFP, CGZ, CGA, KHP, GKF, GHS, GKR, JJY, GLK

Device Description

The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2 pO2, Na . K , CI , Ca * , glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity.

Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iOM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls.

As part of this program, GEM CVP 1 and 2 (Calibration Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartidge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.

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

health care professionals / point of health care delivery in a clinical setting and in a central laboratory.

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)

In-house and field site testing supports that the GEM Premier 4000 with iOM in conjunction with GEM CVP 1 and 2 with CO-Ox and GEM CVP 3 and 4 Hematocrit is not materially different from the above listed predicate devices in performance, safety and effectiveness or 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.

K052121, K963800, K945677

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

§ 862.1120 Blood gases (P

CO2 , PO2 ) and blood pH test system.(a)
Identification. A blood gases (PCO2 , PO2 ) and blood pH test system is a device intended to measure certain gases in blood, serum, plasma or pH of blood, serum, and plasma. Measurements of blood gases (PCO2 , PO2 ) and blood pH are used in the diagnosis and treatment of life-threatening acid-base disturbances.(b)
Classification. Class II.

0

K061974

510(k) Summary GEM Premier 4000 with iQM and GEM CVP

Submitted by:

Instrumentation Laboratory Co. 113 Hartwell Avenue Lexington, MA 02421

Contact Person:

Carol Marble, Regulatory Affairs Director 781-861-4467 Phone: 781-861-4207 Fax: cmarble@qa.ilww.com E-mail:

Summary Prepared:

July 11, 2006

Device Trade Names:

  • GEM® Premier 4000 with iQM® (Intelligent Quality Management) .
  • GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox .
  • GEM CVP 3 and 4 (Calibration Valuation Product) Hematocrit .

Regulatory Information:

  • GEM Premier 4000 with iQM (Intelligent Quality Management) .
DescriptionCFR SectionDevice ClassProduct Code
Blood gases and blood pH862.1120Class IICHL
Sodium test system862.1665Class IIJGS
Potassium test system862.1600Class IICEM
Calcium test system862.1145Class IIJFP
Chloride test system862.1170Class IICGZ
Glucose test system862.1345Class IICGA
Lactic acid test system862.1450Class IKHP
Automated hematocrit instrument864.5600Class IIGKF
Carboxyhemoglobin assay864.7425Class IIGHS
Automated hemoglobin system864.5620Class IIGKR
  • GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox .
DescriptionCFR SectionDevice ClassProduct Code
Quality Control Material862.1660Class IJJY

GEM CVP 3 and 4 (Calibration Valuation Product) Hematocrit .

DescriptionCFR SectionDevice ClassProduct Code
Hematocrit Control864.8625Class IIGLK

Section 5

SEP 15 2006

Page 1 of 2

1

510(k) Summary GEM Premier 4000 with iQM and GEM CVP

Predicate Devices:

Description510(k)Analytes
GEM 3000 with iQM and GEM CVPK052121pH, blood gases, electrolytes (except chloride), glucose, lactate, hematocrit
IL Synthesis with traditional QCK963800Chloride
IL 682 CO-Oximeter with traditional QCK945677CO-Oximeter parameters

Device Description and Indications for Use:

The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2 pO2, Na . K , CI , Ca * , glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity.

Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iOM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls.

As part of this program, GEM CVP 1 and 2 (Calibration Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartidge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.

Statement of Technological Characteristics of the Device Compared to Predicate Device:

In-house and field site testing supports that the GEM Premier 4000 with iOM in conjunction with GEM CVP 1 and 2 with CO-Ox and GEM CVP 3 and 4 Hematocrit is not materially different from the above listed predicate devices in performance, safety and effectiveness or intended use. The operating principles for the different analytes are the same between the GEM Premier 4000 and the predicates:

Operating PrincipleAnalyte(s)
PotentiometricpH, pCO2, Na+, K+, Cl-, Ca++
AmperometricpO2, Glucose, Lactate
ConductivityHematocrit
SpectrophotometryCO-Oximeter parameters

Page 2 of 2

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized depiction of an eagle with its wings spread, rendered in a thick, black line. The eagle is positioned to the right of a circular arrangement of text. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" and is arranged around the upper half of the circle.

Public Health Service

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Ms. Carol Marble Regulatory Affairs Director Instrumentation Laboratory Co. 113 Hartwell Avenue Lexington, MA 02421

SEP 1 5 2006

K061974 Re:

Trade/Device Name: GEM® Premier 4000 with iQM® (Intelligent Quality Management) GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox GEM CVP 3 and 4 (Calibration Valuation Product) Hematocrit Regulation Number: 21 CFR 862.1120 Regulation Name: Blood gases (Pco2, Po2) and blood Ph test system Regulatory Class: Class II Product Code: CHL, JGS, CEM, JFP, CGZ, CGA, KHP, GKF, GHS, GKR, JJY, GLK, GLY Dated: July 11, 2006 Received: July 12, 2006

Dear Ms. Marble:

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 Title 21. Code of Federal Regulations (CFR), Parts 800 to 895. 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 limited to: registration and listing (21

3

Page 2 -

CFR Part 807); labeling (21 CFR Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820).

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 information about the application of labeling requirements to your device, or questions on the promotion and advertising of your device, please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (240) 276-0484. 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,

Carol C. Benson for

Alberto Gutierrez, Ph.D. Director Division of Chemistry and Toxicology Center for Devices and Radiological Health

Enclosure

4

Indications for Use Statement

510(k) Number (if known): K061974

GEM® Premier 4000 with iQM® (Intelligent Quality Management) Device Name: GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox GEM CVP 3 and 4 (Calibration Valuation Product) Hematocrit

Indications for Use:

The GEM Premier 4000 is a portable critical care system for use by health care professionals to rapidly analyze whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of pH, pCO2, pO2, Nat, K+, Cl , Ca+, glucose, lactate, hematocrit and CO-Oximetry (tHb, O2Hb, MetHb, HHb) parameters. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance and oxygen delivery capacity.

Intelligent Quality Management (iQM) is used as the quality control and assessment system for the GEM Premier 4000 system. iQM is an active quality process control program designed to provide continuous monitoring of the analytical process with real-time, automatic error detection, automatic correction of the system and automatic documentation of all corrective actions, replacing the use of traditional external quality controls.

As part of this program, GEM CVP 1 and 2 (Calibration Valuation Product) with CO-Ox and GEM CVP 3 and 4 Hematocrit are external solutions intended to complete the calibration process and final accuracy assessment of the iQM cartridge calibration after initial warm-up. The reported values for the four levels of GEM CVP (two levels for pH, blood gases, electrolytes, metabolites and CO-Oximetry; two levels for hematocrit) must meet specifications before the iQM cartridge can be used for patient sample measurements. Once the cartridge calibration is verified, the internal iQM program monitors the status of the system during the cartridge use life.

で Over-The-Counter Use Prescription Use _____________________________________________________________________________________________________________________________________________________________ AND/OR (21 CFR 807 Subpart C) (Part 21 CFR 801 Subpart D)

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

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

Amy Daugherty for Carol Benson
Division Sign-Off

Office of In Vitro Diagnostic Device Evaluation and Safety

K061974

Section 4

GEM Premier 4000 with iQM and GEM CVP 510(k)