K Number
K062605
Device Name
PHILIPS SPO2 REUSABLE SENSOR, MODELS M1196A AND M1196T
Date Cleared
2006-11-09

(65 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The M1196A and M1196T reusable Clip sensors provide continuous, non-invasive measurement of arterial oxygen saturation (pulse rate signal and plethysmograph wave) to any SpO2 device that has passed validation testing. Either sensor can be comfortably clipped onto the finger of patients weighing > 40 kg (typically adult patients).
Device Description
The Philips SpO2 devices measure, non-invasively, the arterial oxygen saturation of blood. The measurement method is based on the red and infrared light absorption of hemoglobin and oxyhemoglobin. Light of a red and infrared light source is emitted through human tissue and received by a photodiode. The measurement is based on the absorption of light, which is emitted through human tissue (for example through the index finger). The light comes from two sources (red LED and infrared LED) with different wavelengths and is received by a photodiode. Out of the different absorption behavior of the red and infrared light a so-called Ratio can be calculated. The saturation value is defined by the percentage ratio of the oxygenated hemoglobin [HbO2] to the total amount of hemoglobin [Hb]. SpO2 = [HbO2]/([Hb]+[HbO2]) Out of calibration curves, which are based on controlled hypoxia studies with healthy non-smoking adult volunteers over a specified saturation range (SaO2 from 100%-70%), the Ratio can be related to a SpO2 value. The devices contain a red and infrared light source and a photodiode receiving the non-absorbed red and infrared light. The received signals are forwarded to a measurement device that amplifies the acquired signal and an algorithm that calculates the ratio and converts via a validated calibration table the ratio to a saturation value.
More Information

Not Found

No
The description details a standard pulse oximetry device based on light absorption and a calibration table, with no mention of AI or ML algorithms.

No.

The device measures physiological parameters (arterial oxygen saturation and pulse rate) but does not deliver any therapy or treatment.

Yes

The device provides "continuous, non-invasive measurement of arterial oxygen saturation," which is a physiological parameter used in diagnosing and monitoring patient conditions. It measures blood oxygen levels, a crucial diagnostic indicator.

No

The device description explicitly mentions hardware components (red and infrared light source, photodiode) and describes hardware verification testing.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens taken from the human body (like blood, urine, or tissue) to provide information about a person's health. This testing is done outside of the body.
  • Device Function: The description clearly states that the M1196A and M1196T sensors provide continuous, non-invasive measurement of arterial oxygen saturation by clipping onto the finger. This measurement is performed on the body, not on a specimen taken from the body.
  • Measurement Method: The method described involves emitting light through tissue and receiving it with a photodiode, which is a non-invasive technique.

Therefore, based on the provided information, this device falls under the category of a non-invasive medical device used for physiological monitoring, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The M1196A and M1196T reusable Clip sensors provide continuous, non-invasive measurement of arterial oxygen saturation (pulse rate signal and plethysmograph wave) to any SpO2 device that has passed validation testing. Either sensor can be comfortably clipped onto the finger of patients weighing > 40 kg (typically adult patients).

Product codes

DQA

Device Description

The Philips SpO2 devices measure, non-invasively, the arterial oxygen saturation of blood. The measurement method is based on the red and infrared light absorption of hemoglobin and oxyhemoglobin. Light of a red and infrared light source is emitted through human tissue and received by a photodiode.

The measurement is based on the absorption of light, which is emitted through human tissue (for example through the index finger). The light comes from two sources (red LED and infrared LED) with different wavelengths and is received by a photodiode. Out of the different absorption behavior of the red and infrared light a so-called Ratio can be calculated. The saturation value is defined by the percentage ratio of the oxygenated hemoglobin [HbO2] to the total amount of hemoglobin [Hb].

SpO2 = [HbO2]/([Hb]+[HbO2])

Out of calibration curves, which are based on controlled hypoxia studies with healthy non-smoking adult volunteers over a specified saturation range (SaO2 from 100%-70%), the Ratio can be related to a SpO2 value.

The devices contain a red and infrared light source and a photodiode receiving the non-absorbed red and infrared light. The received signals are forwarded to a measurement device that amplifies the acquired signal and an algorithm that calculates the ratio and converts via a validated calibration table the ratio to a saturation value.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

finger

Indicated Patient Age Range

Adults (patients weighing > 40 kg)

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)

Testing involved environmental and clinical evaluations for accuracy. Hardware verification testing and cable interface verification testing were also conducted. Design verification and validation test results confirmed that the device is substantially equivalent with the identified predicate devices.

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

Not Found

Predicate Device(s)

K882609, K990972, K000822, K030973, K032979

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

NOV ~ 9 2006

Special 510(k) Premarket Notification
SpO2 Pulse Oximeter Sensor - Model Nos. M1196A and M1196T

K062605

PHILIPS Medical Systems

510(k) Summary (As required by 21 C.F.R. §807.92)

| Submitted by: | Philips Medical Systems, Inc.
Ultrasound and Monitoring Division / Patient Monitoring Supplies
3000 Minuteman Road
Andover, MA 01810-1099 | | |
|---------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------|--|
| Company Contact: | Mr. Rich McCleary
Senior Manager of Quality and Regulatory Affairs
Tel: (978) 659-4914 | | |
| Date of Summary: | August 31, 2006 | | |
| Device Name | Philips Reusable SpO2 Sensor,
Models M1196A and M1196T | | |
| Common Name | SpO2 pulse oximeter sensor | | |
| Classification Name | Classification Name: | Oximeter | |
| | Regulation Number: | 21 C.F.R §870.2700 | |
| Predicate Device | Philips Medical System Adult SpO2 sensor, model # M1191A
Cleared for marketing via FD&C Act §510(k)# K882609, K990972,
K000822, K030973 and K032979. | | |
| Modifications | The modification involves a change from a soft cuff style to a clip
style housing design to facilitate attachment and removal from a
patient's finger. | | |

1

Device Description

The Philips SpO2 devices measure, non-invasively, the arterial oxygen saturation of blood. The measurement method is based on the red and infrared light absorption of hemoglobin and oxyhemoglobin. Light of a red and infrared light source is emitted through human tissue and received by a photodiode.

The measurement is based on the absorption of light, which is emitted through human tissue (for example through the index finger). The light comes from two sources (red LED and infrared LED) with different wavelengths and is received by a photodiode. Out of the different absorption behavior of the red and infrared light a so-called Ratio can be calculated. The saturation value is defined by the percentage ratio of the oxygenated hemoglobin [HbO2] to the total amount of hemoglobin [Hb].

SpO2 = [HbO2]/([Hb]+[HbO2])

Out of calibration curves, which are based on controlled hypoxia studies with healthy non-smoking adult volunteers over a specified saturation range (SaO2 from 100%-70%), the Ratio can be related to a SpO2 value.

The devices contain a red and infrared light source and a photodiode receiving the non-absorbed red and infrared light. The received signals are forwarded to a measurement device that amplifies the acquired signal and an algorithm that calculates the ratio and converts via a validated calibration table the ratio to a saturation value.

Intended Use

Technological characteristics

Testing

The M1196A and M1196T reusable Clip sensors provide continuous, non-invasive measurement of arterial oxygen saturation (pulse rate signal and plethysmograph wave) to any Sp02 device that has passed validation testing. Either sensor can be comfortably clipped onto the finger of patients weighing > 40 kg (typically adult patients).

The Philips Reusable SpO2 Sensors have the same technological characteristics as the legally marketed predicate devices.

Verification and validation testing activities were conducted to establish the performance and reliability characteristics of the modified device.

Testing involved environmental and clinical evaluations for accuracy. Hardware verification testing and cable interface verification testing were also conducted. Design verification and validation test results confirmed that the device is substantially equivalent with the identified predicate devices.

2

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 eagle or bird-like symbol with three curved lines forming its body and wings. To the left of the symbol, 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

NOV - 9 2006

Mr. Rich McCleary Senior Manager of Quality and Regulatory Affairs Philips Medical Systems, Incorporated Ultrasound and Monitoring Division/Patient Monitoring Supplies 3000 Minuteman Road Andover, Massachusetts 01810-1099

Re: K062605

Trade/Device Name: Philips SpO2 Reusable Clip Sensors Models M1196A and M1196T Regulation Number: 21 CFR 870.2700 Regulation Name: Oximeter Regulatory Class: II Product Code: DQA Dated: October 10, 2006 Received: October 11, 2006

Dear Mr. McCleary:

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.

3

Page 2 - Mr. McCleary

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 (240) 276-0120. 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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

hereby state,

Shule H. Murphy, MD for C. Lin, Ph.D.

Chiu Lin. Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): K062605

| Device Name: | Philips SpO2 Reusable Clip Sensors
Models M1196A and M1196T |
|----------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications For Use: | The M1196A and M1196T reusable Clip sensors provide
continuous, non-invasive measurement of arterial oxygen
saturation (pulse rate signal and plethysmograph wave) to
any SpO2 device that has passed validation testing. Either
sensor can be comfortably clipped onto the finger of patients
weighing > 40 kg (typically adult patients). |

Prescription Use
(Part 21 CFR 801 Subpart D)

Over-The-Counter Use _ (21 CFR 801 Subpart C)

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

AND/OR

Concurrence of CDRH, Office of Device Evaluation (ODE)

NIOM ்லா Sign-Oif)

f Anesthesiology, General Hospital,
Control, Dental Devices

E (0.10 Number:

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