(262 days)
The Dual Lumen Short Term Hemodialysis and Extra Flow (EF) Short Term Hemodialysis catheters are indicated for use in hemodialysis, hemoperfusion and apheresis for short-term duration of less than 30 days via the subclavian, femoral or jugular vein.
The Joline D-Line Catheter ST family of catheters, consisting of the Dual Lumen Short Term Hemodialysis and Extra Flow (EF) Short Term Hemodialysis catheters are a polyurethane radiopaque catheter which allows for hemodialysis, hemoperfusion and apheresis. A crosssectional view of the shaft of the Joline D-Line Catheter ST catheters reveals a double "D" configuration -one "D" for the arterial lumen and the other for the venous lumen. In the Extra Flow (EF) Short Term design the venous lumen extends beyond the arterial lumen and terminates in a round tip. The Dual Lumen Short Term catheter has both lumens exiting together and incorporates side-holes along the shaft of the catheter body in its design. Two color-coded safety clamps, red and blue, identify arterial and venous extensions. lmportant information such as priming volume and catheter length is printed on both sides of the clamp. A swiveling suture ring is available to secure the catheter after placement. Two extensions merge into a tapered bifurcation joint or hub molded to the catheter body. These extensions can be straight, curved or curved-to-one-side. The finished kit consists of either the Dual Lumen Short Term Hemodialysis or Extra Flow ITIc Timenta Kit of Childers packaged with various accessory components. These components include: guidewire, introducer needle, dilator, and luer lock caps.
This document describes the 510(k) summary for the Joline D-Line Catheter ST family of catheters. The submission focuses on demonstrating substantial equivalence to predicate devices through engineering bench testing, rather than clinical performance based on metrics like sensitivity, specificity, or AUC. Therefore, many of the requested criteria related to clinical study design (sample size, expert ground truth, adjudication) are not applicable.
Here's an analysis based on the provided text:
1. Table of Acceptance Criteria and Reported Device Performance
| Acceptance Criteria Category | Specific Criteria (Implicit in Guidance Documents) | Reported Device Performance (Summary) |
|---|---|---|
| Biocompatibility | Compliance with ISO 10993 | "no major differences...in biocompatibility" (implies compliance through comparison to predicate) |
| Performance (Bench) | Flow rates, mechanical integrity, material properties (implied) | Demonstrated substantial equivalence through "engineering bench testing" to FDA guidance. |
| Safety | Material safety, structural integrity (implied) | "no major differences...in safety" (implies compliance through comparison to predicate) |
| Effectiveness | Ability to perform indicated function (implied) | "no major differences...in product effectiveness" (implies compliance through comparison to predicate) |
| Sterility | Compliance with relevant standards (implied) | Not explicitly mentioned but assumed for medical devices (implied by "Sterile, Single-Use" in ISO 10555 reference). |
| Design | Similar to predicate devices | "no major differences in design" and "demonstrated to be substantially equivalent...based on its design" |
| Materials | Similar to predicate devices | "no major differences in design, materials" |
2. Sample Size Used for the Test Set and Data Provenance
- Sample Size: Not applicable. The study was based on engineering bench testing, not clinical data with a "test set" of patients.
- Data Provenance: Not applicable. The data came from engineering laboratory tests, not patient data from specific countries or retrospective/prospective studies.
3. Number of Experts Used to Establish Ground Truth and Qualifications
- Not applicable. The study did not involve expert review of clinical cases to establish ground truth. Compliance was based on engineering data and comparison to predicate devices.
4. Adjudication Method for the Test Set
- Not applicable. No "test set" or clinical adjudication was performed.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- No. An MRMC comparative effectiveness study was not performed. The submission is for a medical device (catheter), not an AI/imaging diagnostic tool that would typically involve human reader performance.
6. Standalone (Algorithm Only) Performance Study
- Not applicable. This is a physical medical device, not a software algorithm.
7. Type of Ground Truth Used
- Engineering Specifications and Predicate Device Performance: The "ground truth" for this submission refers to established engineering standards (e.g., ISO 10555, ISO 10993) and the known performance characteristics of the legally marketed predicate devices. The new device's performance was compared against these established benchmarks.
8. Sample Size for the Training Set
- Not applicable. There was no "training set" as this was not an AI/machine learning study.
9. How the Ground Truth for the Training Set Was Established
- Not applicable. See point 8.
§ 876.5540 Blood access device and accessories.
(a)
Identification. A blood access device and accessories is a device intended to provide access to a patient's blood for hemodialysis or other chronic uses. When used in hemodialysis, it is part of an artificial kidney system for the treatment of patients with renal failure or toxemic conditions and provides access to a patient's blood for hemodialysis. The device includes implanted blood access devices, nonimplanted blood access devices, and accessories for both the implanted and nonimplanted blood access devices.(1) The implanted blood access device is a prescription device and consists of various flexible or rigid tubes, such as catheters, or cannulae, which are surgically implanted in appropriate blood vessels, may come through the skin, and are intended to remain in the body for 30 days or more. This generic type of device includes various catheters, shunts, and connectors specifically designed to provide access to blood. Examples include single and double lumen catheters with cuff(s), fully subcutaneous port-catheter systems, and A-V shunt cannulae (with vessel tips). The implanted blood access device may also contain coatings or additives which may provide additional functionality to the device.
(2) The nonimplanted blood access device consists of various flexible or rigid tubes, such as catheters, cannulae or hollow needles, which are inserted into appropriate blood vessels or a vascular graft prosthesis (§§ 870.3450 and 870.3460), and are intended to remain in the body for less than 30 days. This generic type of device includes fistula needles, the single needle dialysis set (coaxial flow needle), and the single needle dialysis set (alternating flow needle).
(3) Accessories common to either type include the shunt adaptor, cannula clamp, shunt connector, shunt stabilizer, vessel dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor, and declotting tray (including contents).
(b)
Classification. (1) Class II (special controls) for the implanted blood access device. The special controls for this device are:(i) Components of the device that come into human contact must be demonstrated to be biocompatible. Material names and specific designation numbers must be provided.
(ii) Performance data must demonstrate that the device performs as intended under anticipated conditions of use. The following performance characteristics must be tested:
(A) Pressure versus flow rates for both arterial and venous lumens, from the minimum flow rate to the maximum flow rate in 100 milliliter per minute increments, must be established. The fluid and its viscosity used during testing must be stated.
(B) Recirculation rates for both forward and reverse flow configurations must be established, along with the protocol used to perform the assay, which must be provided.
(C) Priming volumes must be established.
(D) Tensile testing of joints and materials must be conducted. The minimum acceptance criteria must be adequate for its intended use.
(E) Air leakage testing and liquid leakage testing must be conducted.
(F) Testing of the repeated clamping of the extensions of the catheter that simulates use over the life of the device must be conducted, and retested for leakage.
(G) Mechanical hemolysis testing must be conducted for new or altered device designs that affect the blood flow pattern.
(H) Chemical tolerance of the device to repeated exposure to commonly used disinfection agents must be established.
(iii) Performance data must demonstrate the sterility of the device.
(iv) Performance data must support the shelf life of the device for continued sterility, package integrity, and functionality over the requested shelf life that must include tensile, repeated clamping, and leakage testing.
(v) Labeling of implanted blood access devices for hemodialysis must include the following:
(A) Labeling must provide arterial and venous pressure versus flow rates, either in tabular or graphical format. The fluid and its viscosity used during testing must be stated.
(B) Labeling must specify the forward and reverse recirculation rates.
(C) Labeling must provide the arterial and venous priming volumes.
(D) Labeling must specify an expiration date.
(E) Labeling must identify any disinfecting agents that cannot be used to clean any components of the device.
(F) Any contraindicated disinfecting agents due to material incompatibility must be identified by printing a warning on the catheter. Alternatively, contraindicated disinfecting agents must be identified by a label affixed to the patient's medical record and with written instructions provided directly to the patient.
(G) Labeling must include a patient implant card.
(H) The labeling must contain comprehensive instructions for the following:
(
1 ) Preparation and insertion of the device, including recommended site of insertion, method of insertion, and a reference on the proper location for tip placement;(
2 ) Proper care and maintenance of the device and device exit site;(
3 ) Removal of the device;(
4 ) Anticoagulation;(
5 ) Management of obstruction and thrombus formation; and(
6 ) Qualifications for clinical providers performing the insertion, maintenance, and removal of the devices.(vi) In addition to Special Controls in paragraphs (b)(1)(i) through (v) of this section, implanted blood access devices that include subcutaneous ports must include the following:
(A) Labeling must include the recommended type of needle for access as well as detailed instructions for care and maintenance of the port, subcutaneous pocket, and skin overlying the port.
(B) Performance testing must include results on repeated use of the ports that simulates use over the intended life of the device.
(C) Clinical performance testing must demonstrate safe and effective use and capture any adverse events observed during clinical use.
(vii) In addition to Special Controls in paragraphs (b)(1)(i) through (v) of this section, implanted blood access devices with coatings or additives must include the following:
(A) A description and material characterization of the coating or additive material, the purpose of the coating or additive, duration of effectiveness, and how and where the coating is applied.
(B) An identification in the labeling of any coatings or additives and a summary of the results of performance testing for any coating or material with special characteristics, such as decreased thrombus formation or antimicrobial properties.
(C) A Warning Statement in the labeling for potential allergic reactions including anaphylaxis if the coating or additive contains known allergens.
(D) Performance data must demonstrate efficacy of the coating or additive and the duration of effectiveness.
(viii) The following must be included for A-V shunt cannulae (with vessel tips):
(A) The device must comply with Special Controls in paragraphs (b)(1)(i) through (v) of this section with the exception of paragraphs (b)(1)(ii)(B), (b)(1)(ii)(C), (b)(1)(v)(B), and (b)(1)(v)(C), which do not apply.
(B) Labeling must include Warning Statements to address the potential for vascular access steal syndrome, arterial stenosis, arterial thrombosis, and hemorrhage including exsanguination given that the device accesses the arterial circulation.
(C) Clinical performance testing must demonstrate safe and effective use and capture any adverse events observed during clinical use.
(2) Class II (performance standards) for the nonimplanted blood access device.
(3) Class II (performance standards) for accessories for both the implanted and the nonimplanted blood access devices not listed in paragraph (b)(4) of this section.
(4) Class I for the cannula clamp, disconnect forceps, crimp plier, tube plier, crimp ring, and joint ring, accessories for both the implanted and nonimplanted blood access device. The devices subject to this paragraph (b)(4) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.