K Number
K083131
Device Name
MEDOS HILITE RESERVOIR, MODEL: 4030
Date Cleared
2009-07-30

(280 days)

Product Code
Regulation Number
870.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir is indicated for use during cardiopulmonary bypass surgery as a storage reservoir for gravity and augmented venous return blood and to filter and defoam intrathoracic suctioned blood prior to its return to the extracorporeal circuit at flow rates of one (1.0) to seven (7.0) liters per minute for periods up to six hours (6.0) hours.
Device Description
The MEDOS HILITE MVC 4030 Hardshell Venous Reservoirs are sterile, non-pyrogenic, single use, disposable, device designed for collection, storage and filtration of blood during cardiopulmonary bypass. The MEDOS HILITE MVC 4030 has a clear polycarbonate shell and an internal defoamer filter cartridge. Venous drainage enters the 1/2' venous inlet at the center top section of the lid. Venous suctioned blood enters the top section of the defoamer/filter cartridge and passed through a defoamer sponge and 30 micron filter. The maximum venous flow rate is 7 lpm. The maximum cardiotomy flow rate is 4 lpm.
More Information

Not Found

No
The description focuses on the mechanical and filtration aspects of a hardshell venous reservoir used in cardiopulmonary bypass, with no mention of AI or ML capabilities.

No.
The device is a reservoir for storing, filtering, and defoaming blood during cardiopulmonary bypass, which is a supportive role in a medical procedure rather than directly treating a condition or disease.

No

Explanation: The device is a hardshell venous reservoir used during cardiopulmonary bypass surgery for blood storage, filtration, and defoaming. It does not perform any diagnostic function.

No

The device description clearly indicates it is a physical, disposable medical device made of polycarbonate with an internal filter and defoamer, used for collecting and filtering blood during surgery. It is not software.

Based on the provided information, the MEDOS HILITE MVC 4030 Hardshell Venous Reservoir is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use is clearly described as a storage reservoir for blood during cardiopulmonary bypass surgery, filtering and defoaming blood prior to its return to the extracorporeal circuit. This is a device used in vivo (within the body's circulation during surgery), not in vitro (outside the body for diagnostic testing).
  • Device Description: The description focuses on the physical components and function of collecting, storing, and filtering blood within the extracorporeal circuit. There is no mention of analyzing blood or other biological samples for diagnostic purposes.
  • Lack of Diagnostic Elements: There are no mentions of analyzing biomarkers, detecting diseases, or providing information for diagnosis, monitoring, or prognosis.

IVD devices are specifically designed to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health status. The MEDOS HILITE MVC 4030 does not perform such tests.

N/A

Intended Use / Indications for Use

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir is indicated for use during cardiopulmonary bypass surgery as a storage reservoir for gravity and augmented venous return blood and to filter and defoam intrathoracic suctioned blood prior to its return to the extracorporeal circuit at flow rates of one (1.0) to seven (7.0) liters per minute for periods up to six hours (6.0) hours.

Product codes

DTN

Device Description

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoirs are sterile, non-pyrogenic, single use, disposable, device designed for collection, storage and filtration of blood during cardiopulmonary bypass. The MEDOS HILITE MVC 4030 has a clear polycarbonate shell and an internal defoamer filter cartridge. Venous drainage enters the 1/2' venous inlet at the center top section of the lid. Venous suctioned blood enters the top section of the defoamer/filter cartridge and passed through a defoamer sponge and 30 micron filter. The maximum venous flow rate is 7 lpm. The maximum cardiotomy flow rate is 4 lpm.

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

cardiopulmonary bypass surgery

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

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir has been subjected to extensive safety, performance, and validations prior to release. Final testing for the system includes various performance tests designed to ensure that the device meets all of its functional requirements and performance specifications. Safety tests have further been performed to ensure the device complies with applicable industry and safety standards.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

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

Not Found

Predicate Device(s)

K964973

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.4400 Cardiopulmonary bypass blood reservoir.

(a)
Identification. A cardiopulmonary bypass blood reservoir is a device used in conjunction with short-term extracorporeal circulation devices to hold a reserve supply of blood in the bypass circulation.(b)
Classification. Class II (special controls), except that a reservoir that contains a defoamer or filter is classified into the same class as the defoamer or filter. The device, when it is a cardiopulmonary bypass blood reservoir that does not contain defoamers or blood filters, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

0

Gish Biomedical, Inc.

1083131/

Traditional 510(k) Section 5, 510(k) Summary

Summary

This summary of 510(k)-safety and effectiveness information is being submitted in accordance with the requirements of 21 CFR § 807.92.

1. Company making the submission:

JUL 8 0 2009

| Name: | Gish BioMedical, Inc.
A member of the MEDOS group | | |
|------------|---------------------------------------------------------------------|--|--|
| Address: | 22942 Arroyo Vista
Rancho Santa Margarita, CA 92688-
2600 | | |
| Telephone: | 949-635-6200 voice
949-635-6294 fax
janetp@gishbiomedical.com | | |
| Contact: | Janet Peets
Regulatory & Clinical Affairs
Specialist | | |

2. Device:

Proprietary Name:Medos Hilite MVC 4030 Hardshell Venous Reservoir
Common Name:Cardiopulmonary Blood Reservoir
Classification Name:Extracorpeal Circuit Blood Defoamer
Cardiopulmonary Bypass Blood Reservoir

3. Predicate Devices:

Gish CAPVRF45 Hardshell Venous Reservoir, K964973, manufactured by Gish Biomedical, Inc.

Classifications Names & Citations: 4.

21 CFR 870.4230, 21 CFR 870.4400, Extracorpeal circuit blood defoamers, Cardiopulmonary bypass blood reservoir, Cardiopulmonary Bypass, Class II, DTN, Cardiovascular.

5. Description:

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoirs are sterile, non-pyrogenic, single use, disposable, device designed for collection, storage and filtration of blood during cardiopulmonary bypass. The MEDOS HILITE MVC 4030 has a clear polycarbonate shell and an internal defoamer filter cartridge. Venous drainage enters the 1/2' venous inlet at the center top section of the lid. Venous suctioned blood enters the top section of the defoamer/filter cartridge and passed through a defoamer sponge and 30 micron filter. The maximum venous flow rate is 7 lpm. The maximum cardiotomy flow rate is 4 lpm.

Section 5 510(k) Submission Page #

1

6. Indications for use:

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir is indicated for use during cardiopulmonary bypass surgery as a storage reservoir for gravity and augmented venous return blood and to filter and defoam intrathoracic suctioned blood prior to its return to the extracorporeal circuit at flow rates of one (1.0) to seven (7.0) liters per minute for periods up to six hours (6.0) hours.

7. Contra-indications:

No contra-indications have been noted.

8. Comparison:

The Medos Hilite MVC 4030 Hardshell Venous Reservoir has the same device characteristics as the predicate devices.

9. Test Data:

:

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir has been subjected to extensive safety, performance, and validations prior to release. Final testing for the system includes various performance tests designed to ensure that the device meets all of its functional requirements and performance specifications. Safety tests have further been performed to ensure the device complies with applicable industry and safety standards.

10. Literature Review:

A review of literature pertaining to the safety and effectiveness has been conducted. Appropriate safeguards have been incorporated in the design of MEDOS HILITE MVC 4030 Hardshell Venous Reservoir.

11. Conclusions:

Based upon the testing and comparison to the predicate device the Medos Hilite MVC 4030 Hardshell Venous Reservoir has the same intended use, with similar technological characteristics. Gish Biomedical, Inc., therefore posits that its device is equivalent in safety and effectiveness to predicate devices.

Confidential Summary.doc

2

Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES · USA" are arranged in a circular pattern around the eagle. The logo is black and white.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 3 0 2009

Gish Biomedical, Inc. c/o Ms. Janet Peets 22942 Arroyo Vista Rancho Santa Margarita, CA 92688

Re: K083131

Medos Hilite MVC 4030 Reservoir Regulation Number: 21 CFR 870.4400 Regulation Name: Reservoir, blood, cardiopulmonary bypass Regulatory Class: Class II (two) Product Code: DTN Dated: June 10, 2009 Received: June 11, 2009

Dear Ms. Peets:

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 - Ms. Janet Peets

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,

R. D. Anderson, M.D.

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Gish Biomedical, Inc.

510(k) Number K_083/3 |

Device Name: MEDOS HILITE MVC 4030 Hardshell Venous Reservoir

Indications for use:

The MEDOS HILITE MVC 4030 Hardshell Venous Reservoir is indicated for use during cardiopulmonary bypass surgery as a storage reservoir for gravity and augmented venous return blood and to filter and defoam intrathoracic suctioned blood prior to the extracorporeal circuit at flow rates of one (1.0) to seven (7.0) liters per minute for periods up to six hours (6.0) hours.

Prescription Device:

Federal Law (US) restricts this device to sale by or on the order of a physician.

Prescription Use :Yes
OR
Over-The-Counter Use:No

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

R

HOH L'Avision of Wardlovascular Devices iki Number

Section 4 510(k) Submission Page

Confidential Indications forUso.dov