K Number
K090255
Device Name
BLOOD TUBING SETS (STERILE FLUID PATH)
Date Cleared
2009-02-10

(8 days)

Product Code
Regulation Number
876.5820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The blood tubing sets are indicated for use with a medically prescribed hemodialyzer. The suitability of a particular configuration is the responsibility of the physician in charge.
Device Description
The blood tubing sets consist of a family of products which are used during extracorporeal procedures to provide a means to connect blood access devices to a hemodialysis or hemofiltration machine and a hemodialyzer or hemofilter. To facilitate a hemodialysis procedure, for example, the arterial and/or venous blood tubing sets may contain features such as air trap chambers, filters, injection sites, pump segments, heparin infusion lines, saline administration lines, pressure pillows, priming sets, and pressure monitoring lines with or without transducer protectors. Numerous product codes are produced to accommodate various manufacturer's dialysis machines, as well as differing clinical preferences and clinical procedures.
More Information

Not Found

No
The device description and performance studies focus on the physical components and functionality of blood tubing sets for hemodialysis, with no mention of AI or ML technologies.

No
The device, blood tubing sets, serves as a connection means for extracorporeal procedures like hemodialysis, facilitating the therapeutic process by connecting access devices to machines and dialyzers. It does not directly provide a therapy itself, but rather is a component required for the therapy.

No
The device description indicates that blood tubing sets are used during extracorporeal procedures to connect blood access devices to a hemodialysis or hemofiltration machine and a hemodialyzer or hemofilter. Its purpose is to facilitate the physical connection and flow of blood, not to diagnose a condition or disease.

No

The device description clearly states it consists of physical components like tubing, chambers, filters, and injection sites, which are hardware.

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

Here's why:

  • Intended Use: The intended use is for connecting blood access devices to a hemodialysis or hemofiltration machine and a hemodialyzer or hemofilter during extracorporeal procedures. This is a therapeutic and supportive function, not a diagnostic one.
  • Device Description: The description details components like tubing, chambers, filters, and lines used for managing blood flow and administering substances during dialysis. These are all related to the physical process of blood treatment outside the body.
  • Lack of Diagnostic Elements: There is no mention of analyzing blood or other biological samples to diagnose a condition, monitor disease progression, or determine the presence of specific substances.

IVD devices are specifically designed to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. This blood tubing set facilitates a treatment procedure, not a diagnostic test.

N/A

Intended Use / Indications for Use

The blood tubing sets are indicated for use with a medically prescribed hemodialyzer. The suitability of a particular configuration is the responsibility of the physician in charge.

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

FJK, KOC

Device Description

The blood tubing sets consist of a family of products which are used during extracorporeal procedures to provide a means to connect blood access devices to a hemodialysis or hemofiltration machine and a hemodialyzer or hemofilter. To facilitate a hemodialysis procedure, for example, the arterial and/or venous blood tubing sets may contain features such as air trap chambers, filters, injection sites, pump segments, heparin infusion lines, saline administration lines, pressure pillows, priming sets, and pressure monitoring lines with or without transducer protectors. Numerous product codes are produced to accommodate various manufacturer's dialysis machines, as well as differing clinical preferences and clinical procedures.

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, verification and validation testing was conducted to characterize performance of the subject blood tubing set to provide a basis of comparison to the predicate device as all features are not identical. Results of this testing have documented that the subject blood tubing set is substantially equivalent to the predicate device and is suitable for the labeled indications for 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.

K080807

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

§ 876.5820 Hemodialysis system and accessories.

(a)
Identification. A hemodialysis system and accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions and that consists of an extracorporeal blood system, a conventional dialyzer, a dialysate delivery system, and accessories. Blood from a patient flows through the tubing of the extracorporeal blood system and accessories to the blood compartment of the dialyzer, then returns through further tubing of the extracorporeal blood system to the patient. The dialyzer has two compartments that are separated by a semipermeable membrane. While the blood is in the blood compartment, undesirable substances in the blood pass through the semipermeable membrane into the dialysate in the dialysate compartment. The dialysate delivery system controls and monitors the dialysate circulating through the dialysate compartment of the dialyzer.(1) The extracorporeal blood system and accessories consists of tubing, pumps, pressure monitors, air foam or bubble detectors, and alarms to keep blood moving safely from the blood access device and accessories for hemodialysis (§ 876.5540) to the blood compartment of the dialyzer and back to the patient.
(2) The conventional dialyzer allows a transfer of water and solutes between the blood and the dialysate through the semipermeable membrane. The semipermeable membrane of the conventional dialyzer has a sufficiently low permeability to water that an ultrafiltration controller is not required to prevent excessive loss of water from the patient's blood. This conventional dialyzer does not include hemodialyzers with the disposable inserts (Kiil type) (§ 876.5830) or dialyzers of high permeability (§ 876.5860).
(3) The dialysate delivery system consists of mechanisms that monitor and control the temperature, conductivity, flow rate, and pressure of the dialysate and circulates dialysate through the dialysate compartment of the dialyzer. The dialysate delivery system includes the dialysate concentrate for hemodialysis (liquid or powder) and alarms to indicate abnormal dialysate conditions. This dialysate delivery system does not include the sorbent regenerated dialysate delivery system for hemodialysis (§ 876.5600), the dialysate delivery system of the peritoneal dialysis system and accessories (§ 876.5630), or the controlled dialysate delivery system of the high permeability hemodialysis system § 876.5860).
(4) Remote accessories to the hemodialysis system include the unpowered dialysis chair without a scale, the powered dialysis chair without a scale, the dialyzer holder set, dialysis tie gun and ties, and hemodialysis start/stop tray.
(b)
Classification. (1) Class II (performance standards) for hemodialysis systems and all accessories directly associated with the extracorporeal blood system and the dialysate delivery system.(2) Class I for other accessories of the hemodialysis system remote from the extracorporeal blood system and the dialysate delivery system, such as the unpowered dialysis chair, hemodialysis start/stop tray, dialyzer holder set, and dialysis tie gun and ties. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

K090255
Page 1 of 3

EB 1 0 2009

NxStage Medical, Inc. Blood Tubing Sets 510(k) Device Modification

This 510(k) Summary of Safety and Effectiveness is being submitted in accordance with the requirements of SMDA 1990.

A. Submitter's Information:

Name:

NxStage Medical Inc.

Address:

439 South Union Street, 5th Floor Lawrence, MA 01843 United States

FDA Establishment Owner/Operator Number:

Contact Person:

Phone: Fax:

Manufacturing Site:

FDA Establishment Registration Number:

Manufacturing/Sterilization Site:

FDA Establishment Registration Number:

Manufacturing/Sterilization Site:

FDA Establishment Registration Number:

Sterilization Site:

9045797

Michael Doyle Manager, Regulatory Affairs

(978) 687-4746 (978) 687-4750

MEDIMEXICO, S. DE R.L. DE C.V. Av. Valle imperial No. 10523 Parque industrial Valle Sur Tijuana, B.C., Mexico 22180

9616074

Kawasumi Laboratories Co. Ltd. 55/26-27 m-13 Phaholyothin Rd. Km-46 Klong Nueng, Klong Luang Pratumtanee, Thailand 12120

9680437


Kawasumi Laboratories Co. Ltd. 48 Moo 8 Ratchasima-Chokchai Rd., Tambon Tha-ang, Amphur Chokchai, Nakhorn Rachasima, Thailand 30190

9615908

Steris Corporation Isomedix Services, Inc. 1000 S. Sarah Place Ontario, CA 91761

1

K090255
Page 2 of 3

NxStage Medical, Inc. Blood Tubing Sets 510{k} Device Modification

FDA Establishment Registration Number:Contract sterilizer
Sterilization Site:STERIS Corporation
Isomedix Service, Inc.
7685 St. Andrews Ave.
San Diego, CA 92154
FDA Establishment Registration Number:Contract sterilizer
Trade/Proprietary Name:Blood Tubing Sets
Common/Usual Name:Tubing sets
Classification Name:Sets, Tubing, Blood, With and Without Anti-
Regurgitation Valve
Regulation Number:876.5820
Product Code:FJK
Device Classification:Class II
Device Panel:Gastroenterology/Urology
Substantial Equivalence/Predicate Devices:

C. Substar

The subject blood tubing set is substantially equivalent to the following legally marketed predicate device, previously cleared by the FDA;

  • · Arterial-Venous Blood Tubing Sets, K080807, July 18, 2008

D. Device Description/Indications for Use:

The blood tubing sets consist of a family of products which are used during extracorporeal procedures to provide a means to connect blood access devices to a hemodialysis or hemofiltration machine and a hemodialyzer or hemofilter. To facilitate a hemodialysis procedure, for example, the arterial and/or venous blood tubing sets may contain features such as air trap chambers, filters, injection sites, pump segments, heparin infusion lines, saline administration lines, pressure pillows, priming sets, and pressure monitoring lines with or without transducer protectors. Numerous product codes are produced to accommodate various manufacturer's dialysis machines, as well as differing clinical preferences and clinical procedures.

Indications for use:

B. Device

The blood tubing sets are indicated for use with a medically prescribed hemodialyzer. The suitability of a particular configuration is the responsibility of the physician in charge.

E. Technological Characteristics:

The subject device has the same technological characteristics and is similar in design and configuration as compared to the predicate device. The subject device is designed with similar components and features that are also used in the predicate device.

F. Summary of Non-Clinical Test/Performance Testing - Bench

NxStage Medical, Inc. believes that the information and data provided in this submission clearly describes the subject device and demonstrates that the device is adequately

2

K09c255
Page 3 of 3

NxStage Medical, Inc. Blood Tubing Sets 510(k) Device Modification

designed for the labeled indications for use. Performance, verification and validation testing was conducted to characterize performance of the subject blood tubing set to provide a basis of comparison to the predicate device as all features are not identical. Results of this testing have documented that the subject blood tubing set is substantially equivalent to the predicate device and is suitable for the labeled indications for use.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/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 figure with three wing-like shapes, positioned to the right of a circular text element. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES (USA)" and is arranged around the circumference of the circle. The bird-like figure is abstract and appears to be in motion.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 1 0 2009

Mr. Michael Doyle Manager, Regulatory Affairs NxStage Medical, Inc. 439 South Union Street, 5th Floor LAWRENCE MA 01843

Re: K090255

Trade/Device Name: Blood Tubing Sets Regulation Number: 21 CFR §876.5820 Regulation Name: Hemodialysis system and accessories Regulatory Class: II Product Code: FJK, KOC Dated: January 30, 2009 Received: February 2, 2009

Dear Mr. Doyle:

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.

4

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 os 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 one of the following numbers, based on the regulation number at the top of this letter.

21 CFR 876.xxx(Gastroenterology/Renal/Urology)(240) 276-0115
21 CFR 884.xxx(Obstetrics/Gynecology)(240) 276-0115
21 CFR 892.xxx(Radiology)(240) 276-0120
Other(240) 276-0100

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometrics' (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 Manufactures, 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.suppor/index.html.

Sincerely yours,

Laura B. Morris

anine M. M. irris Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Indications for Use

510(k) Number (if known): 〈○90255

Device Name: Blood Tubing Sets (Sterile Fluid Path)

Indications for Use:

The blood tubing sets are indicated for use with a medically prescribed hemodialyzer. The suitability of a particular configuration is the responsibility of the physician in charge.

Prescription Use X (Part 21 CFR 801 Subpart D)

AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Reproductive, Abdominal,
and Radiological Devices
510(k) Number K090255

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