K Number
K092031
Device Name
VAPOR-CLEAR, MODEL 100
Manufacturer
Date Cleared
2010-04-16

(284 days)

Product Code
Regulation Number
868.5430
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To remove unwanted anesthetic gases from the patient breathing circuit
Device Description
This device uses two anesthetic vapor adsorbent canisters connected to an anesthesia delivery system to prevent unwanted anesthetic vapors emanating from within an anesthesia gas machine from reaching a patient.
More Information

Not Found

No
The device description and performance studies focus on the physical and chemical properties of anesthetic vapor adsorption, with no mention of AI or ML technologies.

No
The device is described as preventing unwanted anesthetic vapors from reaching a patient, acting as a scavenger for anesthetic gases, rather than directly treating a patient's medical condition or disease.

No

The device is designed to remove unwanted anesthetic gases from a patient breathing circuit, preventing them from reaching the patient. It does not perform any diagnostic function.

No

The device description explicitly states it uses "two anesthetic vapor adsorbent canisters connected to an anesthesia delivery system," which are physical hardware components. The performance studies also describe bench testing of physical properties like adsorption rate, burst pressure, and back-pressure.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, treatment, or prevention of disease.
  • Device Intended Use: The intended use of this device is "To remove unwanted anesthetic gases from the patient breathing circuit." This is a function related to the delivery and management of anesthetic gases during a medical procedure, not the analysis of biological specimens.
  • Device Description: The description details a system for adsorbing anesthetic vapors from a breathing circuit, which is an external system connected to the patient, not a device for analyzing samples taken from the patient.
  • Lack of IVD Characteristics: The provided information does not mention any aspects related to specimen collection, preparation, analysis of biological samples, or providing diagnostic information based on such analysis.

The device described is a component of an anesthesia delivery system, designed to manage the gases within that system. It does not perform any diagnostic testing on biological samples.

N/A

Intended Use / Indications for Use

To remove unwanted anesthetic gases from the patient breathing circuit

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

CBN

Device Description

This device uses two anesthetic vapor adsorbent canisters connected to an anesthesia delivery system to prevent unwanted anesthetic vapors emanating from within an anesthesia gas machine from reaching a patient.

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

Operating room, surgical suite, anywhere inhaled volatile anesthetics are administered.

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)

The bench testing of the Vapor-Clear device demonstrates that the device is capable of removing unwanted anesthetic gases from the breathing circuit with greater efficiency and capacity than the predicate device. The testing also shows that the Vapor-Clear is capable of scavenging greater than 99% of the residual anesthetic vapors emitted by an anesthesia gas machine after the vaporizer has been turned off. Multiple gas removal testing demonstrated than 99% of anesthetic agent is removed for each anesthetic agent (desflurane, isoflurane and sevoflurane). Testing demonstrated that the activated charcoal used in the device is capable of capturing a volume of anesthetic gas that is well beyond what is emitted by an anesthesia gas machine after the vaporizer has been turned off. Testing using aged activated charcoal granules demonstrate that the device will perform as specified throughout the product lifetime. Environmental and mechanical testing demonstrates that the leak, back pressure and internal volume of the device are sufficiently small that installation of the device will not interfere with delivery of mechanical ventilation during an anesthetic and that the device is sufficiently rugged to withstand the rigors of shipping and storage.

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

  • Anesthetic adsorption rate: Vapor-Clear scavenges >99.95% of isoflurane at a high flow rate
  • Scavenging residual vapor from 2 models of modern anesthesia gas machines: Residual vapor exceeds the 5 ppm limit for 78 minutes in the Apollo and 58 minutes in the Aestiva following termination of vapor delivery without the Vapor-Clear. Using, the Vapor-Clear, inspired isoflurane concentration stays below 1 ppm for the duration of the test following termination of vapor delivery. The Vapor-Clear scavenger decreased the concentration of inspiratory isoflurane to less than 1 ppm throughout the tests in both the Draeger Apollo and the Ohmeda Aestiva anesthesia gas machines
  • Anesthetic removal capacity test: A single Vapor-Clear canister removes 1300 ml of isoflurane before a removal rate of less than 99% is observed.
  • Test adsorption using various anesthetic vapors: Greater than 99% of anesthetic is removed regardless of which of the three agents (isoflurane, sevoflurane or desflurane) is used.
  • Product life testing: Initial adsorption of >99% was observed. No degradation of anesthetic gas removal capacity was observed when using the aged product.
  • Environmental testing: No change in device performance was observed following the environmental stresses.
  • Internal volume testing: The internal volume of the device is 92 ml. The internal compliance is 14 ml/kPa.
  • Burst testing: The Vapor-Clear burst at a pressure of 70 pounds per square inch.
  • Back-pressure tests: Added back pressure of 0.5 cm H₂O at 30 L/min was observed
  • Leak test: No leak (0.0 ml/min) was detectable.

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.

K033028

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

§ 868.5430 Gas-scavenging apparatus.

(a)
Identification. A gas-scavenging apparatus is a device intended to collect excess anesthetic, analgesic, or trace gases or vapors from a patient's breathing system, ventilator, or extracorporeal pump-oxygenator, and to conduct these gases out of the area by means of an exhaust system.(b)
Classification. Class II (performance standards).

0

Appendix B, Revised 510K Summary

APR 1 8 2010

510(k) Summary K092031

Page 1 of 6 April 7, 2010

Axon Medical Inc. Tel - (801) 484-3820 2645 Sackett Drive Fax - (801) 581-4367 Park City, Utah 84098

Official Contact: Proprietary or Trade Name: Common/Usual Name: Primary Classification Name Primary Classification Code: Regulation:

Joseph Orr - President Vapor-Clear Breathing circuit anesthetic gas scavenger Gas Scavenging Apparatus CBN 868.5430

Predicate Device: K033028 Gas Scavenging Device (product code: CBN) AneFin 100, Anefin-100 Volatile anesthesia emergence device Manufacturer: Axon Medical Inc

(Note that the product code for this device in the clearance letter dated July 22, 2005 is CBN)

Device Description: This device uses two anesthetic vapor adsorbent canisters connected to an anesthesia delivery system to prevent unwanted anesthetic vapors emanating from within an anesthesia gas machine from reaching a patient.

Intended Use: To remove unwanted anesthetic gases from the patient breathing circuit

Environment of Use: Operating room, surgical suite, anywhere inhaled volatile anesthetics are administered.

1

510(k) Summary Page 2 of 6 April 7, 2010 .

Summary of comparison between device and predicate(s)

AttributeVapor-Clear (K092031)AneFin (K033028)Comparison
General indications for useRemove unwanted
anesthetic gasesRemove unwanted
anesthetic gasesIdentical
Specific indications for useN/ATo speed emergence
from volatile inhaled
anesthetics and
increasing spontaneous
breathing through
partial rebreathing.Vapor-Clear is not
intended to speed
emergence or increase
spontaneous breathing.
Patient populationSurgical patients being
ventilated by an
anesthesia gas machineSurgical patients being
ventilated by an
anesthesia gas machineIdentical
Environment of UseOperating RoomOperating RoomIdentical
Rationale for useTo remove unwanted
residual anesthetic
vapor from the
breathing circuit when
the vaporizer is turned
off.To remove unwanted
residual anesthetic
vapor from the
breathing circuit when
the vaporizer is turned
off.Identical
Placement in the
anesthesia circuitNear the anesthesia gas
machine ports between
the anesthesia gas
machine and the
breathing circuit hoses.Between the patient
and the breathing
circuit wye.The Vapor-Clear does
not rely on rebreathing
so there is no need to
place the device
between the patient
and the wye. Vapor-
Clear does not include
added dead volume.
Change in dead spaceNone as the device is
placed in circuit
between the anesthesia
gas machine and the
breathing circuit hoses

Placement is identical
to the use of a bacterial
filter at the machine
end of the circuit | Adds dead space
between the wye and
the patient.

Placement in the
breathing circuit is
similar to a heat-
moisture exchanger | Vapor-Clear does not
add dead space. AneFin
requires addition of
dead space to achieve
fast emergence and
increase spontaneous
breathing. |
| Equipment | Used with anesthesia
gas machine | Used with anesthesia
gas machine | Identical |
| Attribute | Vapor-Clear (K092031) | AneFin (K033028) | Comparison |
| Anesthetic removal material | Activated charcoal granules | Activated charcoal granules | Identical |
| Charcoal capacity | 0.6" thick, 3 inch diameter. 4.25 cubic inches of charcoal | 0.25" thick, 3inch diameter. 1.76 cubic inches of charcoal | Vapor-Clear contains 2.4 times as much charcoal as the AneFin |
| Anesthetic Removal | >99% of anesthetic gas removed | >95% of anesthetic gas removed | Similar, Vapor-Clear performance is superior |
| Rebreathing hose | None | Rebreathing hose placed between charcoal canister and breathing circuit wye | The rebreathing hose is used by the AneFin to achieve the additional (specific) intended use. Vapor-Clear does not include a rebreathing hose. |
| Back pressure | 99.95% of isoflurane at a high flow rate |
| Scavenging residual vapor from 2 models of modern anesthesia gas machines | Saturate two modern anesthesia gas machines (Draeger Apollo and the Ohmeda Aestiva) with isoflurane for an extended period. Measure the time after the vaporizer has been turned off before the inspired isoflurane falls below 5 parts per million (ppm). Repeat the procedure with and without the Vapor-Clear in the breathing circuit. | Residual vapor exceeds the 5 ppm limit for 78 minutes in the Apollo and 58 minutes in the Aestiva following termination of vapor delivery without the Vapor-Clear. Using, the Vapor- Clear, inspired isoflurane concentration stays below 1 ppm for the duration of the test following termination of vapor delivery. The Vapor-Clear scavenger decreased the concentration of inspiratory isoflurane to less than 1 ppm throughout the tests in both the Draeger Apollo and the Ohmeda Aestiva anesthesia gas machines |
| Anesthetic removal capacity test | Pass isoflurane through the Vapor-Clear device at a known concentration (2%) and flow rate (5 L/min). Measure the total volume of isoflurane that passes through the device before less than 99% of isoflurane gas is being removed by the device. | A single Vapor-Clear canister removes 1300 ml of isoflurane before a removal rate of less than 99% is observed. |
| Test adsorption using various anesthetic vapors | Pass anesthetic gas through the device at a known inspired concentration. Measure the concentration entering and exiting the Vapor-Clear device. Repeat the test for each gas (isoflurane, sevoflurane and desflurane) | Greater than 99% of anesthetic is removed regardless of which of the three agents (isoflurane, sevoflurane or desflurane) is used. |
| Test Condition | Test Method | Test Results |
| Product life testing | Product containing activated
charcoal that has been aged
for 71months was tested for
initial anesthetic removal and
anesthetic removal capacity. | Initial adsorption of >99% was
observed. No degradation of
anesthetic gas removal
capacity was observed when
using the aged product. |
| Environmental testing | The Vapor-Clear device was
subjected to mechanical and
environmental stresses
including shock, vibration,
high and low temperature and
humidity. The stressed
product was then tested for
anesthetic removal, leakage
and increased back pressure | No change in device
performance was observed
following the environmental
stresses. |
| Internal volume testing | The internal compressible
volume was measured using a
direct volume measure. The
internal compliance was
tested by observing the
volume needed to achieve a
pressure change in a sealed
device. | The internal volume of the
device is 92 ml. The internal
compliance is 14 ml/kPa. |
| Burst testing | Increasing pressure was
applied to a sealed device in a
stepwise fashion until the
device burst was observed.
The pressure at which a burst
was observed was recorded. | The Vapor-Clear burst at a
pressure of 70 pounds per
square inch. |
| Back-pressure tests | Added back pressure caused
by placing the Vapor-Clear in
the breathing circuit was
measured per ASTM F 1205 | Added back pressure of 0.5
cm H₂O at 30 L/min was
observed |
| Leak test | A pressure of 30 cm H₂O was
applied to a sealed device.
The flow rate of air into the
sealed device was taken as
the leak rate per ASTM F 1205 | No leak (0.0 ml/min) was
detectable. |

:

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510(k) K092031 Summary Page 5 of 6 April 7, 2010 :

5

510(k) K092031 Summary Page 6 of 6 April 7, 2010

Testing Summary Statement

The bench testing of the Vapor-Clear device demonstrates that the device is capable of removing unwanted anesthetic gases from the breathing circuit with greater efficiency and capacity than the predicate device. The testing also shows that the Vapor-Clear is capable of scavenging greater than 99% of the residual anesthetic vapors emitted by an anesthesia gas machine after the vaporizer has been turned off. Multiple gas removal testing demonstrated than 99% of anesthetic agent is removed for each anesthetic agent (desflurane, isoflurane and sevoflurane). Testing demonstrated that the activated charcoal used in the device is capable of capturing a volume of anesthetic gas that is well beyond what is emitted by an anesthesia gas machine after the vaporizer has been turned off. Testing using aged activated charcoal granules demonstrate that the device will perform as specified throughout the product lifetime. Environmental and mechanical testing demonstrates that the leak, back pressure and internal volume of the device are sufficiently small that installation of the device will not interfere with delivery of mechanical ventilation during an anesthetic and that the device is sufficiently rugged to withstand the rigors of shipping and storage.

These tests demonstrate that the subject device (Vapor-Clear) is substantially equivalent to the predicate device.

6

Image /page/6/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle or bird-like figure with three curved lines representing its wings or feathers.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Dr. Joseph Orr President Axon Medical, Incorporated 2645 Sackett Drive Park City, Utah 84098

APR 1 3 2010

Re: K092031 Trade/Device Name: Vapor-Clear Regulation Number: 21CFR 868.5430 Regulation Name: Gas-Scavenging Apparatus Regulatory Class: II Product Code: CBN Dated: April 5, 2010 Received: April 8, 2010

Dear Dr. Orr:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

7

Page 2- Dr. Orr

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to

http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely vours.

Nh for

Anthony Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

8

Indications for Use Statement

510(k) Number: K092031

Device Name: Vapor-Clear

Indications for Use: To remove unwanted anesthetic gases from the patient breathing circuit

Intended patient population: Surgical patients being ventilated by an anesthesia gas machine.

Environment of Use: Operating room, surgical suite, anywhere inhaled volatile anesthetics are administered.

Prescription Use: XX

OR

Over-The-Counter Use_

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

L. Schultheis

Tivision Sign-Off) ାsion of Anesthesiology, General Hospital ection Control, Dental Devices

3)(k) Number: k-092031