K Number
K123830
Device Name
INTERMITTENT PNEUMATIC COMPRESSION DEVICE
Date Cleared
2013-08-16

(247 days)

Product Code
Regulation Number
870.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Veinoflow SCD system, Model LBTK-M-1 5001 is a system to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients. LBTK-M-I 5001 is indicated for Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema -Acute, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg ulcers, Venous Stasis / Venous Insufficiency.
Device Description
Veinoflow SCD, Model LBTK-M-I 5001, is a pneumatic pump system that supplies compressed air to inflate garments that are attached to a patent's lower limbs. It consists of a pump controller, specially designed inflation and deflation garments for feet and legs, air supply tubes, and power line. The inflation and deflation garments have 3 types: ① thigh-calf garments, ② calf garments, and ③ foot cuffs. The system offers sequential inflation and propels the vein blood from limb to heart, therefore enhance the blood circulation. The controller can automatically detect the external garment type, and provides pressure correspondingly. The pressure value and inflatable interval time are preset and adjustable. The controller has a self test system, when there is any error, it will alarm both in visual and audio.
More Information

Not Found

No
The description focuses on a pneumatic pump system with preset and adjustable parameters, automatic garment type detection, and self-testing. There is no mention of AI or ML algorithms for decision-making, data analysis, or adaptive control beyond basic automation.

Yes

The device's intended use is to prevent DVT and enhance circulation, and it is specifically designed to treat various medical conditions like edema, extremity pain, and leg ulcers, which are all therapeutic purposes.

No

The device is described as a pneumatic pump system that prevents DVT and enhances blood circulation by inflating garments attached to a patient's lower limbs. Its function is to provide therapy (e.g., circulation enhancement, DVT prophylaxis), not to diagnose a condition.

No

The device description explicitly states it is a "pneumatic pump system" consisting of a "pump controller, specially designed inflation and deflation garments... air supply tubes, and power line." These are all hardware components.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used outside of the body (in vitro).
  • Veinoflow SCD System Function: The Veinoflow SCD system is a pneumatic pump system that applies external pressure to the patient's limbs to improve blood circulation and prevent DVT. It works on the patient's body, not on samples taken from the body.
  • Intended Use: The intended use clearly states it's for preventing DVT by improving blood velocity and is indicated for various circulatory issues. This is a therapeutic and preventative function, not a diagnostic one.
  • Device Description: The description details a pump, garments, and air tubes, all components used for external compression, not for analyzing biological samples.

The Veinoflow SCD system is a therapeutic medical device, specifically a pneumatic compression device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Veinoflow SCD system, Model LBTK-M-I 5001 is a system to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients. LBTK-M-I 5001 is indicated for Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema -Acute, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg ulcers, Venous Stasis / Venous Insufficiency.

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

JOW

Device Description

Veinoflow SCD, Model LBTK-M-I 5001, is a pneumatic pump system that supplies compressed air to inflate garments that are attached to a patent's lower limbs. It consists of a pump controller, specially designed inflation and deflation garments for feet and legs, air supply tubes, and power line. The inflation and deflation garments have 3 types: thigh-calf garments, calf garments, and foot cuffs. The system offers sequential inflation and propels the vein blood from limb to heart, therefore enhance the blood circulation. The controller can automatically detect the external garment type, and provides pressure correspondingly. The pressure value and inflatable interval time are preset and adjustable.

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)

The new device (Veinoflow SCD, Model LBTK-M-I 5001) has passed biocompatibility safety, electricity safety and electromagnetic compatibility safety testing according to: ISO 10993-1: 2009, ISO 10993-5: 2009, ISO 10993-10: 2010, IEC 60601-1: 2005, and IEC 60601-1-2:2007.

The garments of the device and the whole system passed bench testing of: Pressure testing, Inflation/deflation time, Anti-stretch test of garment materials, Anti-stretch test of air chamber welding point, Air leakage test, Burst testing of garment, Bladder fatiguing test, and Velcro adhesion test.

The conclusion drawn from the bench testing is that the device is substantially equivalent to the predicate device.

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.

K112677

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

§ 870.5800 Compressible limb sleeve.

(a)
Identification. A compressible limb sleeve is a device that is used to prevent pooling of blood in a limb by inflating periodically a sleeve around the limb.(b)
Classification. Class II (performance standards).

0

Dalian Labtek Science & Development Co., Ltd. 2-2-2-2, No.4 Zhengren Street, Shahekou District, Dalian, China 116021

Section 5

510(k) Summary

[As required by 21 CFR 807.92]

1. Submission Information: AUG 1 6 2013 510(k) Number: K123830 June 26th, 2013 Date: Type of 510(k) Submission: Traditional Basis for 510(k) Submission: New device Submitter/Manufacturer: Dalian Labtek Science & Development Co., Ltd. 2-2-2-2, No.4 Zhengren Street, Shahekou District, Dalian, China 116021 Contactor: Doris Dong, Consultant Shanghai CV Technology Co., Ltd. Room 1706, No. 128 Songle Rd., Songjiang Area, Shanghai, China 201600 E-mail: doris d@126.com / Url: www.ceve.org.cn Tel: 86 21-31261348 / Fax: 86 21-37824346 2. Device Description: Proprietary Name: Veinoflow SCD, Model LBTK-M-I 5001

Common Name:Intermittent Pneumatic Compression Device
Classification Name:Compressible limb sleeve
Regulation Number:21 CFR 870.5800
Product Code:JOW
Device Class:II
Review Panel:Cardiovascular
Indications for use:Veinoflow SCD system, Model LBTK-M-I 5001 is a system to prevent
DVT (Deep Vein Thrombosis) by improving the blood velocity of patients.
LBTK-M-1 5001 is indicated for Circulation Enhancement, Deep Vein
Thrombosis Prophylaxis, Edema -Acute, Edema - Chronic, Extremity Pain
Incident to Trauma or Surgery, Leg ulcers, Venous Stasis / Venous
Insufficiency.
Device Description:1) Description of the compression system
Veinoflow SCD, Model LBTK-M-I 5001, is a pneumatic pump system that
supplies compressed air to inflate garments that are attached to a patent's
lower limbs. It consists of a pump controller, specially designed inflation
and deflation garments for feet and legs, air supply tubes, and power line.
The inflation and deflation garments have 3 types: ① thigh-calf garments,
② calf garments, and ③ foot cuffs.
The system offers sequential inflation and propels the vein blood from
limb to heart, therefore enhance the blood circulation. The controller can
automatically detect the external garment type, and provides pressure
correspondingly. The pressure value and inflatable interval time are preset
and adjustable.

The controller has a self test system, when there is any error, it will alarm both in visual and audio.

1

3. Substantial Equivalence:

.

Detailed comparison data is included in the section 9 of "Substantial Equivalence Discussion" of this 510(k) submission.

2

Dalian Labtek Science & Development Co., Ltd.
2-2-2-2, No.4 Zheneren Street Shahekou District Dalian, China 116021

New DevicePredicate Device
510(k) Number:K123830K112677
Product Code:JOWJOW
Proprietary Name:Veinoflow SCD, LBTK-M-I 5001The Venous Assist System DVT-2600
Manufacturer:Dalian Labtek Science & Development Co., Ltd.DAESUNG MAREF CO LTD
Indications for use:Veinoflow SCD system, Model LBTK-M-I 5001 is a system to prevent DVTDVT-2600 is a system to prevent DVT (Deep Vein Thrombosis) by
(Deep Vein Thrombosis) by improving the blood velocity of patients.improving the blood velocity of patients. DVT-2600 is indicated for
LBTK-M-I 5001 is indicated for Circulation Enhancement, Deep VeinCirculation Enhancement, Deep Vein Thrombosis Prophylaxis,
Thrombosis Prophylaxis, Edema -Acute, Edema - Chronic, Extremity PainEdema -Acute, Edema - Chronic, Extremity Pain Incident to Trauma
Incident to Trauma or Surgery, Leg ulcers, Venous Stasis / Venousor Surgery, Leg ulcers, Venous Stasis / Venous Insufficiency.
Insufficiency.
Components:pump controller, multi-cavity thigh-calf garments, calf garments, foot cuffs,pump controller, multi-cavity thigh-calf garments, calf garments, foot
battery, air supply tubes, power linecuffs, battery, air supply tubes, power line
Ingress of Water ProtectionOrdinaryOrdinary
Compression TypeThigh-calf garments & calf garments: Sequential, GradientThigh-calf garments & calf garments: Sequential, Gradient
Foot Cuffs: UniformFoot Cuffs: Uniform
Compression timeSingle thigh-calf garment: 5.5s CompressionSingle thigh-calf garment: 5.5s Compression
Dual thigh-calf garments: 11s CompressionDual thigh-calf garments: 11s Compression
Single calf garment: 4s CompressionSingle calf garment: 4s Compression
Dual calf garments: 8s CompressionDual calf garments: 8s Compression
Single foot cuff: 2.5s CompressionSingle foot cuff: 2.5s Compression
Dual foot cuffs: 5s CompressionDual foot cuffs: 5s Compression
Deflation time2~3s2~3s
Default inflatable interval time48s48s
Adjustable inflatable interval24s, 48s, 60s24s, 48s, 60s
time
Default PressureThigh-calf garments & calf garments: 40 mmHgThigh-calf garments & calf garments: 40 mmHg
Foot Cuffs: 130 mmHgFoot Cuffs: 120 mmHg
Adjustable pressureThigh-calf garments & calf garments: 30-60mmHgThigh-calf garments & calf garments: 20-60mmHg

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:

3

Dalian Labtek Science & Development Co., Ltd.
2-2-2-2, No.4 Zhengren Street, Shahekou District, Dalian, China 116021
Foot Cuffs: 120~140mmHgFoot Cuffs: 120-140mmHg
Mode of OperationContinuousContinuous
Application mode① Single thigh-calf garment Compression,① Single thigh-calf garment Compression;
② Dual thigh-calf garments Compression;② Dual thigh-calf garments Compression;
③ Single calf garment Compression;③ Single calf garment Compression;
④ Dual calf garments Compression;④ Dual calf garments Compression;
⑤ Single Foot cuff Compression;⑤ Single Foot cuff Compression;
⑥ Dual Foot cuffs Compression;⑥ Dual Foot cuffs Compression;
⑦ Simultaneous single thigh-calf garment and single calf garment⑦ Simultaneous single thigh-calf garment and single calf garment
CompressionCompression;
⑧ Simultaneous single foot cuff and single thigh-calf garment
Compression;
⑨ Simultaneous single foot cuff and single calf garment
Compression
Bed HookYesYes
Power Cord StorageYesYes
Audible/Visual AlarmsNo garment, Pump Error, Valve Error, Temperature Error, Software Error,
System Error, High Pressure, Low Pressure, Low BatteryCuff connection Error, Pressure Error, System Error, Power Error
Controller DimensionsLength: 240mm; Width: 140mm; Height: 263mmLength: 205mm; Width: 155mm; Height: 195mm
Controller Weight3.5kg1.9kg
Power RequirementAC 100-240V, 50VA, 50/60 HzAC 100-240V, 35VA, 50/60 Hz
Battery14.8V, 3100mAhr, Lithium Ion (Optional)11.1V, 2500mAhr, Lithium Ion (Optional)
Run Time: 3-4 hoursRun Time: 6-8 hours
Charge Time: 4~5 hours (charging only)Charge Time: 4 hours (charging only)
Shoulder StrapYes (optional)Yes
Shipping UnitEachEach
Standards:ISO 10993-1, ISO 10993-5, ISO 10993-10,
IEC 60601-1, and IEC 60601-1-2ISO 10993-1, ISO 10993-5, ISO 10993-10,
IEC 60601-1, and IEC 60601-1-2

4-6

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4

Dalian Labtek Science & Development Co., Ltd.

.

2-2-2-2, No 4 Zhengren Street, Shahekou District, Dalian, China 1160212) Electromagnetic compatibility test
3) Anti-stretch test of garment materials3) Electrical Safety test
4) Anti-stretch test of air chamber welding point
5) Air leakage test; 6) Burst testing of garment; 7) Bladder fatiguing test;
8) Velcro adhesion evaluation test; 9) Biological compatibility test;
10) Electromagnetic compatibility test; 11) Electrical Safety test
Non-sterile:Non-sterileNon-sterile
Microprocessor Control?YesYes
Differences:The new device and the predicate device have different Audible/Visual Alarms, dimensions and weight, battery capacity, and LCD display panel. The
new device has more safety testing on thigh-calf garments, calf garments and foot cuffs.
Similarities:The new device and the predicate device, both are portable, equipped with battery, have same intended use, components, function, working principle, operation mode, compression type, power supply, same compression cycle and similar preset pressure values, and similar conformity standards.
Conclusion:Since the new device has same components, working principle, intended use, and safety features with the predicate device, they are substantial equivalent.
Though the two devices have slightly differences, for example, different default pressure for foot cuffs, however, the new device can be adjusted to the same pressure as the predicate device. And the adjustable pressure range for foot cuffs is same.
In addition, the adjustable pressure range for thigh-calf garments/calf garments of the new device is different from the predicate device, however, it is covered by the adjustable pressure range of the predicate device.
Except that single foot cuff can not be used with single thigh-calf garments/calf garment simultaneously, the new device and the predicate device has same application mode of garments/cuffs.
Any difference in technological characteristics does not raise any new safety and effectiveness issues. The conclusion drawn from the testing (Electrical Safety test, Pressure testing, Inflation/deflation time, Air leakage test, Burst testing, and so on) is that the device is substantially equivalent to the predicate device.

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5

Dalian Labtek Science & Development Co., Ltd.

2-2-2-2, No.4 Zhengren Street, Shahekou District, Dalian, China 116021

  1. Discussion of Substantial Equivalence to the Predicate Device

Veinoflow SCD system is a non-invasive medical device that delivers air to the garments and sequentially pressures them. Accordingly, the Veinoflow SCD system is intrinsically safe. Apart from the intrinsic safety of the physiological mechanism of the Veinoflow SCD system, the product components are designed to minimize potential risks to patients during product use. In particular, the product is equipped with the following safety features:

  1. Audio and visual alarms are activated if inflation garments pressure either exceeds or fails to achieve recommended levels.

2 Relevant contraindications, numerous warning proper use and maintenance, are contained in the instruction manual.

3 The product labeling indicates that the device is restricted to sale by or on the order of a physician.

4 Software validation and other safety features.

The Veinoflow SCD, Model LBTK-M-I 5001, has passed biocompatibility safety, electricity safety and electromagnetic compatibility safety testing according to:

ISO 10993-1: 2009: Evaluation and testing within a risk management process

ISO 10993-5: 2009: Tests for cytotoxicity: In vitro methods;

ISO 10993-10: 2010: Tests for Irritation and Sensitization;

IEC 60601-1: 2005: Medical electrical equipment - Part 1: General requirements for basic safety and essential performance

IEC 60601-1-2:2007, Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests.

Moreover, the garments of the device and the whole system passed bench testing of: Pressure testing, Inflation/deflation time, Anti-stretch test of garment materials, Anti-stretch test of air chamber welding point, Air leakage test, Burst testing of garment, Bladder fatiguing test, and Velcro adhesion test.

Veinoflow SCD system, Model LBTK-M-1 5001 has the same technological characteristics, intend use, design, function, composition and mode of operation to the predicate device.

The conclusion drawn from the bench testing is that the device is substantially equivalent to the predicate device. Furthermore, the device complies with the recognized standards and performs its intended tasks as well as the legally marketed predicate device.

୧-୧

6

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WQ66-G609 Silver Spring, MD 20993-0002

August 16, 2013

Dalian Labtek Science & Development Co., Ltd. c/o Doris Dong Consultant Shanghai CV Technology Co., Ltd. Room 1706, No. 128 Songle Rd., Songjiang Area Shanghai, China 201600

Re: K123830

Trade/Device Name: Veinoflow SCD, Model LBTK-M-1 5001 Regulation Number: 21 CFR 870.5800 Regulation Name: Compressible Limb Sleeve Regulatory Class: Class II Product Code: JOW Dated: June 27, 2013 Received: July 16, 2013

Dear Ms. Dong:

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 docs 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.

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

7

Page 2 - Ms. Dong

device-related adverse events} (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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/ResourcesforYou/Industry/default.htm.

Sincerely yours,

M.A. Hillerman

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

Enclosure

8

Section 4 Indications for Use

510(k) Number (if known): K123830

Device Name: Veinoflow SCD, Model LBTK-M-I 5001

Indications for Use:

Veinoflow SCD system, Model LBTK-M-1 5001 is a system to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients. LBTK-M-I 5001 is indicated for Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg ulcers, Venous Stasis / Venous Insufficiency.

Prescription Use V (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of Center for Devices and Radiological Health (CDRH)

MA. Lillehemen

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