K Number
K140205
Device Name
PLEUR-EVAC SAHARA PLUS CONTINUOUS REINFUSION AND AUTOTRANSFUSION SYSTEM
Date Cleared
2014-10-23

(269 days)

Product Code
Regulation Number
868.5830
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
For the collection of autologous blood from the patient's pleural cavity or mediastinal area for reinfusion purposes in trauma and post-operative situations, To evacuate air and/or fluid from the chest cavity or mediastinum, To help prevent air and/or fluid from re-accumulating in the chest cavity or mediastinum, To help re-establish and maintain normal intra-thoracic pressure gradients, To facilitate complete lung re-expansion to restore normal breathing dynamics.
Device Description
Provided as a sterile unit and intended for single patient use, the S-1150-08LF Pleurevac Sahara® Plus Continuous Reinfusion Autotransfusion System is a threechamber, collection/reinfusion system used for the collection and continuous reinfusion of autologous blood. By attaching a blood transfer bag, which is available as an accessory item, the S-1150-08LF Pleur-evac Sahara® Plus serves as a bag reinfusion system with a non-pyrogenic fluid path. When autotransfusion is complete, the S-1150-08LF Pleur-evac Sahara® Plus can serve as a dry seal/dry suction chest drainage collection unit.
More Information

No
The description focuses on a mechanical system for blood collection and reinfusion, with no mention of AI or ML terms, image processing, or data-driven performance metrics.

Yes
The device is used for the collection and reinfusion of autologous blood, as well as evacuating fluid and air from the chest cavity, to restore normal breathing and maintain intra-thoracic pressure. These actions directly aid in the treatment and management of a patient's medical condition.

No

The device description and intended use indicate it is for collecting and reinfusing autologous blood and for chest drainage, which are therapeutic and collection functions, not diagnostic.

No

The device description clearly describes a physical, three-chamber collection/reinfusion system, which is a hardware device, not software.

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

Here's why:

  • Intended Use: The intended use clearly describes the collection and reinfusion of autologous blood from the patient's body, as well as chest drainage. This is a therapeutic and surgical support function, not a diagnostic one.
  • Device Description: The description details a system for collecting and reinfusing blood and managing chest drainage. It does not mention any components or processes related to analyzing biological samples to diagnose a condition.
  • Lack of Diagnostic Elements: There is no mention of analyzing blood or fluid for diagnostic markers, performing tests on samples, or providing information for diagnosis.

IVD devices are specifically designed to examine specimens derived from the human body (like blood, urine, tissue) to provide information for the diagnosis, monitoring, or treatment of a disease or condition. This device's function is entirely focused on managing blood and fluid within the body for therapeutic and supportive purposes.

N/A

Intended Use / Indications for Use

For the collection of autologous blood from the patient's pleural cavity or mediastinal area for reinfusion purposes in trauma and post-operative situations,
To evacuate air and/or fluid from the chest cavity or mediastinum,
To help prevent air and/or fluid from re-accumulating in the chest cavity or mediastinum,
To help re-establish and maintain normal intra-thoracic pressure gradients,
To facilitate complete lung re-expansion to restore normal breathing dynamics.

Product codes

CAC

Device Description

Provided as a sterile unit and intended for single patient use, the S-1150-08LF Pleurevac Sahara® Plus Continuous Reinfusion Autotransfusion System is a threechamber, collection/reinfusion system used for the collection and continuous reinfusion of autologous blood. By attaching a blood transfer bag, which is available as an accessory item, the S-1150-08LF Pleur-evac Sahara® Plus serves as a bag reinfusion system with a non-pyrogenic fluid path. When autotransfusion is complete, the S-1150-08LF Pleur-evac Sahara® Plus can serve as a dry seal/dry suction chest drainage collection unit.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

patient's pleural cavity or mediastinal area, chest cavity or mediastinum

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)

Teleflex has performed bench testing to verify that the performance of the proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is substantially equivalent to the predicate device, and that the Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is seamlessly interchangeable with the predicate device. Various functionality tests were performed to ensure that the faceplate and universal connector will perform as intended.

Test Parameters and Results:

  • Inter-Chamber Leak Test: 60 units tested. All compartments must hold the indicated volumes with liquid spillover occurring only at the spillover level. Result: Pass.
  • Leak Integrity Test: 60 units tested. The unit shall be airtight when operated at negative pressure 60 cm H20. Result: Pass.
  • Burst Test: 60 units tested. The unit shall have a minimum burst strength of 5 psig (PSI Gauge) at welded joints with all openings to atmosphere sealed. Result: Pass.
  • Reinfusion Tube Separation Force Test: 60 units tested. The separation force of the tube and spring from the reinfusion port and the tube from the spike port shall be a minimum of 10 lbs axially. Result: Pass.

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

Not Found

Predicate Device(s)

K130043

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5830 Autotransfusion apparatus.

(a)
Identification. An autotransfusion apparatus is a device used to collect and reinfuse the blood lost by a patient due to surgery or trauma.(b)
Classification. Class II (performance standards).

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Image /page/0/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 text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an abstract symbol that resembles a stylized human figure in profile, with three overlapping faces suggesting community and support.

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

October 23, 2014

Teleflex Medical, Inc. % Ms. Holly Hallock Regulatory Affairs Specialist 2917 Weck Dr. P.O. Box 12600 Research Triangle Park, North Carolina 27709

Re: K140205

Trade/Device Name: Pleur-evac Sahara Plus Continuous Reinfusion And Autotransfusion System Regulation Number: 21 CFR 868.5830 Regulation Name: Autotransfusion Apparatus Regulatory Class: Class II Product Code: CAC Dated: September 9, 2014 Received: September 10, 2014

Dear Ms. Hallock,

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.

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

1

Part 807); labeling (21 CFR Part 801); medical device reporting of medical devicerelated 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 contact the Division of Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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. Hillebrand

for

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

Enclosure

2

Indications for Use

Page 1 of 1

510(k) Number:

K140205

Device Name:

Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System

Indications for Use:

  • . For the collection of autologous blood from the patient's pleural cavity or mediastinal area for reinfusion purposes in trauma and post-operative situations,
  • To evacuate air and/or fluid from the chest cavity or mediastinum,
  • To help prevent air and/or fluid from re-accumulating in the chest cavity or ● mediastinum,
  • To help re-establish and maintain normal intra-thoracic pressure gradients, ●
  • o To facilitate complete lung re-expansion to restore normal breathing dynamics.

Prescription Use XX (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 CDRH, Office of Device Evaluation (ODE)

3

510(k) SUMMARY

Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System

A. Name, Address, Phone and Fax Number of Applicant

Teleflex Medical, Incorporated 2917 Weck Drive Research Triangle Park, NC 27709 USA Phone: 919-433-4918 Fax: 919-433-4996

B. Contact Person

Holly Kornegay Regulatory Affairs Specialist

Lorraine DeLong RA/QE Manager - Surgical

C. Date Prepared

January 24, 2014

D. Device Name

| Trade Name: | Pleur-evac Sahara® Plus Continuous Reinfusion
Autotransfusion System |
|----------------------------|-------------------------------------------------------------------------|
| Common Name: | Autotransfusion Apparatus |
| Regulatory Classification: | Class II |
| Regulation Number: | 21 CFR 868.5830 |
| Product Code: | CAC |

E. Device Description

Provided as a sterile unit and intended for single patient use, the S-1150-08LF Pleurevac Sahara® Plus Continuous Reinfusion Autotransfusion System is a threechamber, collection/reinfusion system used for the collection and continuous reinfusion of autologous blood. By attaching a blood transfer bag, which is available as an accessory item, the S-1150-08LF Pleur-evac Sahara® Plus serves as a bag reinfusion system with a non-pyrogenic fluid path. When autotransfusion is complete, the S-1150-08LF Pleur-evac Sahara® Plus can serve as a dry seal/dry suction chest drainage collection unit.

4

F. Indications for Use

Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion Systems are indicated for:

  • For the collection of autologous blood from the patient's pleural cavity or . mediastinal area for reinfusion purposes in trauma and post-operative situations,
  • To evacuate air and/or fluid from the chest cavity or mediastinum,
  • To help prevent air and/or fluid from re-accumulating in the chest cavity or . mediastinum,
  • To help re-establish and maintain normal intra-thoracic pressure gradients,
  • To facilitate complete lung re-expansion to restore normal breathing dynamics.

G. Contraindications

Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion Systems are contraindicated for:

  • · Pericardial, mediastinal, or systemic infections,
  • · Pulmonary and respiratory infection or infestation,
  • · Presence of malignant neoplasms,
  • · Coagulopathies,
  • · Suspected thoraco-abdominal injuries with possible enteric contamination,
  • · Impaired renal function,
  • · Intraoperative thoracic or mediastinal cavity use of topical thrombin, microfibrillar hemostatic agents or providine-iodine antiseptic gels or solutions and non I.V. compatible antibiotics.

H. Substantial Equivalence

The proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is substantially equivalent to the predicate device:

Predicate DeviceManufacturer510(k) No.Date Cleared
S-1150-08LF Pleur-evac
Sahara® Plus Continuous
Reinfusion Autoransfusion
SystemTeleflex MedicalK130043February 12, 2013

I. Comparison to Predicate Devices

The Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System has the same indication for use and functional characteristics as the predicate system. The proposed modifications are changes in the material of the faceplate and the universal connector.

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J. Materials

All patient contacting materials are in compliance with ISO 10993-1:2009 and FDA Bluebook Memorandum G95-1.

K. Technological Characteristics

A comparison of the technological characteristics of the proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System and the predicate has been performed. The results of this comparison demonstrate that the Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System faceplate and universal connector are equivalent to the marketed predicate device in technological characteristics. A summary of these comparisons is included in the table below. For a complete comparison chart, please refer to Section 16.

| Technological
Characteristics | Predicate Device,
S-1150-08LF | Proposed Device,
S-1150-08LF | Comparison |
|----------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|
| Indications for
Use | For the collection of
autologous blood from
the patient's pleural
cavity or mediastinal
area for reinfusion
purposes in trauma and
post-operative
situations, To evacuate air and/or
fluid from the chest
cavity or mediastinum, To help prevent air
and/or fluid from re-
accumulating in the
chest cavity or
mediastinum, To help re-establish
and maintain normal
intra-thoracic pressure
gradients, To facilitate complete
lung re-expansion to
restore normal
breathing dynamics. | For the collection of
autologous blood from the
patient's pleural cavity or
mediastinal area for
reinfusion purposes in
trauma and post-operative
situations, To evacuate air and/or fluid
from the chest cavity or
mediastinum, To help prevent air and/or
fluid from re-accumulating
in the chest cavity or
mediastinum, To help re-establish and
maintain normal intra-
thoracic pressure gradients, To facilitate complete lung
re-expansion to restore
normal breathing dynamics. | Same |
| Collection | Yes, the predicate featured a
collection compartment for
either gravity or suction
drainage and collection. | Yes, the proposed S-1150-08LF
features a collection
compartment for either gravity
or suction drainage and
collection. | Same |
| Reinfusion | Yes, when connected to an
accessory bag, the predicate | Yes, when connected to an
accessory bag, the proposed S- | Same |

Teleflex Medical, Inc.

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L. Performance Data

Teleflex has performed bench testing to verify that the performance of the proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is substantially equivalent to the predicate device, and that the Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is seamlessly interchangeable with the predicate device. Various functionality tests were performed to ensure that the faceplate and universal connector will perform as intended. The test results are summarized below. For more details, please refer to Section 23

| Product

DescriptionQuantityTest ParametersResults
Inter- Chamber
Leak Test60All compartments must
hold the indicated volumes
with liquid spillover
occurring only at the
spillover level.Pass
Leak Integrity Test60The unit shall be airtight
when operated at negative
pressure 60 cm H20Pass
Burst Test60The unit shall have a
minimum burst strength of
5 psig (PSI Gauge) at
welded joints with all
openings to atmosphere
sealedPass
Reinfusion Tube
Separation Force
Test60The separation force of the
tube and spring from the
reinfusion port and the
tube from the spike port
shall be a minimum of 10
lbs axially.Pass

M. Conclusion

Based upon the comparative test results, the proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System is substantially equivalent to the predicate device cleared to market via 510(k) K130043. The modifications made to the proposed Pleur-evac Sahara® Plus Continuous Reinfusion Autotransfusion System do not introduce any new issues of safety and effectiveness.