K Number
K141496
Device Name
MULTI-PARAMETER MOBILE CAREGUIDE 4100 OXIMETER
Date Cleared
2014-08-04

(59 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Multi-Parameter Mobile CareGuide™ 4100 Oximeter is intended for use as an adjunct, non-invasive monitor of the hemoglobin oxygen saturation and pH of microvascular blood in a region of skeletal muscle tissue beneath the sensor. The sensor may be positioned on pigmented skin. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended to allow for display of SmO2 and pHm data on a third party or Reflectance supplied device, which would interface with the Multi-Parameter Mobile CareGuide 4100 Oximeter via a powered USB connection. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended for prescriptive use (Rx only) by a trained healthcare professional inside and outside a hospital. The Multi-Parameter Mobile CareGuide 4100 Oximeter provides output of the most recent values of SmO2 and pHm in a trend, as well as operational device information. The Multi-Parameter Mobile CareGuide 4100 Oximeter should not be used as the sole basis for diagnosis or therapy. Note: The prospective clinical value of data from the Multi-Parameter Mobile CareGuide 4100 Oximeter has not been demonstrated in disease states.
Device Description
The Multi-Parameter Mobile CareGuide 4100 is a noninvasive optical sensor that determines two separate medical parameters and reports them out for display to the user in real-time. Light sources in the sensor illuminate the skin with near infrared (NIR) light passes through the skin and fat with only some loss to be primarily absorbed by small blood vessels in the muscle tissue. Light which is not absorbed is scattered back and analyzed by the spectroscopic detector, also contained in the sensor. The microprocessor in the sensor converts the reflected light to an absorbance spectrum which is then analyzed by two separate algorithms, also stored in the sensor's microprocessor. The two algorithms calculate muscle oxygen saturation (Sm22), and muscle pH (pHm). The sensor is attached to the patient using the CareGuide Disposable. One Disposable is used per patient, but the CareGuide Sensor is reusable. To use, the adhesive liner is removed from the Disposable and, with the sensor clipped into the Disposable, is adhered to the patient's skin over either the deltoid, calf or thigh muscle. When the sensor is first placed on the patient, software checks to make sure the LEDs are functioning properly and then the sensor automatically performs an optimization routine which sets up the spectral data collection parameters for the individual patient. Once conditions are established the sensor begins collecting spectra and reporting parameter values. The Multi-Parameter Mobile CareGuide 4100 measures and provides for output of SmO2 and pHm data. The Multi-Parameter Mobile CareGuide 4100 communicates with either a 3ª party display or monitoring device, or RMI-supplied tablet, which is compliant with the Mobile CareGuide communications protocol. Sm02 and pHm values suitable for display and trending are sent via the Mobile CareGuide communications protocol to the display device as well as error information and device states.
More Information

Not Found

No
The document describes the use of "two separate algorithms" to calculate parameters from spectroscopic data, but there is no mention of AI, ML, or related terms like neural networks or deep learning. The description of the algorithms is limited to their function in converting reflected light to an absorbance spectrum and then calculating the parameters.

No.
The device is a non-invasive monitor that provides data (SmO2 and pHm) but explicitly states it "should not be used as the sole basis for diagnosis or therapy."

No
The document states, "The Multi-Parameter Mobile CareGuide 4100 Oximeter should not be used as the sole basis for diagnosis or therapy." This indicates it's an adjunct monitor, not a primary diagnostic tool.

No

The device description clearly details a physical sensor with light sources, a spectroscopic detector, and a microprocessor that performs data collection and analysis. While it interfaces with a display device via software, the core medical device functionality resides in the hardware sensor.

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

Here's why:

  • IVDs analyze samples taken from the body (in vitro), such as blood, urine, or tissue. This device is a non-invasive optical sensor that measures parameters in the body (in vivo) by shining light through the skin and analyzing the reflected light.
  • The intended use and device description clearly state it measures parameters of microvascular blood in a region of skeletal muscle tissue beneath the sensor. This is a direct measurement within the body, not an analysis of a sample taken from the body.

Therefore, the Multi-Parameter Mobile CareGuide™ 4100 Oximeter is a non-invasive medical device used for monitoring physiological parameters in vivo.

N/A

Intended Use / Indications for Use

The Multi-Parameter Mobile CareGuide™ 4100 Oximeter is intended for use as an adjunct, non-invasive monitor of the hemoglobin oxygen saturation and pH of microvascular blood in a region of skeletal muscle tissue beneath the sensor. The sensor may be positioned on pigmented skin. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended to allow for display of SmO2 and pHm data on a third party or Reflectance supplied device, which would interface with the Multi-Parameter Mobile CareGuide 4100 Oximeter via a powered USB connection. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended for prescriptive use (Rx only) by a trained healthcare professional inside and outside a hospital. The Multi-Parameter Mobile CareGuide 4100 Oximeter provides output of the most recent values of SmO2 and pHm in a trend, as well as operational device information. The Multi-Parameter Mobile CareGuide 4100 Oximeter should not be used as the sole basis for diagnosis or therapy. Note: The prospective clinical value of data from the Multi-Parameter Mobile CareGuide 4100 Oximeter has not been demonstrated in disease states.

Product codes

MUD, CBZ

Device Description

The Multi-Parameter Mobile CareGuide 4100 is a noninvasive optical sensor that determines two separate medical parameters and reports them out for display to the user in real-time. Light sources in the sensor illuminate the skin with near infrared (NIR) light passes through the skin and fat with only some loss to be primarily absorbed by small blood vessels in the muscle tissue. Light which is not absorbed is scattered back and analyzed by the spectroscopic detector, also contained in the sensor. The microprocessor in the sensor converts the reflected light to an absorbance spectrum which is then analyzed by two separate algorithms, also stored in the sensor's microprocessor. The two algorithms calculate muscle oxygen saturation (Sm22), and muscle pH (pHm).

The sensor is attached to the patient using the CareGuide Disposable. One Disposable is used per patient, but the CareGuide Sensor is reusable. To use, the adhesive liner is removed from the Disposable and, with the sensor clipped into the Disposable, is adhered to the patient's skin over either the deltoid, calf or thigh muscle.

When the sensor is first placed on the patient, software checks to make sure the LEDs are functioning properly and then the sensor automatically performs an optimization routine which sets up the spectral data collection parameters for the individual patient. Once conditions are established the sensor begins collecting spectra and reporting parameter values.

The Multi-Parameter Mobile CareGuide 4100 measures and provides for output of SmO2 and pHm data. The Multi-Parameter Mobile CareGuide 4100 communicates with either a 3rd party display or monitoring device, or RMI-supplied tablet, which is compliant with the Mobile CareGuide communications protocol. Sm02 and pHm values suitable for display and trending are sent via the Mobile CareGuide communications protocol to the display device as well as error information and device states.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

NIR spectroscopy

Anatomical Site

skeletal muscle tissue beneath the sensor, deltoid, calf or thigh muscle.

Indicated Patient Age Range

Not Found

Intended User / Care Setting

trained healthcare professional inside and outside a hospital.

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)

Device Verification and Validation tests such as Vibration and shock, Auto-start, Sensor optimization and background checks and verification of minor updates to the CareGuide 4100 algorithm.
The test results in this submission demonstrate that the Multi-Parameter Mobile CareGuide 4100 Oximeter meets the expected performance requirements for an Oximeter. The accuracy, functionality and safety of the Multi-Parameter Mobile CareGuide 4100 Oximeter is the equivalent to the predicate device.

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

Not Found

Predicate Device(s)

K113656, K122645, K130079, K133923

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

Public Health Service

Image /page/0/Picture/2 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 a stylized image of a human figure embracing a bird, which is a common symbol associated with the department.

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

August 22, 2014

Reflectance Medical, Inc. % Nandini Murthy Regulatory Consultant 116 Flanders Road, Suite 1000 Westborough, Massachusetts 01581

Re: K141496

Trade/Device Name: Multi-parameter Mobile Careguide 4100 Oximeter Regulation Number: 21 CFR 870.2700 Regulation Name: Oximeter Regulatory Class: Class II Product Code: MUD. CBZ Dated: June 4, 2014 Received: June 6, 2014

Dear Nandini Murthy,

This letter corrects our substantially equivalent letter of August 4, 2014.

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.

1

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 devicerelated 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 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 vours.

sincerely yours,

[signature]

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

Enclosure

2

510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

Indications for Use Form

Indications for Use

510(k) Number (if known):

Multi-Parameter Mobile CareGuide™ 4100 Oximeter Device Name:

Indications for Use:

The Multi-Parameter Mobile CareGuide™ 4100 Oximeter is intended for use as an adjunct, non-invasive monitor of the hemoglobin oxygen saturation and pH of microvascular blood in a region of skeletal muscle tissue beneath the sensor. The sensor may be positioned on pigmented skin. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended to allow for display of SmO2 and pHm data on a third party or Reflectance supplied device, which would interface with the Multi-Parameter Mobile CareGuide 4100 Oximeter via a powered USB connection. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended for prescriptive use (Rx only) by a trained healthcare professional inside and outside a hospital. The Multi-Parameter Mobile CareGuide 4100 Oximeter provides output of the most recent values of SmO2 and pHm in a trend, as well as operational device information. The Multi-Parameter Mobile CareGuide 4100 Oximeter should not be used as the sole basis for diagnosis or therapy. Note: The prospective clinical value of data from the Multi-Parameter Mobile CareGuide 4100 Oximeter has not been demonstrated in disease states.

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)

Page of of

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510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

SECTION 5

510(k) SUMMARY

SUMMARY OF SAFETY AND EFFECTIVENESS FOR Multi-Parameter Mobile CareGuide™ 4100 Oximeter

Submitter Information

Name:Reflectance Medical, Inc. (RMI)
Address:116 Flanders Road, Suite 1000
Westborough, MA 01581 USA
Telephone Number:508.366.4700
Registration Number:NA (RMI will apply for registration number following 510(k)
clearance, prior to commencement of commercial shipment.)
Contact Person:Dr. Babs Soller
Telephone Number:508.366.4700, Ext 223
Fax Number:508.366.4770
Email:babs.soller@reflectancemedical.com
Date Prepared:August 1, 2014

Device Name

Trade name of New Device:Multi-Parameter CareGuide™ Oximeter
Model Number:4100
510(k) Holder/Submitter:Reflectance Medical, Inc. (RMI)
510(k) Number:N/A
Applicable product codes:MUD, 21 CFR 870.2700 Oximeter and
CBZ, 21 CFR 868.1170 Analyzer, Hydrogen-Ion
(Ph)
Classification Panel:Cardiovascular

Predicate Devices

Predicate Device #1:CareGuide Oximeter
Trade name of Device:CareGuide™ Oximeter
Model #:1100
510(k) holder/Submitter:Reflectance Medical, Inc.

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510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

510(k) Number:K113656
Predicate Device #2:CareGuide Oximeter
Trade name of Device:Mobile CareGuide™ Oximeter
Model #:2100
510(k) holder/Submitter:Reflectance Medical, Inc.
510(k) Number:K122645
Predicate Device #3:CareGuide Oximeter
Trade name of Device:Multi-Parameter Mobile CareGuide™ Oximeter
Model #:3100
510(k) holder/Submitter:Reflectance Medical, Inc.
510(k) Number:K130079
Predicate Device #4:CareGuide Oximeter
Trade name of Device:Multi-Parameter Mobile CareGuide™ Oximeter
Model #:3100 with Tablet
510(k) holder/Submitter:Reflectance Medical, Inc.
510(k) Number:K133923

Device Description

The Multi-Parameter Mobile CareGuide 4100 has the following technical characteristics in common with the CareGuide family of predicate devices.

| Characteristics | Reflectance Medical Multi-Parameter Mobile CareGuide 4100
Oximeter |
|------------------------|-----------------------------------------------------------------------|
| Principle of Operation | NIR spectroscopy |
| Components | Monitor with reusable sensor and disposable pad |
| Light Source | LEDs |
| Parameters Measured | Tissue oxygen saturation (SmO2) and muscle pH (pHm) |

The Multi-Parameter Mobile CareGuide 4100 is a noninvasive optical sensor that determines two separate medical parameters and reports them out for display to the user in real-time. Light sources in the sensor illuminate the skin with near infrared (NIR) light passes through the skin and fat with only some loss to be primarily absorbed by small blood vessels in the muscle tissue. Light which is not absorbed is scattered back and analyzed by the spectroscopic

5

510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

detector, also contained in the sensor. The microprocessor in the sensor converts the reflected light to an absorbance spectrum which is then analyzed by two separate algorithms, also stored in the sensor's microprocessor. The two algorithms calculate muscle oxygen saturation (Sm22), and muscle pH (pHm).

The sensor is attached to the patient using the CareGuide Disposable. One Disposable is used per patient, but the CareGuide Sensor is reusable. To use, the adhesive liner is removed from the Disposable and, with the sensor clipped into the Disposable, is adhered to the patient's skin over either the deltoid, calf or thigh muscle.

When the sensor is first placed on the patient, software checks to make sure the LEDs are functioning properly and then the sensor automatically performs an optimization routine which sets up the spectral data collection parameters for the individual patient. Once conditions are established the sensor begins collecting spectra and reporting parameter values.

The Multi-Parameter Mobile CareGuide 4100 measures and provides for output of SmO2 and pHm data. The Multi-Parameter Mobile CareGuide 4100 communicates with either a 3ª party display or monitoring device, or RMI-supplied tablet, which is compliant with the Mobile CareGuide communications protocol. Sm02 and pHm values suitable for display and trending are sent via the Mobile CareGuide communications protocol to the display device as well as error information and device states.

Indications for Use

The Multi-Parameter Mobile CareGuide™ 4100 Oximeter is intended for use as an adjunct, noninvasive monitor of the hemoglobin oxygen saturation and pH of microvascular blood in a region of skeletal muscle tissue beneath the sensor may be positioned on pigmented skin. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended to allow for display of SmO2 and pHm data on a third party or Reflectance supplied device, which would interface with the Multi-Parameter Mobile CareGuide 4100 Oximeter via a powered USB connection. The Multi-Parameter Mobile CareGuide 4100 Oximeter is intended for prescriptive use (Rx only) by a trained healthcare professional inside and outside a hospital. The Multi-Parameter Mobile CareGuide 4100 Oximeter provides output of the most recent values of SmO2 and pHm in a trend, as well as operational device information. The Multi-Parameter Mobile CareGuide 4100 Oximeter should not be used as the sole basis for diagnosis or therapy. Note: The prospective clinical value of data from the Multi-Parameter Mobile CareGuide 4100 Oximeter has not been demonstrated in disease states.

Rationale for Substantial Equivalence

The Multi-Parameter Mobile CareGuide 4100 Oximeter is substantially equivalent to the Reflectance Medical CareGuide predicate devices by intended use and design.

6

510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

  • . The Mobile CareGuide 4100 Oximeter is identical to the predicate family in technological optical principles. They all use the identical NIR Spectroscopy hardware and software, using multiple wavelengths in the range 700-900 nm to measure tissue oxygen saturation and pH.
  • The Multi-Parameter Mobile CareGuide 4100 Oximeter has a reusable sensor, disposable . and sensor check functionality equivalent to the predicates.
  • The Multi-Parameter Mobile CareGuide 4100 Oximeter provides identical data to be . displayed as numeric values or trend.
  • . The Intended Use is the same as the predicate.
  • . Therefore, the Multi-Parameter Mobile CareGuide 4100 Oximeter is substantially equivalent to the predicates in terms of the proposed intended use and technology.
  • There are no new or open questions of safety and effectiveness. ●

Summary of Safety and Effectiveness Data

Testing demonstrates that the Multi-Parameter Mobile CareGuide 4100 Oximeter is a safe and effective oximeter meeting all relevant FDA recognized standards and internal testing as listed in Table 1.

| Standard #
or Internal

TestDescription
IEC60825-1
Ed 2.0 (2007)Safety of laser products - Part 1: Equipment classification, and
requirements
IEC 60601-1-
1: 2005Medical electrical equipment -- Part 1-1: General requirements for safety –
Collateral standards: Safety requirements for medical electrical systems
IEC 60601-1-
2: 2007-03Medical Electrical Equipment - Part 1-2: General Requirements for basic
safety and essential performance – Collateral standard: Electromagnetic
Compatibility – Requirements and tests
ISO 10993-5
2009Biological evaluation of medical devices-Part 5: Test for in vitro
cytotoxicity
ISO 10993-10
2010Biological evaluation of medical devices-Part 10: Tests for irritation and
delay-type hypersensitivity
AAMI TIR
12:2010Designing, testing and labeling reusable medical devices for reprocessing
in health care facilities: A guide for medical device manufacturers
AAMI TIR
30:2003A compendium of processes, materials, test methods, and acceptance
criteria for cleaning reusable medical devices

Table 1 Standards and Internal Testing

7

510(k) Premarket Notification Submission: Multi-Parameter Mobile CareGuide™ 4100 Oximeter

| Standard #
or Internal

TestDescription
ISTA 1ASeries Non-Simulation Integrity Performance Test Procedure: Packaged-
Products 150 lb (68 kg) or Less
Internal TestsDevice Verification and Validation tests such as Vibration and shock,
Auto-start, Sensor optimization and background checks and verification of
minor updates to the CareGuide 4100 algorithm

The test results in this submission demonstrate that the Multi-Parameter Mobile CareGuide 4100 Oximeter meets the expected performance requirements for an Oximeter. The accuracy, functionality and safety of the Multi-Parameter Mobile CareGuide 4100 Oximeter is the equivalent to the predicate device.

Conclusion

The Multi-Parameter Mobile CareGuide 4100 Oximeter is equivalent to predicate devices in terms of technology (NIR Spectroscopy) and intended use. The Multi-Parameter Mobile CareGuide 4100 Oximeter does not raise new questions of safety or effectiveness, as compared to the predicate. Therefore, the Multi-Parameter Mobile CareGuide 4100 Oximeter is substantially equivalent to the predicate device.