K Number
K151498
Device Name
Breathing circuit bacterial/viral filter
Date Cleared
2015-12-18

(197 days)

Product Code
Regulation Number
868.5260
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For use with ventilators, anesthesia machines and open flow systems where filtration of inspired and/or expired gases is desired and to add, maintain, retain moisture for the exhaled breathe of the patient. Use up to 24 hours. The Models of the filters are A501-1, A501-2, A501-3, and A501-4. The filters are intended for patient population that weighs greater than 10Kgs.
Device Description
Breathing circuit bacterial/viral filter has into two models: - 1) Bacterial/ viral filters; 2) Bacterial/viral filters HME. Breathing circuit bacterial/viral filters are available in multiple sizes and shapes, rectangular and round, and incorporate standard 15/22 mm connectors with a gas sampling luer port. The depth filter use electrostatic media for filtration and a foam media for the HME media.
More Information

No
The document describes a passive breathing circuit filter and HME device. There is no mention of AI or ML in the intended use, device description, or performance studies. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

Yes
The device is intended to 'add, maintain, retain moisture for the exhaled breathe of the patient' and filters inspired and/or expired gases for patients on ventilators or anesthesia machines, which directly contributes to the patient's physiological function and treatment.

No

This device is a breathing circuit bacterial/viral filter, used to filter inspired and expired gases and add moisture, not to diagnose medical conditions.

No

The device description clearly details physical components like filters, connectors, and media, indicating it is a hardware device, not software-only.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for use with ventilators, anesthesia machines, and open flow systems to filter inspired/expired gases and manage moisture in the patient's breath. This is a direct interaction with the patient's breathing circuit, not the analysis of samples taken from the body.
  • Device Description: The description details a physical filter and HME (Heat and Moisture Exchanger) that are part of a breathing circuit. It doesn't mention any components for analyzing biological samples.
  • Lack of IVD Characteristics: IVDs are typically used to examine specimens (like blood, urine, tissue) to provide information about a person's health status, diagnose conditions, or monitor treatment. This device does none of that.

The device described is a breathing circuit accessory used to improve the quality of inspired and expired air during ventilation or anesthesia.

N/A

Intended Use / Indications for Use

For use with ventilators, anesthesia machines and open filtration of inspired and/or expired gases is desired and to add, maintain, retain moisture for the exhaled breathe of the patient. Use up to 24 hours.

The Models of the filters are A501-1. A501-2. A501-4. The filters are intended for patient population that weighs greater than 10Kgs.

Product codes

CAH

Device Description

Breathing circuit bacterial/viral filter has into two models: - 1) Bacterial/ viral filters; 2) Bacterial/viral filters HME. Breathing circuit bacterial/viral filters are available in multiple sizes and shapes, rectangular and round, and incorporate standard 15/22 mm connectors with a gas sampling luer port. The depth filter use electrostatic media for filtration and a foam media for the HME media.

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

The filters are intended for patient population that weighs greater than 10Kgs.

150cc-adult
70-250cc-pediatric

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 breathing circuit bacterial/viral filter of Haisheng has been tested for biocompatibility, sterility and performance testing in accordance to conformance standards, FDA guidance and international standards. Test data and reports were provided as part of the 510(k) submission. A comparison between the subject device and predicate is provided below:

Performance Testing:
Device Biocompatibility Test: See section 016 -Patient Contact Materials and Compatibility
EO Residual:

§ 868.5260 Breathing circuit bacterial filter.

(a)
Identification. A breathing circuit bacterial filter is a device that is intended to remove microbiological and particulate matter from the gases in the breathing circuit.(b)
Classification. Class II (performance standards).

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Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-000

December 18, 2015

Zheiiang Haisheng Medical Device Co., Ltd Mr. Hu Junbin, Quality Director 305 Tanggong Road, Paojiang Industrial Zone Shaoxing City, Zhejiang 312071 China

Re: K151498

Trade/Device Name: Breathing Circuit Bacterial/viral Filter Regulation Number: 21 CFR 868.5260 Regulation Name: Breathing Circuit Bacterial/Viral filter Regulatory Class: II Product Code: CAH Dated: November 11, 2015 Received: November 17, 2015

Dear Mr. Junbin,

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.

Image /page/0/Picture/10 description: The image shows the logo for the U.S. Department of Health and 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 three faces in profile, overlapping each other. The faces are rendered in a simple, line-art style.

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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 (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.

Tejashri Purohit-Sheth, M.D.

Tejashri Purohit-Sheth, M.D. Clinical Deputy Director DAGRID/ODE/CDRH FOR

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital. Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K151498

Device Name Breathing circuit bacterial/viral filter

Indications for Use (Describe)

For use with ventilators, anesthesia machines and open filtration of inspired and/or expired gases is desired and to add, maintain, retain moisture for the exhaled breathe of the patient. Use up to 24 hours.

The Models of the filters are A501-1. A501-2. A501-4. The filters are intended for patient population that weighs greater than 10Kgs.

Type of Use (Select one or both, as applicable)

☑ Prescription Use (Part 21 CFR 801 Subpart D)
☐ Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary

[As required by 21 CFR 807.92]

K151498

1. Date Prepared [21 CFR807.92 (a) (1)]

December 16, 2015

2. Submitter's Information [21 CFR807.92 (a) (1)]

Name of Sponsor: ZHEJIANG HAISHENG MEDICAL DEVICE CO., LTD. Address: 305#Tanggong Road, Paojiang Industrial Zone Shaoxing City, Zhejiang 312071, P.R.China Contact Name: Hu Junbin Telephone No.: 86-575-88158510 Fax No.: 86-575-88158559 Email Address: hujb@hisern.com Correspondent: Jonathan Hu (Shanghai Medwheat Consulting)

3. Trade Name, Common Name, Classification [21 CFR 807.92(a)(2)]

Trade Name:Breathing circuit bacterial/viral filter
Common Name:Bacterial/viral filters and Heat and Moisture Exchanger
Model Name:A501-1, A501-2, A501-3, A501-4
Regulation Classification21 CFR 868.5260, Breathing circuit bacterial filter
Product Code:CAH
Classification Panel:Anesthesiology
Device Class:II

4. Identification of Predicate Device(s) [21 CFR 807.92(a)(3)[

The identified predicate within this submission is as follows:

The EMS Electra Filter and Filter/HME have been cleared by FDA through 510(k) K013122 (Decision Date - April 19, 2002)

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5. Description of the Device [21 CFR 807.92(a)(4)]

Breathing circuit bacterial/viral filter has into two models: - 1) Bacterial/ viral filters; 2) Bacterial/viral filters HME. Breathing circuit bacterial/viral filters are available in multiple sizes and shapes, rectangular and round, and incorporate standard 15/22 mm connectors with a gas sampling luer port. The depth filter use electrostatic media for filtration and a foam media for the HME media.

6. Intended Use [21 CFR 807.92(a)(5)]

For use with ventilators, anesthesia machines and open flow systems where filtration of inspired and/or expired gases is desired and to add, maintain, retain moisture for the exhaled breathe of the patient. Use up to 24 hours.

The Models of the filters are A501-1, A501-2, A501-3, and A501-4. The filters are intended for patient population that weighs greater than 10Kgs.

AttributeBreathing circuit bacterial/viral filter
Indications for use – To filter inspired and /or expired gases.Same
Intended for extended or single patient up to 24 hrsYes
Prescription UseYes
Intended PopulationAny patient
Intended environment of useHome, hospital, sub-acute, emergency services
Placement in various locations in circuitYes
Design
Gas sampling portYes
Standard 15/22 mm connectorsYes
Dead space (ml)10 to 65(ml)
Resistance to flow≤3cm H2O@ 60lpm-adult
1cm H2O@ 20lpm-pediatric
Bacterial filtration-BFE-Nelson Lab99.999+%
Viral filtration-VFE-Nelson Lab99.99+%
Weight(g)10-32 (g)
Humidification output(mg H2O/L)32 mg H2O/L at TV of 1000cc-adult
32 mg H2O/L at TV of 250cc-pediatric
Tidal volume ranges>150cc-adult
70-250cc-pediatric
Materials
Housing polystyreneYes

7. Technological Characteristics [21 CFR 807.92(a)(6)]

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Filter mediaElectrostatic polypropylene
Performance Standards
None under Section 514Yes
ISO 5356-1 Conical 15/22Yes
ISO 594-2 Luer fittingsYes
ISO 9360-HME moisture outputYes

8. Substantial Equivalence [21 CFR 807.92(b) (1) and 807.92]

The breathing circuit bacterial/viral filter of Haisheng has been tested for biocompatibility, sterility and performance testing in accordance to conformance standards, FDA guidance and international standards. Test data and reports were provided as part of the 510(k) submission. A comparison between the subject device and predicate is provided below:

| Item | Subject Device | Predicate Device | Justification
&
Comments |
|-------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------|
| Indications For Use | | | |
| Description | For use with ventilators,
anesthesia machines and
open flow systems where
filtration of inspired and / or
expired gases is desired and
add maintain retain moisture
for the exhaled breathe of the
patient. Use up to 24 hours. | For use with ventilators,
anesthesia machines and
open flow systems where
filtration of inspired and / or
expired gases is desired and
add maintain retain moisture
for the exhaled breathe of the
patient. Use up to 24 hours. | same |
| Technology | | | |
| Product Structure | The product can be divided into
four main sections, which is top
cover, filter media and lower
cover, sampling port. | The product can be divided
into four main sections, which
is top cover, filter media, and
lower cover, and sampling
port. | same |
| Top Cover Material | Housing polystyrene | Housing polystyrene | same |
| Filter Media | Electrostatic polypropylene | Electrostatic polypropylene | same |
| Lower Cover Material | Housing polystyrene | Housing polystyrene | same |
| Gas Sampling Port
Material | PE | PE | same |
| Package Material | Dialyzing paper and PE film | Dialyzing paper and PE film | same |
| Color Additive | None | None | same |
| Sterilization | EO | EO | same |
| Standards | ISO 5356-1
ISO 594-2
ISO 9360 | ISO 5356-1
ISO 594-2
ISO 9360 | same |

Table: Comparison to Predicate Device (K013122)

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Performance Testing
Device Biocompatibility
TestSee section 016 -Patient
Contact Materials and
Compatibility
EO Residual