K Number
K151637
Device Name
UPT Series Medical RO Water System
Date Cleared
2015-09-23

(98 days)

Product Code
Regulation Number
876.5665
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
UPT Series Medical Reverse Osmosis Water Treatment System is intended to be used to remove organic and inorganic contaminants from a tap water supply to dilute a dialysate concentrate for hemodialysis treatments, as well as for use for dialyzer reprocessing and dialysis equipment disinfecting and rinsing. This System is strictly for multi patient use, such as for a dialysis clinic or hospital serving multiple patients with a Central Water Purification System and is intended for use only with conventional hemodialysis treatments. It is not intended for use with high-flux, CRRT, or any other form of dialysis.
Device Description
The UPT Series Medical Reverse Osmosis Water Treatment System is an accessory device that is intended for use with hemodialysis applications and is intended to remove orqanic and inorganic substances and microbial contaminates from tap water used to dilute dialysis concentrate to form dialysate. The UPT Series Medical Reverse Osmosis Water Treatment System will produce water as prescribed by the Association for the Advancement of Medical Instrumentation (AAMI) Standard ANSI/AAMI/ISO 13959:2014 Water for Hemodialysis and Related Therapies provided adequate flow rate of the feed (tap) water and compliance with existing drinking water standards and proper pre-treatment.
More Information

Not Found

No
The document describes a standard reverse osmosis water treatment system for hemodialysis and does not mention any AI or ML components or functionalities.

No.
The device treats water, not a medical condition. It's an accessory to hemodialysis, not a direct therapeutic device.

No

Explanation: The device is a water treatment system for hemodialysis and focuses on removing contaminants from water used for treatment, not on diagnosing medical conditions in patients.

No

The device description clearly indicates it is a "Water Treatment System" which is a physical piece of equipment designed to remove contaminants from water. It is not solely software.

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

Here's why:

  • Intended Use: The intended use is to treat water for hemodialysis, dialyzer reprocessing, and dialysis equipment disinfecting and rinsing. This is a process that prepares a substance (water) for use in a medical procedure performed on a patient, not a test performed in vitro (outside the body) on a sample from a patient to diagnose a condition.
  • Device Description: The description reinforces that it's an accessory device for hemodialysis applications, focused on removing contaminants from water.
  • Lack of IVD Characteristics: The text does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing diagnostic information about a patient's health status
    • Using reagents or assays to detect specific substances in a sample

The device is a water treatment system used in a clinical setting to prepare water for a medical procedure. This falls under the category of medical devices, but not specifically in vitro diagnostics.

N/A

Intended Use / Indications for Use

UPT Series Medical Reverse Osmosis Water Treatment System is intended to be used to remove organic and inorganic contaminants from a tap water supply to dilute a dialysate concentrate for hemodialysis treatments, as well as for use for dialyzer reprocessing and dialysis equipment disinfecting and rinsing.

This System is strictly for multi patient use, such as for a dialysis clinic or hospital serving multiple patients with a Central Water Purification System and is intended for use only with conventional hemodialysis treatments. It is not intended for use with high-flux, CRRT, or any other form of dialysis.

Product codes

FIP

Device Description

The UPT Series Medical Reverse Osmosis Water Treatment System is an accessory device that is intended for use with hemodialysis applications and is intended to remove organic and inorganic substances and microbial contaminates from tap water used to dilute dialysis concentrate to form dialysate. The UPT Series Medical Reverse Osmosis Water Treatment System will produce water as prescribed by the Association for the Advancement of Medical Instrumentation (AAMI) Standard ANSI/AAMI/ISO 13959:2014 Water for Hemodialysis and Related Therapies provided adequate flow rate of the feed (tap) water and compliance with existing drinking water standards and proper pre-treatment.

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

multi patient use, such as for a dialysis clinic or hospital serving multiple patients with a Central Water Purification System

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

Not required for determination of substantial equivilance for this type and class of device.

Key Metrics

Not Found

Predicate Device(s)

K051620, K041163

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5665 Water purification system for hemodialysis.

(a)
Identification. A water purification system for hemodialysis is a device that is intended for use with a hemodialysis system and that is intended to remove organic and inorganic substances and microbial contaminants from water used to dilute dialysate concentrate to form dialysate. This generic type of device may include a water softener, sediment filter, carbon filter, and water distillation system.(b)
Classification. Class II (special controls). The device, when it is a water purification subsystem disinfectant, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

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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" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized caduceus or a human figure with three heads or faces, with flowing lines suggesting movement or connection.

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

September 23, 2015

Specialty Water Technologies Alex Clark Compliance Manager 1020 Industrial Drive Orlinda, TN 37141

Re: K151637

Trade/Device Name: UPT Series Medical Reverse Osmosis Water Treatment System Regulation Number: 21 CFR 876.5665 Regulation Name: Water purification system for hemodialysis Regulatory Class: II Product Code: FIP Dated: August 21, 2015 Received: August 24, 2015

Dear Alex Clark,

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.

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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 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,

Benjamin R. Fisher -S

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known)

K151637

Device Name

UPT Series Medical Reverse Osmosis Water Treatment System

Indications for Use (Describe)

UPT Series Medical Reverse Osmosis Water Treatment System is intended to be used to remove organic and inorganic contaminants from a tap water supply to dilute a dialysate concentrate for hemodialysis treatments, as well as for use for dialyzer reprocessing and dialysis equipment disinfecting and rinsing.

This System is strictly for multi patient use, such as for a dialysis clinic or hospital serving multiple patients with a Central Water Purification System and is intended for use only with conventional hemodialysis treatments. It is not intended for use with high-flux, CRRT, or any other form of dialysis.

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

510(k) Number: _______________________________________________________________________________________________________________________________________________________________

Manufacturer:Specialty Water Technologies
Address:1020 Industrial Drive
Orlinda, TN 37141
(615) 654-4441
Official Contact:Alex Clark
Compliance Manager
Trade Name:UPT Series Medical Reverse Osmosis Water Treatment
System
Common Name:Water Purification System
Classification Name:Water Purification System for Hemodialysis
Product Code:78 FIP
Device Class:II
Classification Reg:876.5665

Specialty Water Technologies has provided the following information to the US Food and Drug Administration to support substantial equivalence of the UPT Series Medical Reverse Osmosis (RO) Water Purification System to other RO water purification systems currently cleared for sale in the U.S.

1. Device Description

The UPT Series Medical Reverse Osmosis Water Treatment System is an accessory device that is intended for use with hemodialysis applications and is intended to remove orqanic and inorganic substances and microbial contaminates from tap water used to dilute dialysis concentrate to form dialysate. The UPT Series Medical Reverse Osmosis Water Treatment System will produce water as prescribed by the Association for the Advancement of Medical Instrumentation (AAMI) Standard ANSI/AAMI/ISO 13959:2014 Water for Hemodialysis and Related Therapies provided adequate flow rate of the feed (tap) water and compliance with existing drinking water standards and proper pre-treatment.

2. Intended Use

UPT Series Medical Reverse Osmosis Water Treatment System is intended to be used to remove organic and inorqanic contaminants from a tap water supply to dilute a dialysate concentrate for hemodialysis treatments, as well as for use for dialyzer reprocessing and dialysis equipment disinfecting and rinsing.

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This System is strictly for multi patient use, such as for a dialysis clinic or hospital serving multiple patients with a Central Water Purification System and is intended for use only with conventional hemodialysis treatments. It is not intended for use with high-flux, CRRT, or any other form of dialysis.

SpecificationsPredicate Devices
SpecificationsUPT Series Medical Reverse
Osmosis Water Treatment SystemMatrix Series Digital Reverse
OsmosisComplete Water System Models
MD610, 620, 630 and 640
ManufacturerSpecialty Water TechnologiesBetter Water, IncIsopure Corporation
510(k) NumberK051620K041163
Decision Date11/18/200510/7/2004
Classification876.5665, Class II876.5665, Class II876.5665, Class II
Product Code78 FIP78 FIP78 FIP
Water Contact
MaterialsFDA-NSF CompliantFDA-NSF CompliantFDA-NSF Compliant
Pre-Treatment
OptionsBased upon site specific feed
water chemical analysisBased upon site specific feed water
chemical analysisBased upon site specific feed water
chemical analysis
Feed water Pre-Treatment may
include:Feed water Pre-Treatment may
include:Feed water Pre-Treatment may
include:
Carbon FiltrationCarbon FiltrationCarbon Filtration
SoftenersSoftenersSofteners
Temperature ControlTemperature ControlTemperature Control
Pressure CompensationPressure CompensationPressure Compensation
Special FiltrationSpecial FiltrationSpecial Filtration
Ultra-Violet (UV)Ultra-Violet (UV)Ultra-Violet (UV)
Operational
FeaturesElectronic Touch Screen InterfaceElectronic Touch Screen InterfaceElectronic Touch Screen Interface
All components mounded on an
open frame for accessibilityAll components mounted on an
open frame for accessibilityAll components mounted on an open
frame for accessibility
Electronic Monitoring of:Electronic Monitoring of:Electronic Monitoring of:
Feed Water Pressure / FlowFeed Water Pressure / FlowFeed Water Pressure
Product Water Pressure / FlowProduct Water Pressure / FlowProduct Water Pressure
Membrane Feed PressureMembrane Feed PressureMembrane Feed Pressure
Pump PressurePump PressurePump Pressure
Reject Water Pressure / FlowReject Water Pressure / FlowReject Water Pressure / Flow
Product Water ConductivityProduct Water ConductivityProduct Water Conductivity
Feed Water ConductivityFeed Water ConductivityFeed Water Conductivity
Safety Features100% Diversion to drain above
product conductivity set-point100% Diversion to drain above
product conductivity set-point100% Diversion to drain above
product conductivity set-point
Low Supply Pressure AlarmLow Supply Pressure AlarmLow Supply Pressure Alarm
High Product Water Conductivity
AlarmHigh Product Water Conductivity
AlarmHigh Product Water Conductivity Shut
Down
High Supply Water Temperature
Shut DownHigh Supply Water Temperature
Shut DownHigh Supply Water Temperature Shut
Down
Power Disturbance AlarmPower Disturbance AlarmPower Disturbance Alarm
Remote Alarm (Nurses Station)Remote Alarm (Nurses Station)Remote Alarm (Nurses Station)
May include 0.5 micron or better
ultra-filtrationMay include 0.5 micron or better
ultra-filtrationMay include 0.5 micron or better
ultra-filtration
Post-Treatment
PerformanceDelivery of AAMI Standard WaterDelivery of AAMI Standard WaterDelivery of AAMI Standard Water

3. Substantial Equivalence to Predicate Device

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4. Safety and Effectiveness

The intended use and technological characteristics of the UPT Series Medical Reverse Osmosis Water Treatment System are similar or equivilant to the predicate devices indicated. Any differences between the device and the predicate devices have no significant influence on the safety or effectiveness of the product.

5. Clinical Performance Data

Not required for determination of substantial equivilance for this type and class of device.

6. Electromagnetic Compatibility & Safety

The water system does not contain any wifi, wireless or other transmitting or receiving devices. Any electrical connections between components are wired to include any remote alarms.

The electrical control components purchased and used in the construction of the components used for this water system comply with:

EN/IEC 61000-4-2 Electrostatic Discharges EN/IEC 61000-4-3 Radiated Fields and Transients / Burst EN/IEC 61000-4-4 Electrical Fast Transients / Burst EN/IEC 61000-4-8 Maqnetic Field UL Approved / Recognized for safety

All pumps used are UL recognized (UR) and CSA Approved for safety

7. Conclusion Drawn from Clinical and Nonclinical Test Data

As compared with the predicate devices, K051620 and K041663, the UPT Series Medical Reverse Osmosis Water Treatment System will produce water that will meet the minimum water quality requirements as specified by Association for the Advancement of Medical Instrumentation (AAMI) standard ANSI/AAMI/ISO 13959:2014, Water for Hemodialysis and Related Therapies; and ANSI/AAMI/ISO 26722:2014, Water Treatment Equipment for Hemodialysis Applications and Related Therapies, when used as directed.