K Number
K160881
Device Name
Tablo Console
Date Cleared
2016-11-15

(230 days)

Product Code
Regulation Number
876.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Tablo™ System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician's prescription, with a trained individual available as needed who is considered competent in the use of the prescribing physician.
Device Description
The Tablo™ Console is a self-contained hemodialysis system (Console) intended for acute and chronic dialysis therapy with or without ultrafiltration, in an acute or chronic care facility. The console consists of fluidic systems that perform the activities of a Water Purification System (WPS) and a conventional Dialysis Delivery System (DDS). Since the original 510(k) clearance, the Tablo Console has incorporated design and corresponding labeling updates whose purpose was to improve ease of manufacturing, increase reliability, simplify the design, and optimize performance.
More Information

Not Found

No
The document describes a hemodialysis system and its updates, focusing on manufacturing, reliability, and performance optimization of fluidic and mechanical systems. There is no mention of AI, ML, image processing, or data training/testing sets, which are typical indicators of AI/ML integration in medical devices.

Yes

The device is indicated for use in patients with acute and/or chronic renal failure and performs hemodialysis, which is a therapeutic intervention.

No

The device description clearly states its purpose as a self-contained hemodialysis system for acute and chronic dialysis therapy, which is a treatment, not a diagnostic procedure.

No

The device description explicitly states it is a "self-contained hemodialysis system (Console)" consisting of "fluidic systems," indicating it is a hardware device with integrated software, not a software-only medical device.

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

Here's why:

  • Intended Use: The intended use is for treating patients with renal failure through hemodialysis. This is a therapeutic treatment performed directly on the patient, not a test performed on a sample taken from the patient.
  • Device Description: The device is described as a self-contained hemodialysis system that performs water purification and dialysis delivery. These are functions related to the treatment process itself, not the analysis of biological samples.
  • Lack of IVD Characteristics: The description does not mention any components or functions related to analyzing biological samples (like blood, urine, etc.) to diagnose a condition, monitor a disease, or screen for a disease.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. The Tablo™ System's purpose is to provide a therapeutic treatment for renal failure.

N/A

Intended Use / Indications for Use

The Tablo™ System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician's prescription, with a trained individual available as needed who is considered competent in the use of the prescribing physician.

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

KDI, FIP

Device Description

The Tablo™ Console is a self-contained hemodialysis system (Console) intended for acute and chronic dialysis therapy with or without ultrafiltration, in an acute or chronic care facility. The console consists of fluidic systems that perform the activities of a Water Purification System (WPS) and a conventional Dialysis Delivery System (DDS). Since the original 510(k) clearance, the Tablo Console has incorporated design and corresponding labeling updates whose purpose was to improve ease of manufacturing, increase reliability, simplify the design, and optimize performance.

Mentions image processing

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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

acute or chronic care facility. Treatments must be administered under physician's prescription, with a trained individual available as needed who is considered competent in the use of the device by the prescribing physician.

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)

Performance testing completed on the proposed device to support the determination of substantial equivalence is summarized below and has been developed in accordance with appropriate FDA guidance documents and relevant standards.

Since the original clearance, the Tablo Console has incorporated design and corresponding labeling updates whose purpose was to improve ease of manufacturing, increase reliability, simplify the design, and optimize performance. The complete list of changes implemented and included in the Tablo Console Roll-Up attachment are included in the summary of performance data below.

Biocompatibility Testing: Design updates to the fluidic system have been made to the modified device and biocompatibility has been evaluated. There were no changes to the material type, formulation, chemical composition, material processing or contact duration. No additional testing was required.

Electrical Safety and Electromagnetic Compatibility (EMC): The Tablo Console with Wireless Capability has been evaluated against the requirements for Electromagnetic Compatibility and Electrical Safety. The evaluation of the device was conducted in accordance with IEC 60601-1, IEC 60601-1-2, IEC 60601-1-6, IEC 60601-1-8, and IEC 60601-2-16.

Software Verification and Validation Testing: For all software modifications, system level software verification testing demonstrated that the Tablo meets functional and performance software requirements.

System Performance Testing: System Performance Testing included verification of design updates specific to the roll-up changes in the following areas:

  • Fluidic System Optimization
  • Front Panel Interface
  • Console External and Internal Design
  • System Accessories
  • Dialyzer Prime
  • Heat Disinfection

Animal Studies: No animal studies were performed in support of the modifications.

Clinical Studies: No clinical studies were performed in support of the modifications.

Conclusion: The performance testing demonstrates that the Tablo Console with expanded wireless capability meets all performance specifications and complies with applicable standards and FDA Guidance Documents. The proposed Tablo Console with expanded Wireless Capability is substantially equivalent to the predicate device, and the minor differences in the technological characteristics of the proposed and the predicate devices do not raise any new or different questions of safety or effectiveness.

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

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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.

K140866, K150880

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

§ 876.5860 High permeability hemodialysis system.

(a)
Identification. A high permeability hemodialysis system is a device intended for use as an artificial kidney system for the treatment of patients with renal failure, fluid overload, or toxemic conditions by performing such therapies as hemodialysis, hemofiltration, hemoconcentration, and hemodiafiltration. Using a hemodialyzer with a semipermeable membrane that is more permeable to water than the semipermeable membrane of the conventional hemodialysis system (§ 876.5820), the high permeability hemodialysis system removes toxins or excess fluid from the patient's blood using the principles of convection (via a high ultrafiltration rate) and/or diffusion (via a concentration gradient in dialysate). During treatment, blood is circulated from the patient through the hemodialyzer's blood compartment, while the dialysate solution flows countercurrent through the dialysate compartment. In this process, toxins and/or fluid are transferred across the membrane from the blood to the dialysate compartment. The hemodialysis delivery machine controls and monitors the parameters related to this processing, including the rate at which blood and dialysate are pumped through the system, and the rate at which fluid is removed from the patient. The high permeability hemodialysis system consists of the following devices:(1) The hemodialyzer consists of a semipermeable membrane with an in vitro ultrafiltration coefficient (K
uf ) greater than 8 milliliters per hour per conventional millimeter of mercury, as measured with bovine or expired human blood, and is used with either an automated ultrafiltration controller or anther method of ultrafiltration control to prevent fluid imbalance.(2) The hemodialysis delivery machine is similar to the extracorporeal blood system and dialysate delivery system of the hemodialysis system and accessories (§ 876.5820), with the addition of an ultrafiltration controller and mechanisms that monitor and/or control such parameters as fluid balance, dialysate composition, and patient treatment parameters (e.g., blood pressure, hematocrit, urea, etc.).
(3) The high permeability hemodialysis system accessories include, but are not limited to, tubing lines and various treatment related monitors (e.g., dialysate pH, blood pressure, hematocrit, and blood recirculation monitors).
(b)
Classification. Class II. The special controls for this device are FDA's:(1) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Device—Part I: Evaluation and Testing,’ ”
(2) “Guidance for the Content of 510(k)s for Conventional and High Permeability Hemodialyzers,”
(3) “Guidance for Industry and CDRH Reviewers on the Content of Premarket Notifications for Hemodialysis Delivery Systems,”
(4) “Guidance for the Content of Premarket Notifications for Water Purification Components and Systems for Hemodialysis,” and
(5) “Guidance for Hemodialyzer Reuse Labeling.”

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Image /page/0/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized image of three human profiles facing to the right, with the profiles overlapping each other. The profiles are positioned above a set of three wavy lines. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the top of the logo.

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

November 15, 2016

Outset Medical, Inc. Julie Newsome Vice President of Quality and Regulatory Operations 1830 Bering Drive San Jose, CA 95112

Re: K160881 Trade/Device Name: Tablo Console Regulation Number: 21 CFR§ 876.5860 Regulation Name: High Permeability Hemodialysis System Regulatory Class: II Product Code: KDI, FIP Dated: October 13, 2016 Received: October 14, 2016

Dear Julie Newsome:

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) K160881

Device Name Tablo Console

Indications for Use (Describe)

The Tablo™ System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician's prescription, with a trained individual available as needed who is considered competent in the use of the prescribing physician.

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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K160881 - 510(k) Summary

This 510(k) Summary is in accordance with the requirements of the Safe Medical Device Act (SMDA) of 1990. The content of this 510(k) summary is provided in conformance with 21 CFR Part 807.92.

| Submitter's Name: | Julie Newsome
Vice President, Quality and Regulatory Operations
Outset Medical, Inc.
1830 Bering Drive, San Jose, CA 95112 |
|------------------------------|-------------------------------------------------------------------------------------------------------------------------------------|
| Company: | Vice President, Quality and Regulatory Operations |
| Address: | 1830 Bering Drive, San Jose, CA 95112 |
| Contact Person: | Julie Newsome
Vice President, Quality and Regulatory Operations
Outset Medical, Inc. |
| Phone: | 650.521.2245 |
| Facsimile: | 669.231.8201 |
| Email: | jnewsome@outsetmedical.com |
| Date of Summary Preparation: | |

Submitter's Information

Device Information

Trade Name:Tablo™ Console
Common Name:Hemodialysis Delivery SystemPortable Water Treatment System
Classification Name:High Permeability Hemodialysis
Delivery SystemWater Purification System for
Hemodialysis
Classification
Number:Class II per 21 CFR 876.5860Class II per 21 CFR 876.5665
Product Code:KDIFIP
Classification Panel:Gastroenterology/UrologyGastroenterology/Urology

Predicate Device Information

The Tablo Console was originally cleared under K140866 and most recently cleared under K150880 for the addition of one-way Wireless Capability.

Device Description

The Tablo™ Console is a self-contained hemodialysis system (Console) intended for acute and chronic dialysis therapy with or without ultrafiltration, in an acute or chronic care facility. The console consists of fluidic systems that perform the activities of a Water Purification System (WPS) and a conventional Dialysis Delivery System (DDS). Since the original 510(k) clearance, the Tablo Console has incorporated design and corresponding labeling updates whose purpose was

4

to improve ease of manufacturing, increase reliability, simplify the design, and optimize performance.

Indications for Use

The Tablo System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician's prescription, with a trained individual available as needed who is considered competent in the use of the device by the prescribing physician.

Key Performance Specifications/Characteristics of the Device

The proposed Tablo Console with Expanded Wireless Data Transmission Capability and the predicate device (K150880) are equivalent in technological characteristics:

  • Design and Construction
  • Water Purification Method
  • Dialysate Preparation ●
  • Disinfection - Heat and chemical disinfection
  • . Materials (patient and non-patient contacting)
  • Electrical safety and associated testing
  • Compatibility - Interface with the Tablo Cartridge (Blood Tubing Set)
  • Off the shelf components - Dialyzers and non-invasive blood pressure cuffs (NIBP).
  • Standards - Electrical and electromagnetic safety, Water Purification, and Hemodialysis System standards.
  • Software - Software controlled, and utilizes Graphic User Interface (GUI)
  • Software verification and validation ●
  • Wireless data transmission capability

The principal purpose of this 510(k) is to describe the expanded wireless communication capabilities for the Tablo Console. The changes made to the device since the last 510(k) clearance K150880 are also covered within this 510(k) submission.

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Comparison of Technological Characteristics with the Predicate Device

Performance testing completed on the proposed device to support the determination of substantial equivalence is summarized below and has been developed in accordance with appropriate FDA guidance documents and relevant standards.

Since the original clearance, the Tablo Console has incorporated design and corresponding labeling updates whose purpose was to improve ease of manufacturing, increase reliability, simplify the design, and optimize performance. The complete list of changes implemented and included in the Tablo Console Roll-Up attachment are included in the summary of performance data below.

Biocompatibility Testing

Design updates to the fluidic system have been made to the modified device and biocompatibility has been evaluated. There were no changes to the material type, formulation, chemical composition, material processing or contact duration. No additional testing was required.

Electrical Safety and Electromagnetic Compatibility (EMC)

The Tablo Console with Wireless Capability has been evaluated against the requirements for Electromagnetic Compatibility and Electrical Safety. The evaluation of the device was conducted in accordance with IEC 60601-1, IEC 60601-1-2, IEC 60601-1-6, IEC 60601-1-8, and IEC 60601-2-16.

Software Verification and Validation Testing

For all software modifications, system level software verification testing demonstrated that the Tablo meets functional and performance software requirements.

System Performance Testing

System Performance Testing included verification of design updates specific to the roll-up changes in the following areas:

  • Fluidic System Optimization
  • Front Panel Interface
  • Console External and Internal Design ●
  • System Accessories
  • Dialyzer Prime
  • . Heat Disinfection

Animal Studies

No animal studies were performed in support of the modifications.

Clinical Studies

No clinical studies were performed in support of the modifications.

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Conclusion

The performance testing demonstrates that the Tablo Console with expanded wireless capability meets all performance specifications and complies with applicable standards and FDA Guidance Documents. The proposed Tablo Console with expanded Wireless Capability is substantially equivalent to the predicate device, and the minor differences in the technological characteristics of the proposed and the predicate devices do not raise any new or different questions of safety or effectiveness.