K Number
K161613
Device Name
Hang&Go PAC
Manufacturer
Date Cleared
2016-12-28

(201 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Disposable device intended to recirculate, filtrate and perfuse physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity. The device is intended for use in a single procedure.
Device Description
The Hang&Go PAC, just like the Hang&Go HT Basic, is a disposable, single use kit intended to circulate and filtrate physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity. The Hang&Go PAC is supplied sterile and packaged in a proprietary-design container and it is intended to be used only with the PERFORMER HT. The Hang&Go PAC, just like the Hang&Go HT Basic, includes all necessary tubing and components for the treatment execution: circulation tubing, heater bag, reservoir, table pack (Patient inlet and outlet tubing) with thermal protections. The Flow Reverse is a disposable, sterile component of the Hang&Go PAC. It is supplied sterile, individually packaged and included in the Hang&Go PAC carton box. The crossed layout of the 4 tubing segments allow to exchange the Patient's inlet and outlet flows by selectively opening / closing two segments at a time with the provided manual clamps.
More Information

No
The device description and performance studies focus on mechanical and fluid dynamics, with no mention of AI or ML.

No.
The device is used to recirculate, filtrate, and perfuse sterile solutions, which is a supportive function rather than directly treating a disease or condition. It is an accessory to another device (PERFORMER HT) that likely performs the therapeutic function.

No

The device is described as flushing and recirculating solutions in the body for therapeutic purposes (perfusing and treating), not for identifying or diagnosing a condition.

No

The device description clearly outlines physical components like tubing, a heater bag, a reservoir, and a Flow Reverse component, indicating it is a hardware-based medical device.

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

Here's why:

  • Intended Use: The intended use is to "recirculate, filtrate and perfuse physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity." This describes a procedure performed on the patient's body cavity, not a test performed on a sample taken from the patient.
  • Device Description: The description details tubing, a heater bag, a reservoir, and components for circulating and filtering a solution within a body cavity. This aligns with a surgical or therapeutic device, not a diagnostic one.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting biomarkers, or providing diagnostic information.
  • Anatomical Site: The device is used within the thoracic or abdominal cavity, which is a direct interaction with the patient's body, not a laboratory analysis of a sample.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for the diagnosis, monitoring, or treatment of diseases or conditions. This device's function is entirely focused on a therapeutic procedure within the body.

N/A

Intended Use / Indications for Use

The Hang&Go PAC is a disposable device intended to recirculate, filtrate and perfuse physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity.

The device is intended for use in a single procedure.

Product codes

LGZ

Device Description

The Hang&Go PAC is intended to be used like the Hang&Go HT Basic R9900090, cleared under K120026. The Hang&Go PAC, just like the Hang&Go HT Basic, is a disposable, single use kit intended to circulate and filtrate physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity. The Hang&Go PAC is supplied sterile and packaged in a proprietary-design container and it is intended to be used only with the PERFORMER HT.

The Hang&Go PAC, just like the Hang&Go HT Basic, includes all necessary tubing and components for the treatment execution:

  • · circulation tubing
  • · heater bag
  • · reservoir
  • · table pack (Patient inlet and outlet tubing) with thermal protections

21 CFR 807.92(a)(4): Description of the device (Flow Reverse)

The Flow Reverse is a disposable, sterile component of the Hang&Go PAC. It is supplied sterile, individually packaged and included in the Hang&Go PAC carton box. The crossed layout of the 4 tubing segments allow to exchange the Patient's inlet and outlet flows by selectively opening / closing two segments at a time with the provided manual clamps.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

thoracic or abdominal cavity

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)

Non-clinical tests were conducted to demonstrate compliance with standards and continued conformance of new design outputs with defined requirements. These tests included packaging qualification, accelerated aging, and force at break of pre-assembled catheters. Additional tests were conducted using saline solution, including static priming volume, qualification of additional temperature probes, pressure drops determination, verification of fitting interfaces and effectiveness of the Flow Reverse, and physical integrity verification through hydraulic test. The biocompatibility and sterilization verification testing associated with the standards applied to the predicate device were cross-referenced to support substantial equivalence.

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

Not Found

Predicate Device(s)

K120026

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5725 Infusion pump.

(a)
Identification. An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.(b)
Classification. Class II (performance standards).

0

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 stylized caduceus symbol, which is a staff with two snakes coiled around it. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the symbol. The logo is black and white.

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

December 28, 2016

RanD S.r.1. Simone Ceretti Regulatory Affairs Manager via Statale 12, 62 Medolla 41036 ITALY

Re: K161613

Trade/Device Name: Hang&Go PAC Regulation Number: 21 CFR 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: LGZ Dated: November 25, 2016 Received: December 1, 2016

Dear Simone Ceretti:

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 (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,

Image /page/1/Picture/8 description: The image contains a signature and a name. The name is "Tina Kiang-S". The signature is to the left of the name and is illegible.

Tina Kiang, Ph.D. Acting Director Division of Anesthesiology. General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K161613

Device Name

Hang&Go PAC

Indications for Use (Describe)

Disposable device intended to recirculate, filtrate and perfuse physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity. The device is intended for use in a single procedure.

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the
time to review instructions, search existing data sources, gather and maintain the data needed and complete
and review the collection of information. Send comments regarding this burden estimate or any other aspect
of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services

Food and Drug Administration

Office of Chief Information Officer

Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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

3

Image /page/3/Picture/0 description: The image shows the logo for the RAND Corporation. The logo consists of an abstract graphic on the left, resembling a stylized person with a blue circle for the head and an orange crescent shape for the body. To the right of the graphic is the text "RAND" in a serif font, with the letters in a muted gray color. A blue bar is at the bottom of the image.

INNOVATION IN MEDICAL TECHNOLOGY

510(k) Summary

21 CFR 807.92(a)(1): Submitter and Manufacturing site information RanD S.r.1. via Statale 12, 62 41036 Medolla (MO) – ITAL Y Telephone: +39 0535 49283 Fax: +39 0535 660636 Contact person: Simone Ceretti

Establishment registration number: 3003793891

Date of the present summary preparation: 28th December, 2016

21 CFR 807.92(a)(2): Device information
Trade name:Hang&Go PAC
Device:Infusion pump
Classification Panel:General Hospital
Product Code:LGZ (Warmer, Thermal, Infusion Fluid)
Regulation name:Infusion pump
Regulation number:21 CFR § 880.5725
Regulatory Class:2

21 CFR 807.92(a)(3): Predicate device

Hang&Go HT Basic (cleared under K120026, dtd. May 8 2012).

21 CFR 807.92(a)(4): Description of the device

The Hang&Go PAC is intended to be used like the Hang&Go HT Basic R9900090, cleared under K120026. The Hang&Go PAC, just like the Hang&Go HT Basic, is a disposable, single use kit intended to circulate and filtrate physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity. The Hang&Go PAC is supplied sterile and packaged in a proprietary-design container and it is intended to be used only with the PERFORMER HT.

The Hang&Go PAC, just like the Hang&Go HT Basic, includes all necessary tubing and components for the treatment execution:

  • · circulation tubing
  • · heater bag
  • · reservoir
  • · table pack (Patient inlet and outlet tubing) with thermal protections

21 CFR 807.92(a)(4): Description of the device (Flow Reverse)

The Flow Reverse is a disposable, sterile component of the Hang&Go PAC. It is supplied sterile, individually packaged and included in the Hang&Go PAC carton box. The crossed layout of the 4 tubing segments allow to exchange the Patient's inlet and outlet flows by selectively opening / closing two segments at a time with the provided manual clamps.

4

Image /page/4/Picture/0 description: The image shows the logo for RAND Corporation. The logo consists of an orange crescent shape with a blue circle above it, followed by the letters "R," "A," "N," and "D" in a gray serif font. The crescent shape and circle are positioned to the left of the letters, creating a visual representation of a person with their arm raised.

INNOVATION IN MEDICAL TECHNOLOGY

21 CFR 807.92(a)(5): Indications for use

The Hang&Go PAC is a disposable device intended to recirculate, filtrate and perfuse physiologically compatible sterile solution (i.e. saline solution) in the thoracic or abdominal cavity.

The device is intended for use in a single procedure.

Predicate device intended use

The Hang&Go HT Basic is a disposable device intended to recirculate, filtrate and perfuse clear solutions in the thoracic or abdominal cavity.

The device is intended for use in a single procedure.

21 CFR 807.92(a)(6): Comparison of technological characteristics

The Hang&Go PAC has the same intended, materials and principle of use of the Hang&Go HT Basic.

The design of the Hang&Go PAC differs from the Hang&Go HT Basic in the following aspects:

  • . The inlet and outlet tubing to/from the Patient of the Hang&Go PAC have two access points, instead of three:
  • . The inlet and outlet tubing of the Hang&Go PAC have two additional integrated temperature probes;
  • . The inlet and outlet tubing of the Hang&Go PAC have pre-assembled catheters, instead the Hang&Go HT Basic inlet and outlet tubing have proper connectors at one end ant the user must connect catheters at the moment of use;
  • . the Hang&Go PAC includes in the packaging an accessory, the Flow Reverse. Comparison with this component is detailed in the following section.

Manufacturing process for the assembly of the components and the sterilization process are the same conducted on the Hang&Go HT Basic. Moreover, main technical features and mode of use are the same. Thus, all the validation activities made on the Hang&Go HT Basic (mechanical tests, efficacy tests, shelf life, compatibility, validation of sterilization process and microbiological controls) apply to the Hang&Go PAC too.

21 CFR 807.92(a)(6): Comparison of technological characteristics (Flow Reverse)

As said above, the Flow Reverse is a component included into the Hang&Go PAC packaging. The Flow Reverse is made of elements (i.e. tubing, quick connectors, Y connectors, manual clamps) already used for the Hang&Go HT Basic manufacture. Manufacturing process for the assembly of the components and the sterilization process are the same conducted on the Hang&Go HT Basic.

21 CFR 807.92(b)(1): Discussion of the non-clinical tests

The table below lists all standards to which the Hang&Go PAC is compliant. Biocompatibility and sterilization are covered by the testing and validation done on the Hang&Go HT Basic.

Packaging qualification acc. to ASTM D4169 and accelerated aging test acc. to ASTM F1980 were instead repeated using the same protocols of the Hang&Go HT Basic, and force at break of the pre-assembled catheters acc. to EN 1617 (not applicable to the Hang&Go HT

5

Image /page/5/Picture/0 description: The image shows the logo for RAND Corporation. The logo consists of an orange crescent shape with a blue sphere above it, followed by the text "RAND" in a gray serif font. A blue bar is at the bottom of the image.

TO M Fr STE

Basic) was also conducted. The biocompatibility and sterilization verification testing associated with the standards listed below were applied to the predicate device and cross referenced to support the substantial equivalence of the Hang&Go PAC and Reverse Flow components.

AreaUS Recognized standard #Title
GeneralISO 14971:2007Medical devices - Application of risk management to medical devices
Packaging and labelingASTM D4169-14Standard Practice for Performance Testing of Shipping Containers and Systems
BiocompatibilityAAMI ANSI ISO 10993-1:2009/(R)2013Biological evaluation of medical devices - Part 1: Evaluation and testing
AAMI ANSI ISO 10993-5:2009/(R)2014Biological evaluation of medical devices - Part 4: Selection of tests for interactions with blood
AAMI ANSI ISO 10993-7:2008/(R)2012Biological evaluation of medical devices - Part 5: Tests for In Vitro cytotoxicity
ISO 10993-10:2010Biological evaluation of medical devices - Part 7: Ethylene oxide sterilization residuals
AAMI ANSI ISO 10993-11:2006/(R)2010)Biological evaluation of medical devices - Part 10: Tests for irritation and skin sensitization
ISO 11135:2014Biological evaluation of medical devices - Part 11: Tests for systemic toxicity
SterilityISO 11607-1:2006Sterilization of health care products - Ethylene oxide - Part 1: Requirements for the development, validation, and routine control of a sterilization process for medical devices.
ISO 11607-2:2006Packaging for terminally sterilized medical devices - Part 1: Requirements for materials, sterile barrier systems and packaging systems
ASTM F1980-07(2011)Packaging for terminally sterilized medical devices - Part 2: Validation requirements for forming, sealing and assembly processes
ISO 11737-1:2006Standard Guide for Accelerated Aging of Sterile Barrier Systems for Medical Devices.
Sterilization of medical devices-Microbiological methods-Part 1: Determination of the population of microorganisms on product

Table 1: Applicable Reference Standards list

In addition, the following tests (they do not follow any reference standard method) were conducted using saline solution to demonstrate continued conformance of new design outputs with the defined requirements:

  • Static priming volume of the Hang&Go table pack inlet/outlet lines; ●
  • . Qualification of the two additional temperature probes assembled on the table pack lines;

6

Image /page/6/Picture/0 description: The image shows the RAND Corporation logo. The logo consists of a stylized orange crescent shape with a blue circle above it, followed by the text "RAND" in a gray serif font. The crescent shape and circle are positioned to the left of the text.

CALLE

  • Pressure drops determination of the Hang&Go table pack inlet/outlet lines; ●
  • Verification of the fitting interfaces and effectiveness of the Flow Reverse. ●
  • Physical integrity verification through hydraulic test in pressure of the Flow Reverse ●
  • Static and Dynamic Priming Volume of the Flow Reverse. .

21 CFR 807.92(b)(1): Discussion of the non-clinical tests (Flow Reverse)

As said, the Flow Reverse uses the same components already in use in the Hang&Go HT Basic. Manufacturing process, sterilization, and packaging are also the same. All above listed reference standards apply also to the Flow Reverse (except EN 1617 being specifically related for the catheters, preassembled to the Hang&Go PAC table pack lines). All testing and validations for packaging, sterilization and biocompatibility conducted on the Hang&Go HT Basic apply to the Hang&Go PAC and the Flow Reverse too.

The tests listed in the last 3 bullet points of the previous paragraph were conducted on the Flow Reverse for qualification of the related features. The protocols used in these tests were similar to those used for qualifying the same features of the Hang&Go HT Basic. Saline was used as the test liquid to represent the physiologically compatible sterile solution.

21 CFR 807.92(b) (3): Conclusions

Based upon performance testing and compliance with voluntary standards, RanD believes that the Hang&Go PAC is substantially equivalent to the predicate device, and does not raise new concerns of safety or effectiveness.