K Number
K161907
Device Name
Pressure Therapy System
Date Cleared
2017-02-23

(226 days)

Product Code
Regulation Number
890.5650
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The device is indicated for use by medical professionals and patient at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injuries, post immobilization edema, venous insufficiencies, lymphedema.
Device Description
The system consists of an air pump, leg sleeves and hoses working together as one unit. The air pump is connected to the dedicated sleeves via a series of hoses; one sleeve has 4 compression chambers. The compression massage direction is from limb end to body center by inflating the air chambers sequentially and then deflating as one cycle, the pressure can be adjusted to avoid any discomfort to the patient. The sleeve works under the action of sensor and microprocessor. This software is to control the timing and the pressure reflected by the sensor, it cycles the airflow to reach the function of cycling compression of body parts.
More Information

Not Found

No
The device description mentions a sensor and microprocessor controlling timing and pressure, which is standard for automated medical devices and does not indicate AI/ML. There are no mentions of AI, DNN, or ML in the provided text.

Yes
The device is used for treating various medical conditions such as lymphedema and venous insufficiencies, and its function involves providing compression therapy to limbs, which directly impacts the body for therapeutic purposes.

No

The device description indicates it is a therapy system that provides compression massage, not a device used for diagnosis. Its function is to treat conditions, not to identify them.

No

The device description explicitly states the system consists of an air pump, leg sleeves, and hoses working together as one unit, indicating hardware components are integral to the device's function. While software controls the timing and pressure, it is part of a larger hardware system.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The description clearly states the device is a "pressure therapy system" that uses an air pump and sleeves to apply compression to limbs. This is a physical therapy or medical device that acts externally on the body.
  • Intended Use: The intended use is for treating conditions like lymphedema and edema through external compression, not by analyzing biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, reagents, or any of the typical components or processes associated with IVD devices.

Therefore, this device falls under the category of a therapeutic medical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The device is indicated for use by medical professionals and patient at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injuries, post immobilization edema, venous insufficiencies, lymphedema.

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

IRP

Device Description

The system consists of an air pump, leg sleeves and hoses working together as one unit. The air pump is connected to the dedicated sleeves via a series of hoses; one sleeve has 4 compression chambers. The compression massage direction is from limb end to body center by inflating the air chambers sequentially and then deflating as one cycle, the pressure can be adjusted to avoid any discomfort to the patient. The sleeve works under the action of sensor and microprocessor. This software is to control the timing and the pressure reflected by the sensor, it cycles the airflow to reach the function of cycling compression of body parts.

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

medical professionals and patient at home, who are under medical supervision

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 Pt1002 pressure therapy system has been tested and met the following standards: IEC 60601-1 Medical electrical equipment - Part 1: General requirements for basic safety and essential performance, IEC 60601-1-2 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests, ISO10993-5 Biological evaluations of medical devices -- Part 5: Tests for In Vitro cytotoxicity, ISO 10993-10 Biological evaluation of medical devices - Part 10: Tests for irritation and skin sensitization.

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

Not Found

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.

K113275

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

§ 890.5650 Powered inflatable tube massager.

(a)
Identification. A powered inflatable tube massager is a powered device intended for medical purposes, such as to relieve minor muscle aches and pains and to increase circulation. It simulates kneading and stroking of tissues with the hands by use of an inflatable pressure cuff.(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 features a stylized caduceus symbol, which is often associated with healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the symbol. The logo is simple and recognizable, and it is used to represent the U.S. Department of Health & Human Services.

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

February 22, 2017

Xiamen Senyang Co., Ltd. % Raymond Luo Technical Manager Shanghai SUNGO Management Consulting Company Limited 4th Floor 1500# Central Avenue Shanghai, Shanghai 200122 CN

Re: K161907

Trade/Device Name: Pressure Therapy System Regulation Number: 21 CFR 890.5650 Regulation Name: Powered Inflatable Tube Massager Regulatory Class: Class II Product Code: IRP Dated: January 26, 2017 Received: January 26, 2017

Dear Mr. Luo:

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. 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

1

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,

Image /page/1/Picture/8 description: The image shows the name "Michael J. Hoffmann -S" in a simple, sans-serif font. The text is horizontally aligned and appears to be the primary focus of the image. The letters are clear and legible, with consistent spacing between them.

  • for Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health
    Enclosure

2

Indications for Use

510(k) Number (if known) K161907

Device Name Pressure Therapy System

Indications for Use (Describe)

The device is indicated for use by medical professionals and patient at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injuries, post immobilization edema, venous insufficiencies, lymphedema.

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

3

510(K) Summary

K161907

A. Applicant:

Name: XIAMEN SENYANG CO., LTD. Address: 4-5 FLOOR, XINGBEI INDUSTRY, NO 95-99, WEST 2 ROAD, JIU TIANHU, XINGLIN XIAMEN, 361000, P.R. China

Official Contact Person Information Name: Raymond Luo Tel: 0086-21-68828050 Mail: fda.sungo@gmail.com

B. Subject device:

Trade name:Pressure Therapy System
Common name:Powered inflatable Tube Massager
Classification name:Massager, Powered Inflatable Tube
Regulation Medical SpecialtyPhysical Medicine
Regulation Number890.5650
Product CodeIRP
ClassificationClass II

c. Predicate device:

K113275 - Compressible Limb Therapy System (Power-Q1000 Premium)

D. Indications for Use:

The device is indicated for use by medical professionals and patient at home, who are under medical supervision, in treating many conditions, such as: Primary lymph edema following trauma and sport injures, Post immobilization edema, Venous insufficiencies, Lymph edema.

E. Device Description:

The system consists of an air pump, leg sleeves and hoses working together as one unit. The air pump is connected to the dedicated sleeves via a series of hoses; one sleeve has 4 compression chambers. The compression massage direction is from limb end to body center by inflating the air chambers sequentially and then deflating as one cycle, the pressure can be adjusted to avoid any discomfort to the patient. The sleeve works under the action of sensor and microprocessor. This software is to control the timing and the pressure reflected by the sensor, it cycles the airflow to reach the function of cycling compression of body parts.

F. Technical Characteristic:

NamePt 1002
---------------

4

Pressure (mmHg)0~250 mmHg
ModeMode A and Mode B selection and the initial is A
Cycle time30s
Pressure TimeTime 0-30 min, selection (10, 20, 30min)

G. Substantial Equivalence Table:

DeviceSubject Device (K161907)Predicate Device (K113275)
ManufacturerXIAMEN SENYANG CO., LTD.BSR KOREA Corp.
Model NamePt 1002Power Q1000 Premium
ClassificationClass II Device, IRP (21 CFR890.5650)Class II Device, IRP (21 CFR890.5650)
Indications for UseThe device is indicated for use by
medical professionals and patient at
home, who are under medical
supervision, in treating many
conditions, such as: Primary
lymphedema, edema following
trauma and sport injures,
Post-immobilization edema, Venous
insufficiencies, Lymphedema.The device is indicated for use by medical
professionals and patient at home, who are under
medical supervision, in treating many conditions,
such as: Primary lymphedema, edema following
trauma and sport injures, Post-immobilization
edema, Venous insufficiencies, Lymphedema.
DescriptionPt 1002 is a pneumatic pressure
treatment system that repeats
expansion of sleeves to help blood
circulation and prevent blood clots or
clogs.Power Q1000 Premium is a pneumatic pressure
treatment system that repeats expansion of
sleeves to help blood circulation and prevent
blood clots or clogs.
StandardIEC 60601-1 & IEC 60601-1-2
ISO10993-5 & ISO10993-10EN 60601-1 & EN 60601-1-2
IndicationsPrimary lymphedema, edema
following trauma and sport injures,
Post-immobilization edema, Venous
insufficiencies, LymphedemaPrimary lymphedema, edema following trauma
and sport injures, Post-immobilization edema,
Venous insufficiencies, Lymphedema
Mode of
CompressionSequentialSequential
Power Source110 V, 60Hz110V, 60Hz
Therapy Time0 – 30 mins0 - 99 mins
Max Pressure0-250mm Hg0-240mm Hg
Min Pressure
Number of
Chambers4 Chambers for each unit4 Chambers for each unit
Compression
Applicator
GarmentsThermoplastic UrethaneNylon
Sleeve Material
Power30W30W
consumption
Cycle time30s0, 5, 10, 15, 20, 25, 30s selection
Initial is 0s
SizeSize 260170130mm
Image: White device with black control panelSize:150210210mm
Image: White and purple device with two knobs
Body area
specific cuffsSmall Leg Cuff LXW:90X30cm
Large Leg Cuff LXW:110X30cm
Image: Blue leg cuffLeg:
Image: Silver leg cuff
Preprogrammed
modesModel A
Image: Diagram of leg cuff model AModel A
Image: Diagram of leg cuff model A
Model B
Image: Diagram of leg cuff model BModel C
Image: Diagram of leg cuff model C

5

6

From the comparison in the form above, the intended use, indication for use and the Mode of Compression,

Power Source, Power consumption of the two devices are same. There are some factors that are different:

    1. Biocompatibility: The subject device has different sleeve material than the predicate device but subject device complies to ISO 10993-5 and ISO 10993-10 standards.
    1. Therapy Time: For one time use, the max time for this device is 30 min. This is safer than the predicate device's max time of 90 min. If the user wants, he/she can repeat the 30 min cycle.
    1. Min Pressure and Max Pressure of the subject device is 250 mmHg which is similar to the max pressure of 240mm Hg in the predicate device.
    1. Preprogrammed modes: The subject device only has 2 selections which are within the scope of the predicate device. Model A of the subject device is identical to Model A of the predicate device. Model B of the subject device is identical to Model C of the predicate device.

H. Performance characteristic

The Pt1002 pressure therapy system has been tested and met the following standards: IEC 60601-1 Medical electrical equipment - Part 1: General requirements for basic safety and essential performance

IEC 60601-1-2 Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests

ISO10993-5 Biological evaluations of medical devices -- Part 5: Tests for In Vitro cytotoxicity

ISO 10993-10 Biological evaluation of medical devices - Part 10: Tests for irritation and skin sensitization

-Conclusion

The Pt1002 Pressure Therapy System has substantially equivalent intended use as the cleared Power Q1000 Premium Compression Limb Therapy System and has substantially equivalent technological and performance characteristics. After analyzing laboratory testing to applicable standards, it is concluded that Pt1002 Pressure Therapy System is as safe and effective as the predicate device, has few technological differe are no new indications for use and does not raise any new safety and/or effectiveness concerns. Consequently, it is substantially equivalent to the predicate device.