K Number
K190793
Device Name
Tablo Hemodialysis System, Tablo Cartridge
Date Cleared
2019-12-12

(259 days)

Product Code
Regulation Number
876.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Tablo® Hemodialysis 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. The Tablo® Cartridge is a single use, disposable arterial and venous bloodline set intended to provide extra-corporeal access during hemodialysis. The Tablo Cartridge is compatible only with the Tablo Hemodialysis System.
Device Description
The Tablo Hemodialysis System is a self-contained hemodialysis system intended for acute and chronic dialysis therapy, with or without ultrafiltration, in an acute or chronic care facility. The system's innovative design includes the: - . Tablo Console, a single module consisting of multiple fluidic systems that perform the activities of a water purification system (WPS) and a conventional dialysis delivery system (DDS), and - Tablo Cartridge, a single use blood tubing set attached to an organizer tray. The ethylene oxide (EO) sterilized and disposable cartridge is inserted onto the front panel of the console for each dialysis treatment (Figure 1). - . Tablo Script, an accessory software to the Tablo Console, is designed for use by medical professionals to a) prepare, update and verify patient dialysis prescriptions b) view and export dialysis treatment information and billing activities and c) set and modify Tablo Console settings. Note: Tablo Script is optional, patient prescriptions can still be created or changed directly on the Tablo Console.
More Information

No reference devices were used in this submission.

No
The document does not mention AI, ML, or related terms, and the device description focuses on hardware and standard software functionalities for hemodialysis.

Yes
The device is a hemodialysis system used to treat patients with acute and/or chronic renal failure, which is a therapeutic intervention.

No

The device is a hemodialysis system used for treating patients with renal failure, which is a therapeutic function, not a diagnostic one.

No

The device description clearly outlines hardware components (Tablo Console, Tablo Cartridge) in addition to the software (Tablo Script). The software is described as an "accessory software" to the console, not the primary or sole component.

Based on the provided text, the Tablo® Hemodialysis 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, which is a therapeutic procedure performed directly on the patient's blood outside the body (extracorporeal).
  • Device Description: The system describes a console that performs water purification and dialysis delivery, and a cartridge that provides extracorporeal blood access. These are all components of a system designed for a therapeutic treatment, not for analyzing samples in vitro (in a test tube or other artificial environment).
  • Lack of IVD Characteristics: The description does not mention any components or functions related to analyzing biological samples (like blood, urine, or tissue) to provide diagnostic information. There's no mention of reagents, assays, or measurement of analytes.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The Tablo system's purpose is to filter and clean the patient's blood as a treatment for kidney failure.

N/A

Intended Use / Indications for Use

The Tablo® Hemodialysis 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.

The Tablo® Cartridge is a single use, disposable arterial and venous bloodline set intended to provide extra-corporeal access during hemodialysis. The Tablo Cartridge is compatible only with the Tablo Hemodialysis System.

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

KDI, FIP, FJK

Device Description

The Tablo Hemodialysis System is a self-contained hemodialysis system intended for acute and chronic dialysis therapy, with or without ultrafiltration, in an acute or chronic care facility. The system's innovative design includes the:

  • Tablo Console, a single module consisting of multiple fluidic systems that perform the activities of a water purification system (WPS) and a conventional dialysis delivery system (DDS), and
  • Tablo Cartridge, a single use blood tubing set attached to an organizer tray. The ethylene oxide (EO) sterilized and disposable cartridge is inserted onto the front panel of the console for each dialysis treatment (Figure 1).
  • Tablo Script, an accessory software to the Tablo Console, is designed for use by medical professionals to a) prepare, update and verify patient dialysis prescriptions b) view and export dialysis treatment information and billing activities and c) set and modify Tablo Console settings. Note: Tablo Script is optional, patient prescriptions can still be created or changed directly on the Tablo Console.

The following are accessories supplied by Outset for use with Tablo:

  • Tablo Straws
  • Patient Key (USB)
  • Outset Acid Concentrate 1K, 2K and 3K (Optional)
  • Outset Bicarbonate Concentrate (Optional)
  • Non-invasive Blood Pressure Cuff (NIPB) kit
  • Hand-Crank
  • Locking Power Cord
  • Drain Line
  • Water Line
  • Insert and straws for Minncare Cold Sterilant

Field Replaceable Units:

  • Filter, Chlorine/Chloramines (Carbon Filter)
  • Filter, Sediment
  • Filter, RO Membrane
  • Ultrafilter (Water and Dialysate Ultrafilter)

The following are dialysis treatment recommended accessories which are commercially available by other manufacturers:

  • High Flux Dialyzer
  • Acid jug (If not using Outset Supplied Acid jug)
  • Bicarbonate jug (If not using Outset Supplied Bicarbonate jug)
  • Minncare Cold Sterilant
  • Chlorine/Chloramine test kit
  • Saline bags
  • Heparin
  • Syringes and needles
  • Gloves and mask
  • Biohazard container
  • Disinfectant, gauze pads, and tape for access site

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

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)

Biocompatibility testing:
For the Tablo Cartridge, biocompatibility evaluation was conducted in accordance with the FDA guidance document, Hemodialysis Blood Tubing Sets - Premarket Notification [510(k)] Submissions, dated April 23, 2008. The battery of tests include the following tests for externally communicating devices, contacting circulating blood, prolonged contact Class II (Category B): Cytotoxicity, Sensitization, Intracutaneous reactivity, Acute systemic toxicity, Hemocompatibility, Genotoxicity. Results were passing under the conditions of the individual tests.

For the fluid contact materials of the Tablo Console, in accordance with the FDA Guidance for the Content of Premarket Notifications for Hemodialysis Delivery Systems, issued August 7, 1998, Section VII, C, Outset Medical followed the alternative path and conducted leachable testing in lieu of biocompatibility tests. Toxicological assessment was performed and device materials are considered safe for use as intended.

Electrical safety and electromagnetic compatibility (EMC):
Electrical safety and EMC testing were conducted on the Tablo Hemodialysis System, consisting of the blood tubing set cartridge and Tablo console. The system complies with the ES 60601-1, main and its collateral standards.

Software Verification and Validation Testing:
Software verification and validation testing were conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices. The software for this device was considered as a "major" level of concern, since a failure or latent flaw in the software could directly result in serious injury or death to the patient or operator.

Shelf Life and Sterilization Testing (Tablo Cartridge):
Bench Performance Testing was conducted on the Tablo Hemodialysis System. The system passed all tests, including: Device Performance, Packaging integrity, Sterilization, EO residuals, Bacterial endotoxin (LAL) testing, Environmental Operation, Transit, Prime Discard, Pinch Valve, Maximum Power, Dialyzer Compatibility, External Device Compatibility, Cartridge Hemolysis Testing (12 Hours), Various hardware tests, Water Ingress (IP21), Mechanical requirements, Front Panel Interface with Cartridge Installed, Essential Performance per IEC 60601-2-16, Battery Failure, AAMI Water and Dialysate Quality, Total Dissolved Solids, Water Treatment System, Dialysate flow and Conductivity Monitoring, Air-In-Line, Pre-Treatment Mode, Post-Treatment Mode, Blood Pump and Pinch Valve Control, and Saline Delivery Performance, Heat Disinfection Mode, Chemical Disinfection Mode, Ultrafiltration Accuracy, Maintenance and Service User, Heat and Chemical Disinfection Effectiveness, External Disinfectant Chemical Compatibility Testing (IEC 60601-2-16 Test), Bring Your Own Concentrate Conductivity Test, Human Factors Validation.

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

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

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.

Tablo Console, K160881; Tablo Cartridge, K140841

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.

No reference devices were used in this submission.

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.”

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

December 12, 2019

Outset Medical, Inc. Jennifer Mascioli-Tudor VP, Quality Assurance and Regulatory Affairs 1830 Bering Drive San Jose, CA 95112

Re: K190793

Trade/Device Name: Tablo® Hemodialysis System Tablo® Cartridge Regulation Number: 21 CFR 876.5860 Regulation Name: High Permeability Hemodialysis System Regulatory Class: II Product Code: KDI, FIP, FJK Dated: April 16, 2019 Received: April 18, 2019

Dear Jennifer Mascioli-Tudor:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Carolyn Y. Neuland, Ph.D. Assistant Director DHT3A: Division of Renal, Gastrointestinal, Obesity and Transplant Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K190793

Device Name

Tablo® Hemodialysis System, Tablo® Cartridge

Indications for Use (Describe)

The Tablo® Hemodialysis 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.

The Tablo® Cartridge is a single use, disposable arterial and venous bloodline set intended to provide extra-corporeal access during hemodialysis. The Tablo Cartridge is compatible only with the Tablo Hemodialysis System.

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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3

510(k) Summary

I. SUBMITTER

Outset Medical, Inc. 1830 Bering Drive San Jose, CA 95112

Phone: (669) 231-8200

Primary Contact:Jennifer Mascioli-Tudor
Secondary Contact:Mara Marshak
Date Prepared:November 8, 2019

II. DEVICE

Name of Device: Tablo® Hemodialysis System; Tablo® Cartridge

Common or Usual Name: Hemodialysis delivery system and water purification system; Blood tubing set

Classification Name: High Permeability Hemodialysis System (21 CFR § 876.5860) Product Code: KDI Water Purification System for Hemodialysis - Product Code: FIP Hemodialysis system and accessories – Product Code: FJK

Regulatory Class: II

III. PREDICATE DEVICE

Tablo Console, K160881; Tablo Cartridge, K140841

These predicates have not been subject to a design related recall.

No reference devices were used in this submission.

4

IV. DEVICE DESCRIPTION

The Tablo Hemodialysis System is a self-contained hemodialysis system intended for acute and chronic dialysis therapy, with or without ultrafiltration, in an acute or chronic care facility. The system's innovative design includes the:

  • . Tablo Console, a single module consisting of multiple fluidic systems that perform the activities of a water purification system (WPS) and a conventional dialysis delivery system (DDS), and
  • Tablo Cartridge, a single use blood tubing set attached to an organizer tray. The ethylene oxide (EO) sterilized and disposable cartridge is inserted onto the front panel of the console for each dialysis treatment (Figure 1).
  • . Tablo Script, an accessory software to the Tablo Console, is designed for use by medical professionals to a) prepare, update and verify patient dialysis prescriptions b) view and export dialysis treatment information and billing activities and c) set and modify Tablo Console settings. Note: Tablo Script is optional, patient prescriptions can still be created or changed directly on the Tablo Console.

Image /page/4/Picture/7 description: The image shows a Tablo Hemodialysis System. The machine is dark blue and has the word "tablo" printed on the side. The machine has wheels on the bottom, which makes it portable.

Console with Integrated Dialysis Delivery and Water Purification

Image /page/4/Picture/9 description: The image shows a medical device with a cartridge installed on the console front panel. The device has a screen on top that displays a tree graphic. The device is on wheels and has a door that is open, revealing the cartridge and other components. The device is likely used for some type of medical treatment or procedure.

Figure 1: Tablo Hemodialysis System with Cartridge Inserted

The following are accessories supplied by Outset for use with Tablo:

  • Tablo Straws
  • . Patient Key (USB)
  • Outset Acid Concentrate 1K, 2K and 3K (Optional) ●
  • Outset Bicarbonate Concentrate (Optional) ●
  • Non-invasive Blood Pressure Cuff (NIPB) kit
  • Hand-Crank

5

  • Locking Power Cord
  • . Drain Line
  • Water Line
  • Insert and straws for Minncare Cold Sterilant

Field Replaceable Units:

  • Filter, Chlorine/Chloramines (Carbon Filter)
  • Filter, Sediment
  • Filter, RO Membrane
  • . Ultrafilter (Water and Dialysate Ultrafilter)

The following are dialysis treatment recommended accessories which are commercially available by other manufacturers:

  • High Flux Dialyzer
  • Acid jug (If not using Outset Supplied Acid jug)
  • Bicarbonate jug (If not using Outset Supplied Bicarbonate jug) ●
  • Minncare Cold Sterilant
  • . Chlorine/Chloramine test kit
  • Saline bags
  • Heparin
  • Syringes and needles ●
  • Gloves and mask
  • Biohazard container
  • Disinfectant, gauze pads, and tape for access site

V. INDICATIONS FOR USE

The identical indications for use statement, except for registered trademarks and clarified tradename, are as follows:

The Tablo® Hemodialysis 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.

The Tablo® Cartridge is a single use, disposable arterial and venous bloodline set intended to provide extra-corporeal access during hemodialysis. The Tablo Cartridge is compatible only with the Tablo Hemodialysis System.

6

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE

The modified Tablo Hemodialysis System and Tablo Cartridge have the same fundamental technology, principle of operation, and principle functionality. The device is a high permeability hemodialysis system, which uses the same principle of reverse osmosis as its water purification system combined into one preconfigured integrated machine. The Tablo Cartridge is intended as the hemodialysis blood tubing set and has the same compatibility only with Tablo.

The subject and predicate devices are based on the following same technological elements:

  • essential performance per IEC 60601-2-16
  • internal water purification system
  • dialysate delivery system

The following technological differences were described for the proposed device:

  • Tablo Console Front Panel ●
  • . Tablo Peristaltic Venous Air Pump (VAP)
  • Tablo Active Conductivity
  • Tablo Heaters and Thermal Management
  • Tablo 60601-2-16 Sensor Changes
  • Tablo Maintenance of AAMI Quality Water and Dialysate
  • Tablo Thermistors
  • Tablo Electrical Architecture
  • . Tablo Diener Pumps
  • Tablo Ultrafiltration Accuracy
  • Tablo Chemical and Heat Validation
  • . Cartridge Pouch as Prime Discard Receptacle
  • Y Connector that attaches Arterial and Venous Lines together
  • Minor Molded Organizer Tray Changes
  • . Heparin Pump Removal and Infusion Line Minor ID Increase
  • Tube Coiling and Length Increase
  • Needleless Infusion Port Design ●
  • . Shelf Life to 12 months
  • Maximum Operating Pressure roll-up from Console
  • Labeled Priming Volume
  • Compatibility with Commercial Accessories
  • Soft Power Switch
  • Specification update for Treatment Time
  • Allow the use of Non-Outset Branded Concentrates
  • Allow entering patient prescription data directly on the console
  • Improve reliability of wireless data transmission

7

VII. PERFORMANCE DATA

The following performance data were provided to support substantial equivalence of the device.

Biocompatibility testing

For the Tablo Cartridge, biocompatibility evaluation was conducted in accordance with the FDA guidance document, Hemodialysis Blood Tubing Sets - Premarket Notification [510(k)] Submissions, dated April 23, 2008. The battery of tests include the following tests for externally communicating devices, contacting circulating blood, prolonged contact Class II (Category B):

  • Cytotoxicity
  • Sensitization
  • Intracutaneous reactivity
  • Acute systemic toxicity
  • Hemocompatibility
  • Genotoxicity

Results were passing under the conditions of the individual tests.

For the fluid contact materials of the Tablo Console, in accordance with the FDA Guidance for the Content of Premarket Notifications for Hemodialysis Delivery Systems, issued August 7, 1998, Section VII, C, Outset Medical followed the alternative path and conducted leachable testing in lieu of biocompatibility tests. Toxicological assessment was performed and device materials are considered safe for use as intended.

Electrical safety and electromagnetic compatibility (EMC)

Electrical safety and EMC testing were conducted on the Tablo Hemodialysis System, consisting of the blood tubing set cartridge and Tablo console. The system complies with the ES 60601-1, main and its collateral standards.

Software Verification and Validation Testing

Software verification and validation testing were conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices. The software for this device was considered as a "major" level of concern, since a failure or latent flaw in the software could directly result in serious injury or death to the patient or operator.

TestAcceptance CriteriaResult
Device PerformanceDevice meets performance requirements following 1
year accelerated agingPass
Packaging integrityPackaging system meets performance requirements
following 1 year accelerated aging.Pass
SterilizationDevice is EO sterilized, meets SAL of 10-6Pass
EO residualsMeets ISO 10993-7 for prolonged contact devicePass
Bacterial endotoxin
(LAL) testingMeets ANSI/AAMI ST72Pass
Test PerformedAcceptance CriteriaResult
1. Environmental
OperationThe device shall meet the system requirements for
environmental operation.Pass
2. TransitThe system shall operate within specification after transit.Pass
3. Prime DiscardThe Tablo Cartridge shall meet the requirements for prime
discard.Pass
4. Pinch ValveThe system shall meet requirements for the blood and
saline pinch valves.Pass
5. Maximum PowerThe system shall meet requirements for maximum power
and current.Pass
6. Dialyzer
CompatibilityThe system shall be compatible with hemodialyzers of
sizes with the following ranges:Pass
Major Diameter: 2.14 - 2.75"
Minor Diameter: 1.45 - 2.05"
Total Length: 11.55 - 13.15"
Dialysate Port Distance: 8.15 - 9.55"
7. External Device
CompatibilityThe system shall be compatible with external devices (i.e.,
external infusion pump, manual syringe injection of saline
bolus and Transonic sensors (Transonic part number
H4FX).Pass
8. Cartridge
Hemolysis
Testing, 12 HoursThe increase in hemolysis in a sample of blood circulating
through the fluidic path during treatment as compared to
a control sample of blood idle for the same amount of
time shall not exceed 1%.Pass
The system shall meet its hemolysis requirements with a
Crit-Line blood chamber (Fresenius part number 191058)
connected within the extracorporeal circuit.
9. Various hardwareThe system shall meet the following requirements for
various hardware.Pass
10. Water Ingress
(IP21)The console enclosure shall have an IP21 ingress
protection rating per IEC 60529.Pass
11. MechanicalThe system shall meet requirements for labeled priming
volume, be designed with an ultrafilter that removes
microbial materials and particles > 5nm, shall be designed
with the required ports so that sampling for monitoring
can be taken.Pass
12. Front Panel
Interface with
Cartridge
InstalledThe system shall meet the following requirements for
front panel interface with the cartridge installed.Pass
13. Essential
Performance
per IEC 60601-
2-16The system shall meet Essential Performance per IEC
60601-2-16.Pass
Test PerformedAcceptance CriteriaResult
14. Battery FailureThe system shall prevent treatment initiation if it detects a low battery voltage.Pass
15. AAMI Water
and Dialysate
QualityThe system shall meet ANSI/AAMI 13959:2014 and ANSI/AAMI 11663:2014 requirements for water and dialysate.Pass
16. Total Dissolved
SolidsThe system shall meet the requirements for total dissolved solids:
  • Water sample results meet ANSI/AAMI 13959 toxic contaminant standards and ISO 23500 trace element standards
  • Water from the Post RO sample port meets ISO 23500 electrolyte concentration limits when prepared from water with hardness of 150 mg/L | Pass |
    | 17. Water
    Treatment
    System | The system shall meet requirements for a water treatment system. | Pass |
    | 18. Dialysate flow
    and
    Conductivity
    Monitoring | The system shall meet requirements for dialysate flow, temperature, volume, and conductivity monitoring. | Pass |
    | 19. Air-In-Line | The system shall meet requirements related to the system's purging and detection of air bubbles in the extracorporeal circuit. | Pass |
    | 20. Pre-Treatment
    Mode | The system shall meet requirements for pre-treatment mode. | Pass |
    | 21. Post-Treatment
    Mode | The system shall meet requirements for post-treatment mode. | Pass |
    | 22. Blood Pump
    and Pinch Valve
    Control, and
    Saline Delivery
    Performance | The system shall meet requirements for operation, performance, and control of the peristaltic blood pump. | Pass |
    | 23. Heat
    Disinfection
    Mode | The system shall meet requirements for heat disinfection mode. | Pass |
    | 24. Chemical
    Disinfection
    Mode | The system shall meet requirements for chemical disinfection mode. | Pass |
    | 25. Ultrafiltration
    Accuracy | The system shall provide a treatment fluid removal accuracy of +/- 100 mL per hour of the treatment time. | Pass |

Shelf Life and Sterilization Testing (Tablo Cartridge)

8

Bench Performance Testing

9

Bench Performance Testing

10

Bench Performance Testing
Test PerformedAcceptance CriteriaResult
26. Maintenance
and Service
UserThe system shall meet requirements for maintenance and
service user.Pass
27. Maintenance
and Service
UserThe system shall allow the user to run mock treatments in
Service Interface without the need of a Patient USB (a
patient-specific secured USB storage device that contains
encrypted treatment and prescription details).Pass
28. Heat and
Chemical
Disinfection
EffectivenessDisinfection validation was performed on n=3 consoles per
organism, totaling n=6 consoles to demonstrate that
chemical and heat disinfection cycles reduce vegetative
bacterial species (i.e., Pseudomonas aeruginosa) by six
logs and non-tuberculous Mycobacterium species (i.e.,
Mycobacterium terrae) by three logs.Pass
29. External
Disinfectant
Chemical
Compatibility
Testing (IEC
60601-2-16
Test)The system and its accessories shall be capable of
withstanding daily cleaning, using the chemicals below,
over the service life of the device per the chemical
manufacturer instructions, with:
  • 70% Isopropyl Alcohol
  • 10% bleach (0.3% - 0.6 % hypochlorite)
  • PDI Super Sani Cloth Germicidal Wipes
  • CaviWipes
  • CaviWipes1 Disinfecting Wipe
  • Oxivir 5
  • Oxivir TB Wipes | Pass | | | | | | | | | | |
    | 30. Bring Your Own
    Concentrate
    Conductivity
    Test | The system shall be compatible with dialysis fluid
    concentrates intended for a 45X-proportioning ratio.
    When mixed at a 45X ratio, the acid concentrate should
    comply with the following labeled formulation range:
    ParameterFormulationSodium100 mEq/LPotassium0 - 4 mEq/LCalcium0 - 3.5 mEq/LAcetate4 mEq/L | | | | | | | | | | | Pass |
    | 31. Human Factors
    Validation | The system shall be assessed for usability with
    representative users (i.e., nurses and patient care
    technicians in clinical settings and acute-care facilities) in
    accordance with its intended use/indications for use. | Pass | | | | | | | | | | |

11

Animal Study

No animal studies were performed in support of the modifications.

Clinical Studies

No clinical studies were performed in support of the modifications.

VIII. CONCLUSIONS

Non-clinical testing supports the safety and effectiveness of the Tablo Hemodialysis System and Tablo Cartridge. The bench testing demonstrates that the device systems comparably to the predicate device and is substantially equivalent to the legally marketed device.