K Number
K191107
Device Name
Plexus
Date Cleared
2019-08-27

(123 days)

Product Code
Regulation Number
870.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Plexus RP00 Disposable Portable Deep Vein Thrombosis (DVT) Prevention Device is intended to be used in either home or clinical settings for: - · Aiding the prevention of DVT onset - · Enhancing blood circulation in the lower extremities - · Diminishing post-operative pain and swelling - · Reducing wound healing time, and - · Serving as a prophylaxis for DVT for stationary or bedridden individuals · Aid in the treatment of: stasis dermatitis, venous stasis ulcers, arterial and diabetic leg ulcers, chronic venous insufficiency and reduction of edema in the lower limbs
Device Description
The Plexus RP100 Portable Deep Vein Thrombosis ("DVT") Prevention Device is an electronic device that helps to prevent the onset of deep vein thrombosis by stimulating blood flow and increasing venous flow velocity. Each RP100 DVT Prevention Device consists of a pump body and a pressure sleeve with internal air bladder. When turned on, the air bladder inside the sleeve will be automatically inflated to a pre-set level, thereby providing intermittent pressure to the calf. The commercial saleable package will consist of two pump units with their sleeves, one for each leg. The unit operates by inflating the air bladder until the pressure reaches 50mmHg. After reaching this pressure level, the unit will automatically deflate for 50 seconds to complete one cycle. Therapy could persist as long as the patient needs or is instructed by their physician. When the therapy ends, the patient simply would turn off the device by the press of a power button.
More Information

Not Found

No
The device description details a simple electronic device with a pre-set inflation and deflation cycle, with no mention of adaptive behavior, learning, or data processing beyond basic control. The lack of mention of AI/ML terms, training/test data, or performance metrics typically associated with AI/ML further supports this conclusion.

Yes
The "Intended Use" section explicitly lists aiding in the prevention and treatment of various medical conditions, such as DVT, stasis dermatitis, and ulcers, indicating its purpose in managing health and well-being.

No

The device is described as aiding in the prevention and treatment of various conditions related to circulation in the lower extremities by stimulating blood flow and increasing venous flow velocity through intermittent pressure. Its functions include preventing DVT, enhancing circulation, diminishing pain and swelling, reducing wound healing time, and serving as prophylaxis for DVT, as well as aiding in the treatment of stasis dermatitis, venous stasis ulcers, arterial and diabetic leg ulcers, chronic venous insufficiency, and reduction of edema. These are all therapeutic and preventative functions, not diagnostic ones that identify or characterize a disease.

No

The device description explicitly states it is an "electronic device" consisting of a "pump body and a pressure sleeve with internal air bladder," which are hardware components. The testing also includes hardware-related tests like biocompatibility, electrical safety, and functional performance tests on the physical device.

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 Plexus RP00/RP100 device is a mechanical device that applies intermittent pressure to the lower extremities to stimulate blood flow. It does not analyze any biological samples.
  • Intended Use: The intended uses listed are related to preventing DVT, enhancing circulation, reducing pain/swelling, and aiding in the treatment of various circulatory conditions. These are all therapeutic or preventative actions, not diagnostic ones based on analyzing samples.

Therefore, the Plexus RP00/RP100 Disposable Portable Deep Vein Thrombosis (DVT) Prevention Device is a therapeutic/preventative medical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Plexus RP00 Disposable Portable Deep Vein Thrombosis (DVT) Prevention Device is intended to be used in either home or clinical settings for:

  • · Aiding the prevention of DVT onset
  • · Enhancing blood circulation in the lower extremities
  • · Diminishing post-operative pain and swelling
  • · Reducing wound healing time, and
  • · Serving as a prophylaxis for DVT for stationary or bedridden individuals
  • Aid in the treatment of: stasis dermatitis, venous stasis ulcers, arterial and diabetic leg ulcers, chronic venous insufficiency and reduction of edema in the lower limbs

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

JOW

Device Description

The Plexus RP100 Portable Deep Vein Thrombosis ("DVT") Prevention Device is an electronic device that helps to prevent the onset of deep vein thrombosis by stimulating blood flow and increasing venous flow velocity. Each RP100 DVT Prevention Device consists of a pump body and a pressure sleeve with internal air bladder. When turned on, the air bladder inside the sleeve will be automatically inflated to a pre-set level, thereby providing intermittent pressure to the calf. The commercial saleable package will consist of two pump units with their sleeves, one for each leg. The unit operates by inflating the air bladder until the pressure reaches 50mmHg. After reaching this pressure level, the unit will automatically deflate for 50 seconds to complete one cycle. Therapy could persist as long as the patient needs or is instructed by their physician. When the therapy ends, the patient simply would turn off the device by the press of a power button.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Lower limbs/calves

Indicated Patient Age Range

patients 21 years of age or older

Intended User / Care Setting

home or clinical settings

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 following non-clinical testing has been completed to demonstrate that the Plexus RP100 device is performing as intended and has performance characteristics that are substantially equivalent to the listed predicate device.

Biocompatibility Testing:
ISO10993-5:2009 In-Vitro Cytotoxicity - Passed
ISO10993-10:2010 Intracutaneous Reactivity - Passed
ISO10993-10: 2010 Skin Sensitization - Passed

Electromagnetic Compatibility and Electrical Safety Testing:
IEC 60601-1:2005 (Third Edition) + A1:2012(or IEC 60601-1: 2012 reprint) - Passed
IEC 60601-1-2:2014 - Passed

Functional Performance Testing:
Battery charging time test - Design requirements met
Sleeve leakage test - Design requirements met
Pressure accuracy test - Design requirements met
Inflation time test - Design requirements met
Deflation time test - Design requirements met
Battery operating life test - Design requirements met
Sleeve integrity test - Design requirements met
Total worklife test - Design requirements met

Software Verification and Validation activities were completed and there were no unresolved anomalies. The software was considered a "moderate" level of concern, since a failure or latent flaw in the software could directly result in minor injury to the user.

No clinical testing was performed to support the claim of substantial equivalence to the Cirona 6300 device.

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.

Cirona 6300 DVT Prevention Device, Devon Medical Products, K151189

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

§ 870.5800 Compressible limb sleeve.

(a)
Identification. A compressible limb sleeve is a device that is used to prevent pooling of blood in a limb by inflating periodically a sleeve around the limb.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health and 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.

August 27, 2019

Alleva Medical (D.G.) Ltd Max Choi CEO Suite M-Q, 12th Floor, Kings Wing Plaza 2, 1 On Kwan Street Hong Kong, Hk

Re: K191107

Trade/Device Name: Plexus RP100 Disposable Portable Deep Vein Thrombosis Prevention Device Regulation Number: 21 CFR 870.5800 Regulation Name: Compressible Limb Sleeve Regulatory Class: Class II Product Code: JOW Dated: July 29, 2019 Received: July 31, 2019

Dear Max Choi:

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 (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.

Fernando Aguel Assistant Director DHT2B: Division of Circulatory Support, Structural and Vascular Devices OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K191107

Device Name

Plexus RP100 Disposable Portable Deep Vein Thrombosis Prevention Device

Indications for Use (Describe)

The Plexus RP00 Disposable Portable Deep Vein Thrombosis (DVT) Prevention Device is intended to be used in either home or clinical settings for:

  • · Aiding the prevention of DVT onset
  • · Enhancing blood circulation in the lower extremities
  • · Diminishing post-operative pain and swelling
  • · Reducing wound healing time, and
  • · Serving as a prophylaxis for DVT for stationary or bedridden individuals

· Aid in the treatment of: stasis dermatitis, venous stasis ulcers, arterial and diabetic leg ulcers, chronic venous insufficiency and reduction of edema in the lower limbs

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)

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Image /page/3/Picture/1 description: The image shows the logo for Alleva Medical LTD. The logo features a stylized letter "A" in blue, followed by the company name in a sans-serif font. Below the company name is the address: Suite M-Q, 12th Floor, Kings Wing Plaza 2, 1 On Kwan St. Shek Mun, Shatin, N.T., Hong Kong, along with the phone number +852 3166 7200, fax number +852 2355 7663, and website www.allevamedical.com.

510(k) Summary

Summary Preparation Date:

April 10, 2019

Submitter

Alleva Medical Ltd Suite M-Q, 12th Floor, Kings Wing Plaza 2 1 On Kwan Street, Shek Mun, Shatin New Territories, Hong Kong

Contact Person

Mr. Max Choi Chief Executive Officer Phone: +852-3166-7239 Fax: +852-2355-7663 Email: max@allevamedical.com

Device Name

Device Name: Portable Deep Vein Thrombosis Prevention Device Proprietary Trade Name: Plexus RP100 Common Name: Compressible Limb Sleeve Device

Product Classification

Product Classification: Compressible Lim Sleeve, 21 CFR 870.5800 Product Code: JOW Device Class: II

Predicate Device:

Cirona 6300 DVT Prevention Device, Devon Medical Products, K151189

Device Description

The Plexus RP100 Portable Deep Vein Thrombosis ("DVT") Prevention Device is an electronic device that helps to prevent the onset of deep vein thrombosis by stimulating blood flow and increasing venous flow velocity. Each RP100 DVT Prevention Device consists of a pump body and a pressure sleeve with internal air bladder. When turned on, the air bladder inside the sleeve will be automatically inflated to a pre-set level, thereby providing intermittent pressure to the calf.

4

Image /page/4/Picture/0 description: The image shows the logo and contact information for Alleva Medical LTD. The logo features a stylized letter A in blue. The text includes the company name, address (Suite M-Q, 12th Floor, Kings Wing Plaza 2, 1 On Kwan St. Shek Mun, Shatin, N.T., Hong Kong), telephone number (+852 3166 7200), fax number (+852 2355 7663), and website address (www.allevamedical.com).

The commercial saleable package will consist of two pump units with their sleeves, one for each leg.

The unit operates by inflating the air bladder until the pressure reaches 50mmHg. After reaching this pressure level, the unit will automatically deflate for 50 seconds to complete one cycle. Therapy could persist as long as the patient needs or is instructed by their physician. When the therapy ends, the patient simply would turn off the device by the press of a power button.

Indications for Use

The Plexus RP100 Portable DVT Prevention Device is intended to be used by patients 21 years of age or older, in either home or clinical settings for:

  • Aiding the prevention of DVT onset ●
  • . Enhancing blood circulation in the lower extremities
  • . Diminishing post-operative pain and swelling
  • Reducing wound healing time
  • Serving as a prophylaxis for DVT for stationary or bedridden individuals
  • . Aiding in the treatment of: stasis dermatitis, venous stasis ulcers, arterial and diabetic leg ulcers, chronic venous insufficiency and reduction of edema in the lower limbs

Summary of Technological Characteristics

Both the Plexus RP100 and predicate device, Cirona 6300 (K151189), share the same operating principles whereby each unit provides intermittent compression and inflation is supplied by a miniature air pump and deflation is managed by the pressure relief valve. Both devices utilize a microprocessor to deliver 50mmHg of pressurized air to the bladders in the sleeve garment for a predefined period of time. Further, both devices have similar usability, in that they both utilize a single button to initiate device use and utilize Velcro in securing the device to the lower limb. Both pump casings are constructed of hard ABS plastic to provide structural protection to the internal components and the sleeves are made of soft, non-woven materials with the bladders made of Polyurethane films. Both devices are also powered by an internal rechargeable battery.

Summary of Non-Clinical Testing

The following non-clinical testing has been completed to demonstrate that the Plexus RP100 device is performing as intended and has performance characteristics that are substantially equivalent to the listed predicate device.

Standards and Regulations AppliedResults
ISO10993-5:2009 In-Vitro CytotoxicityPassed
ISO10993-10:2010 Intracutaneous ReactivityPassed

Biocompatibility Testing

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Image /page/5/Picture/0 description: The image shows the logo and contact information for Alleva Medical LTD. The logo features a stylized letter A in blue. The text includes the company's address, which is Suite M-Q, 12th Floor, Kings Wing Plaza 2, 1 On Kwan St. Shek Mun, Shatin, N.T., Hong Kong, as well as their phone number +852 3166 7200, fax number +852 2355 7663, and website www.allevamedical.com.

ISO10993-10: 2010 Skin SensitizationPassed
----------------------------------------------

Electromagnetic Compatibility and Electrical Safety Testing

Standards and Regulations AppliedResults
IEC 60601-1:2005 (Third Edition) + A1:2012(or IEC 60601-1: 2012 reprint)Passed
IEC 60601-1-2:2014Passed

Functional Performance Testing

Test ItemsResults
Battery charging time testDesign requirements met
Sleeve leakage testDesign requirements met
Pressure accuracy testDesign requirements met
Inflation time testDesign requirements met
Deflation time testDesign requirements met
Battery operating life testDesign requirements met
Sleeve integrity testDesign requirements met
Total worklife testDesign requirements met

Software Verification and Validation

Software verification and validation activities were completed and there were no unresolved anomalies. The software was considered a "moderate" level of concern, since a failure or latent flaw in the software could directly result in minor injury to the user.

Summary of Clinical Testings

No clinical testing was performed to support the claim of substantial equivalence to the Cirona 6300 device.

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Image /page/6/Picture/0 description: The image shows the logo and contact information for Alleva Medical LTD. The logo features a stylized letter A in blue. Below the logo is the company name, address (Suite M-Q, 12th Floor, Kings Wing Plaza 2, 1 On Kwan St. Shek Mun, Shatin, N.T., Hong Kong), telephone number (+852 3166 7200), fax number (+852 2355 7663), and website (www.allevamedical.com).

Summary of Substantial Equivalence

CharacteristicsSubject DevicePredicate DeviceComparison
ManufacturerAlleva Medical (D.G) LtdAscent Healthcare, LLC, DBA
Devon Medical Products-
510(k) NumberN/AK151189-
ClassIIIIEquivalent
Product NameDisposable Deep Vein
Thrombosis Prevention
DeviceDisposable Deep Vein
Thrombosis Prevention
Device-
Product CodeJOWJOWEquivalent
Regulation Number21 CFR 870.580021 CFR 870.5800Equivalent
Intended Use• Aiding the prevention of
DVT onset
• Enhancing blood
circulation in the lower
extremities
• Diminishing post-
operative pain and
swelling
• Reducing wound healing
time
• Serving as a prophylaxis
for DVT for stationary or
bedridden individuals
• Aid in the treatment of:
stasis dermatitis, venous
stasis ulcers, arterial and
diabetic leg ulcers,
chronic venous
insufficiency and
reduction of edema in
the lower limbs• Aid in the prevention of
DVT
• Enhance blood circulation
• Diminish post-operative
pain and swelling
• Reduce wound healing
time
• Aid in the treatment of:
stasis dermatitis, venous
stasis ulcers, arterial and
diabetic leg ulcers, chronic
venous insufficiency and
reduction of edema in the
lower limbs
• Serve as a prophylaxis for
DVT by persons expecting
to be stationary for long
periods of timeEquivalent
Use SettingsHome, hospital, surgery
centerHome, hospital, surgery
centerEquivalent
PortabilityPortablePortableEquivalent
Principles of
operationAir pump supplying
pressure to the air bladder
on the pressure garment.
Air pressure is relieved
through an open air valveAir pump supplying
pressure to the air bladder
on the pressure garment.
Air pressure is relieved
through an open air valveEquivalent
Location of treatmentLower limbs/calvesLower limb/calvesEquivalent
Pressure sourceMiniature air pumpMiniature air pumpEquivalent
Therapy ModeOneOneEquivalent
Compression
pressure level50mmHg50mmHgEquivalent
Cycle patternInflation to target pressure,
then 50 seconds rest periodInflation to target pressure,
then 50 seconds rest periodEquivalent
SterilityClean/non-sterileClean/non-sterileEquivalent
Source of powerLithium Battery 3.7V
2600mAhLithium Battery 3.7V
1350mAhRP100/Plexus has a
higher battery
capacity, otherwise
equivalent
Power supplyAC Input: 100~240V,
AC50/60Hz, 500mA Max;
DC output 5V 2A (2 Plugs)AC Input: 100~240V,
AC50/60Hz, 500mA Max;
DC output 5V 2A (2 Plugs)Equivalent
Sleeve materialSoft non-woven fabricSoft non-woven fabricEquivalent
Pump housing
materialHard Plastic (ABS)Hard Plastic (ABS)Equivalent
Sleeve orientationLeft and right sleeves are
different. Indicated on
sleeve.Left and right sleeves are
different. Indicated on
sleeveEquivalent
LED indicatorYes
(Blue & Yellow)Yes
(Yellow)Equivalent in both
having a LED
indicator; (Plexus
has two colors to
provide visual aid on
power and alarm
status)
Alarm
communicationsAudible and VisualAudible and VisualEquivalent: only
different in color
and duration of the
alarm
Alarm modesPressure error, low battery
error, charging errorPressure error, low battery
error, charging errorEquivalent
Operating time16 hours continuous for a
single charge8 hours continuous for a
single chargeEquivalent;
RP100/Plexus has a
longer operating
time
Storage-25-70°C,-25-70°C,Equivalent
Requirements