K Number
K191856
Device Name
Compression Therapy Device
Date Cleared
2020-03-19

(252 days)

Product Code
Regulation Number
870.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Compression Therapy Device (Model: LGT-2201DVT) is intended to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients. LGT-2201DVT is Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg Ulcers, Venous Stasis / Venous Insufficiency.
Device Description
Compression Therapy Device LGT-2201DVT a compression therapy device comprised of intermittent pneumatic controller, sleeves and connectable hose. The working principle is the air inflating and deflating the sleeve sequentially to develop the circulating pressure on the human body. Squeezing the proximal and distal of the limbs to promote blood circulation lymphatic system and improve body microcirculation. Besides, prevent thrombus, reduce limbs drops and this kind disease which is related to blood and lymph circulation directly or indirectly.
More Information

Not Found

No
The description focuses on the mechanical principle of intermittent pneumatic compression and does not mention any AI/ML components or functionalities.

Yes

The device is intended to prevent DVT (Deep Vein Thrombosis) by improving blood velocity and promotes blood circulation, which are therapeutic effects for health conditions.

No

The device is a compression therapy device intended to prevent DVT and improve blood velocity, not to diagnose a condition.

No

The device description explicitly states it is comprised of an intermittent pneumatic controller, sleeves, and connectable hose, which are hardware components.

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 Compression Therapy Device LGT-2201DVT works by applying external pressure to the limbs to improve blood circulation. It does not analyze any biological samples taken from the patient.
  • Intended Use: The intended use is to prevent DVT and treat conditions related to poor circulation by physically manipulating the limbs.
  • Device Description: The description clearly outlines a mechanical process of inflating and deflating sleeves.
  • Lack of IVD Indicators: There is no mention of analyzing samples, reagents, or any other components typically associated with IVD testing.

Therefore, the LGT-2201DVT is a therapeutic device that acts externally on the body, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Compression Therapy Device (Model: LGT-2201DVT) is intended to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients.

LGT-2201DVT is Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg Ulcers, Venous Stasis / Venous Insufficiency.

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

JOW

Device Description

Compression Therapy Device LGT-2201DVT a compression therapy device comprised of intermittent pneumatic controller, sleeves and connectable hose. The working principle is the air inflating and deflating the sleeve sequentially to develop the circulating pressure on the human body. Squeezing the proximal and distal of the limbs to promote blood circulation lymphatic system and improve body microcirculation. Besides, prevent thrombus, reduce limbs drops and this kind disease which is related to blood and lymph circulation directly or indirectly.

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

Prescription Use

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 Compression Therapy Device has been evaluated the safety and performance by lab bench testing according to the following standards:

  • IEC 60601-1, Medical Electrical Equipment - Part 1: General Requirements for Safety, 1988+A1:2012
  • 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, 2014
  • ISO 10993-5, Biological evaluation of medical devices -- Part 5: Tests for In Vitro cytotoxicity, 2009
  • ISO 10993-10, Biological evaluation of medical devices -- Part 10: Tests for irritation and skin sensitization, 2010
  • IEC 62133-2:2017, Secondary cells and batteries containing alkaline or other nonacid electrolytes - Safety requirements for portable sealed secondary cells, and for batteries made from them, for use in portable applications- Part 2: Lithium systems

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.

K160180

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 square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

March 19, 2020

Guangzhou Longest Science & Technology Co., Ltd. % Jet Li Regulation Manager Guangzhou KEDA Biological Tech Co., Ltd. 6F. No.1 TianTai road. Science City. LuoGang District Guangzhou. Cn

Re: K191856

Trade/Device Name: Compression Therapy Device (Model: LGT-2201DVT) Regulation Number: 21 CFR 870.5800 Regulation Name: Compressible Limb Sleeve Regulatory Class: Class II Product Code: JOW Dated: February 12, 2020 Received: February 18, 2020

Dear Jet Li:

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/cfpmr/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, 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

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801); medical device reporting (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-devices/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

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Indications for Use

Device Name

Compression Therapy Device (Model: LGT-2201DVT)

Indications for Use (Describe)

Compression Therapy Device (Model: LGT-2201DVT) is intended to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients.

LGT-2201DVT is Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg Ulcers, Venous Stasis / Venous Insufficiency.

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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510(k) Summary

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of SMDA and 21 CFR 870.1130.

Submitter Information 1.

Sponsor Name: Guangzhou Longest Science & Technology Co., Ltd.

Address: 5&6f, Building B4, No.11, Kaiyuan Avenue, Science City Guangzhou Hi-Tech Industrial Development Zone, Guangzhou Guangdong, CHINA 510530

Contact Person: Xiaobing Luo (Deputy general manager)

Phone: +86-020-66353999

E-mail: gzlongest@126.com

Application Correspondent:

Guangzhou KEDA Biological Tech Co., Ltd.

Contact person: Jet Li

Email: med-jl@foxmail.com

Tel: +86-20-22325619

Address: 6F, No.1 TianTai road, Science City, LuoGang District, GuangZhou City, China

2. Subject Device Information

Type of 510(k) submission: Traditional

Common Name:Compressible limb sleeve
Trade Name:Compression Therapy Device Model: LGT-2201DVT
Classification Name:sleeve, limb, compressible
Review Panel:Cardiovascular
Product Code:JOW
Regulation Number:870.5800
Regulation Class:II

3. Predicate Device Information

Sponsor:DAESUNG MAREF CO.,LTD
---------------------------------

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Common Name:Intermittent Pneumatic Compression system
Trade Name:DVT-4000
510(k) number:K160180
Review Panel:Cardiovascular
Product Code:JOW
Regulation Number:870.5800
Regulation Class:II

4. Device Description

Compression Therapy Device LGT-2201DVT a compression therapy device comprised of intermittent pneumatic controller, sleeves and connectable hose. The working principle is the air inflating and deflating the sleeve sequentially to develop the circulating pressure on the human body. Squeezing the proximal and distal of the limbs to promote blood circulation lymphatic system and improve body microcirculation. Besides, prevent thrombus, reduce limbs drops and this kind disease which is related to blood and lymph circulation directly or indirectly .

5. Intended Use / Indication for Use

Compression Therapy Device (Model: LGT-2201DVT) is intended to prevent DVT (Deep Vein Thrombosis) by improving the blood velocity of patients.

LGT-2201DVT is Circulation Enhancement, Deep Vein Thrombosis Prophylaxis, Edema -Acute, Edema - Chronic, Extremity Pain Incident to Trauma or Surgery, Leg Ulcers, Venous Stasis / Venous Insufficiency.

6. Test Summary

The Compression Therapy Device has been evaluated the safety and performance by lab bench testing according to the following standards:

  • � IEC 60601-1, Medical Electrical Equipment - Part 1: General Requirements for Safety, 1988+A1:2012
  • � 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, 2014
  • ISO 10993-5, Biological evaluation of medical devices -- Part 5: Tests for In Vitro � cytotoxicity, 2009
  • � ISO 10993-10, Biological evaluation of medical devices -- Part 10: Tests for irritation and skin sensitization, 2010

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  • � IEC 62133-2:2017, Secondary cells and batteries containing alkaline or other nonacid electrolytes - Safety requirements for portable sealed secondary cells, and for batteries made from them, for use in portable applications- Part 2: Lithium systems

7. Comparison to Predicate Device

Compare with predicate device, the subject device is very similar in design principle, intended use, indications for use, functions, material and the applicable standards. The differences between subject device and predicate device do not raise and new questions of safety or effectiveness.

| Elements of

ComparisonSubject DevicePredicate DeviceVerdict
ManufacturerGuangzhou Longest Science &
Technology Co., LtdDAESUNG MAREF CO.,LTD--
Product NameCompression Therapy DeviceDVT-4000--
Intended UseCompression Therapy Device
(Model: LGT-2201DVT) is intended
to prevent DVT (Deep Vein
Thrombosis) by improving the
blood velocity of patients.
LGT-2201DVT is Circulation
Enhancement, Deep Vein
Thrombosis Prophylaxis, Edema -
Acute, Edema - Chronic, Extremity
Pain Incident to Trauma or Surgery,
Leg Ulcers, Venous Stasis /
Venous Insufficiency.DVT-4000 is a system to prevent
DVT (Deep Vein Thrombosis) by
improving the blood velocity of
patients.
DVT-4000 is Circulation
Enhancement, Deep Vein
Thrombosis Prophylaxis, Edema -
Acute, Edema - Chronic, Extremity
Pain Incident to Trauma or Surgery,
Leg Ulcers, Venous Stasis /
Venous InsufficiencySE
Type of usePrescription UsePrescription UseSE
Size (L X W XH)27 x14.8 x 12.8 cm21.4 x18.1 x18.6 cmSimilar
Note 1
Weight2.3kg2.0 kgSimilar
Note 1
Input ratingAC 100-240 V 50/60HzAC 100-240 V 50/60HzSE
IEC
classificationClass II , Type BFClass II , Type BFSE
Input power90VA60-80VASimilar
Note 2
Battery Voltage11.1V /6500mAh, lithium
battery14.4V/2600mAhSimilar
Note 2
Pressure range30 - 150mmHg20 - 140±10mmHgSimilar
Note 3

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| Elements of

ComparisonSubject DevicePredicate DeviceVerdict
Setting Time1min~99hours or continuous1min~999hoursSE
Mode of
OperationContinuousContinuousSE
Applied partCompression sleevesCompression sleevesSE
Electrical,
Mechanical and
Thermal
EvaluationIEC 60601-1
IEC 60601-1-2
IEC62133IEC 60601-1
IEC 60601-1-2
IEC62133SE
Biocompatibility
EvaluationAll the patient contracting materials
are evaluated by the
biocompatibility standard ISO
10993 -5, -10.All the patient contracting materials
are evaluated by the
biocompatibility standard ISO
10993 -5, -10.SE

Note 1

Although there is a bit difference of the size and weight between the predicate device and subject device, they are all complied with the IEC 60601-1. Thus the differences do not affect the safety and effectiveness.

Note 2

The little difference of the input power does not affect the safety and effectiveness for the predicate device and subject device are complied with the IEC 60601-1. And although there is a bit difference of the battery, the LGT-2201DVT battery is verified in accordance with IEC62133. So the differences do not affect the safety and effectiveness.

Note 3

Although there is a bit difference of the Pressure range between the predicate device and subject device, they are all complied with the IEC 60601-1. Thus the differences do not affect the safety and effectiveness.

8. Conclusion

The subject device Compression Therapy Device, model: LGT-2201DVT has same intended use, principle of operation and similar technological characteristics as the predicate device. Although there are some specification that are different between two device, the subject device has undergone safety and performance tests, and the results complied with the test requests. Therefore, the difference between the Compression Therapy Device, model: LGT-2201DVT and the predicate device did not raise any problem

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of substantial equivalence. Thus the subject device is substantially equivalent to the predicate device.

9. Summary Prepared Date

12 February 2020