K Number
K193288
Device Name
Koya Ripple
Manufacturer
Date Cleared
2020-06-16

(202 days)

Product Code
Regulation Number
870.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Koya Dayspring system is a prescription only wearable compression system that is intended for use in a clinic or home setting by medical professionals and patients who are under medical supervision for the following: - Lymphedema - Primary lymphedema - Post mastectomy edema - Edema following trauma and sports injuries - Post immobilization edema - Venous insufficiency - Reducing wound healing time The Koya Dayspring system is developed on a wearable compression technology platform, which is designed to provide mobility for patients.
Device Description
The Koya Dayspring™ system is powered by an active smart compression technology that is calibrated, instant-acting, and silent. This technology uses a Nickel Titanium (Ni-Ti) shape-memory alloy programmed by a controller system. A disposable stockinette is worn as an accessory under the device to prevent direct patient contact with the device is wrapped around the patient's arm so that the device fits snugly. The device has up to 16 independently controlled sections in each arm. The controller can be programmed to provide sequential compression therapy to the affected area over a range of 0-100 mmHg. The device is powered by a rechargeable Lithium-ion battery pack. The device was developed to provide patients with untethered access and a functional range of motion and mobility while treating chronic lymphedema.
More Information

No
The description mentions a "smart compression technology" and a "controller system" that can be "programmed," but there is no mention of AI, ML, or any learning or adaptive capabilities based on data. The control appears to be based on pre-programmed parameters.

Yes
The device is described as a wearable compression system intended to treat various medical conditions like lymphedema, edema, and venous insufficiency, which directly aligns with the definition of a therapeutic device designed to treat or alleviate a disease or condition.

No

The device is a wearable compression system intended for therapeutic purposes (treating lymphedema, edema, venous insufficiency, etc.), not for diagnosing medical conditions.

No

The device description clearly outlines hardware components such as a wearable compression system, shape-memory alloy, controller system, disposable stockinette, rechargeable Lithium-ion battery pack, and mentions electrical safety and electromagnetic compatibility testing, indicating it is not software-only.

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

Here's why:

  • IVD Definition: In vitro diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information for diagnosis, monitoring, or screening.
  • Koya Dayspring Function: The Koya Dayspring system is a wearable compression system that applies external pressure to the body. It does not analyze any biological specimens.
  • Intended Use: The intended use is for treating conditions like lymphedema and venous insufficiency by applying compression, not by analyzing samples.
  • Device Description: The description focuses on the mechanical and electrical components of the compression system, not on any analytical or diagnostic capabilities.

Therefore, the Koya Dayspring system falls under the category of a therapeutic medical device, specifically a compression therapy device, rather than an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Koya Dayspring system is a prescription only wearable compression system that is intended for use in a clinic or home setting by medical professionals and patients who are under medical supervision for the treatment of the following:

  • Lymphedema
  • Primary lymphedema
  • Post mastectomy edema
  • Edema following trauma and sports injuries
  • Post immobilization edema
  • Venous insufficiency
  • Reducing wound healing time

The system is developed on a wearable compression technology platform, which is designed to provide mobility for patients.

Product codes

JOW

Device Description

The Koya Dayspring™ system is powered by an active smart compression technology that is calibrated, instant-acting, and silent. This technology uses a Nickel Titanium (Ni-Ti) shape-memory alloy programmed by a controller system. A disposable stockinette is worn as an accessory under the device to prevent direct patient contact with the device is wrapped around the patient's arm so that the device fits snugly. The device has up to 16 independently controlled sections in each arm. The controller can be programmed to provide sequential compression therapy to the affected area over a range of 0-100 mmHg. The device is powered by a rechargeable Lithium-ion battery pack. The device was developed to provide patients with untethered access and a functional range of motion and mobility while treating chronic lymphedema.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Arm

Indicated Patient Age Range

Not Found

Intended User / Care Setting

medical professionals and patients who are under medical supervision / clinic or home setting

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

Mechanical and acoustic Testing: A benchtop mechanical testing study was performed to compare the pressure applied by the subject device with the pressure applied by the predicate device. Additionally, transport shipping testing was conducted in accordance with ASTM D4169.

Clinical Studies: Clinical testing was not required to demonstrate the safety and effectiveness of the Koya Dayspring™ system. Instead, substantial equivalence is based upon benchtop performance testing.

Key Metrics

Not Found

Predicate Device(s)

K170216

Reference Device(s)

K162481

Predetermined Change Control Plan (PCCP) - All Relevant Information

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). The logo consists of two parts: a symbol on the left and the FDA name on the right. The symbol on the left is a stylized image of a human figure, while the FDA name on the right is written in blue letters. The words "U.S. FOOD & DRUG ADMINISTRATION" are written in a clear, sans-serif font.

June 16, 2020

Koya, Inc. % Robert Packard President Medical Device Academy, Inc. 345 Lincoln Hill Road Shrewsbury, Vermont 05738

Re: K193288

Trade/Device Name: Koya Dayspring Regulation Number: 21 CFR 870.5800 Regulation Name: Compressible Limb Sleeve Regulatory Class: Class II Product Code: JOW Dated: May 19, 2020 Received: May 19, 2020

Dear Robert Packard:

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.

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

1

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 (OS) 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 mediation-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,

Fernando Aguel for 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

510(k) Number (if known) K193288

Device Name Koya Dayspring

Indications for Use (Describe)

The Koya Dayspring system is a prescription only wearable compression system that is intended for use in a clinic or home setting by medical professionals and patients who are under medical supervision for the following:

  • · Lymphedema
  • Primary lymphedema
  • · Post mastectomy edema
  • · Edema following trauma and sports injuries
  • Post immobilization edema
  • · Venous insufficiency
  • · Reducing wound healing time

The Koya Dayspring system is developed on a wearable compression technology platform, which is designed to provide mobility for patients.

Type of Use (Select one or both, as applicable)
-------------------------------------------------
Research Use (Part 21 CFR 361 Subpart B) Over-The-Counter Use (21 CFR 361 Subpart C)

Prescription Use (Part 21 CFR 801 Subpart D)

| | Over-The-Counter Use (21 CFR 801 Subpart C)

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K193288 - 510(k) SUMMARY

This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of 21 CFR §807.92:

I. SUBMITTER

Koya, Inc. 357 Tehama St., Suite 1 San Francisco, CA, 94103 USA +1.415.851.0337 Fax: N/A Contact Person: Andy Doraiswamy, PhD Date Prepared: February 21, 2020

DEVICE II.

Name of Device:Koya Dayspring™
Classification Name:Compressible Limb Sleeve
Regulation:21 CFR § 870.5800
Regulatory Class:Class II
Product Classification Code:JOW

III. PREDICATE DEVICE

Predicate Manufacturer:Tactile Systems Technology, Inc. (dba Tactile Medical)
Predicate Trade Name:Flexitouch Plus System, Model PD32-G3
Predicate 510(k):K170216
Reference Device:K162481

DEVICE DESCRIPTION IV.

The Koya Dayspring™ system is powered by an active smart compression technology that is calibrated, instant-acting, and silent. This technology uses a Nickel Titanium (Ni-Ti) shape-memory alloy programmed by a controller system. A disposable stockinette is worn as an accessory under the device to prevent direct patient contact with the device is wrapped around the patient's arm so that the device fits snugly. The device has up to 16 independently controlled sections in each arm. The controller can be programmed to provide sequential compression therapy to the affected area over a range of 0-100 mmHg. The device is powered by a rechargeable Lithium-ion battery pack. The device was developed to provide patients with untethered access and a functional range of motion and mobility while treating chronic lymphedema.

INDICATIONS FOR USE V.

The Koya Dayspring system is a prescription only wearable compression system that is intended for use in a clinic or home setting by medical professionals and patients who are under medical supervision for the treatment of the following:

  • · Lymphedema
  • · Primary lymphedema
  • Post mastectomy edema
  • · Edema following trauma and sports injuries

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  • · Post immobilization edema
  • · Venous insufficiency
  • Reducing wound healing time

The system is developed on a wearable compression technology platform, which is designed to provide mobility for patients.

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVCE

A reference device, K162481, was provided to address the concern that the subject device is using a different principle of operation (i.e., shape-memory materials) when compared to the predicate device (i.e., air pressure). The reference device identified uses the same principle as the subject device.

The following characteristics were compared between the subject device and the predicate device in order to demonstrate substantial equivalence:

FeatureSubject Device (K193288)Predicate Device (K170216)
Indications for UseThe Koya Dayspring system is a
prescription only wearable
compression system that is
intended for use in a clinic or
home setting by medical
professionals and patients who
are under medical supervision for
the treatment of the following:
• Lymphedema
• Primary lymphedema
• Post mastectomy edema
• Edema following trauma and
sports injuries
• Post immobilization edema
• Venous insufficiency
• Reducing wound healing time
The Koya Dayspring system is
developed on a wearable
compression technology
platform, which is designed to
provide mobility for patients.The Flexitouch Plus System and
garments for legs, arms, trunk,
and chest are intended for use by
medical professionals and
patients who are under medical
supervision, for the treatment of
many conditions such as:
• Lymphedema
• Primary lymphedema
• Post mastectomy edema
• Edema following trauma and
sports injuries
• Post immobilization edema
• Venous insufficiency
• Reducing wound healing time
• Treatment and assistance in
healing stasis dermatitis, venous
stasis ulcers, or arterial and
diabetic leg ulcers
The Flexitouch Plus System and
garments for the head and neck
are intended for use by medical
professionals and patients who
are under medical supervision
for the treatment of head and
neck lymphedema.
Electrical RequirementsRechargeable Li-ion Battery
Pack, with 1.7A input from 100-240 VAC 50/60 Hz to AC
Adapter, with output voltage of 19.0V DC and 3.4A100-240 VAC 50/60 Hz to AC
Adapter with output voltage of
12.0V DC and 3.0A
OutputSequential calibrated gradient
PressureSequential calibrated gradient
Pressure
Mechanism of ActionExertion of sequential pressure to
affected areaExertion of sequential pressure
to affected area
Principles of OperationLithium-ion battery powered
integrated shape memory alloy
channels creating compressive
pressureElectrically powered integrated
pneumatic air channels creating
compressive pressure
Device Total Pressure Range0-100 mmHg0-100 mmHg
Controller UnitImage: Controller Unit 1Image: Controller Unit 2
Controller unit size and weight3.3" x 3.6" x 0.8"
3 lbs8"x10"x8"
6.2 lbs
Controller Enclosure MaterialAll plastic constructionAll plastic construction
User InterfacePushbuttons.
Also available is Bluetooth Low
Energy (BLE) Module for
communication with mobile
application on mobile devicePushbuttons
Mobile application or BLE not
available
Mechanism of ActionExertion of sequential pressure to
affected areaExertion of sequential pressure
to affected area
Software/HardwareAnalog and digital electronic
with microprocessorAnalog and digital electronic
with microprocessor
Garment
Garment MaterialNylon fabric with velcro strapsNylon fabric with velcro straps
StockinetteClass I biocompatibile liner provided
with the unitClass I biocompatibile liner
provided with the unit
Chambers/SectionsUp to 16 chambers for the
extremityUp to 16 chambers for the
extremity
Short: 12Short: 12
Medium: 14Medium: 14
Long: 16Long: 16

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VII. PERFORMANCE DATA

The following performance data were provided in support of the substantial equivalence determination.

Sterilization & Shelf-life Testing

Device is non-sterile, and components are unlikely to deteriorate with age with the exception of Li-ion battery. Battery shelf-life and charge/discharge testing data was provided.

Biocompatibility Testing

The patient contacting portion of the device is the stockinette liner which is a biocompatible, Class 1 device that is marketed in the USA. Since the material comes in contact with intact skin with an exposure duration of less than 24 hours, it was tested to ensure the safety using cytotoxicity study (ISO 10993-5), sensitization study (ISO 10993-10), and irritation study (ISO 10993-10). All results were found to be acceptable and the material found to safe for the intended use.

Electrical safety and electromagnetic compatibility (EMC)

Electrical safety and EMC testing included:

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  • ANSI AAMI ES60601-1:2005/(R)2012 And A1:2012, ●
  • IEC 60601-1-2 Ed. 4.0
  • IEC 60601-1-11 Ed. 2.0 ●
  • IEC 62133-2 Ed. 1.0 ●

Software Verification and Validation Testing

Software verification and validation testing was performed in accordance with IEC 62304 Ed. 1.1. Additional software verification and validation testing was conducted and documentation was provided as recommended by the following FDA Guidance documents for Industry and FDA Staff:

  • Guidance for the Content of Premarket Submissions for Software Contained in . Medical Devices
  • Guidance for Industry, FDA Reviewers and Compliance on Off-The-Shelf Software . Use in Medical Devices
  • Guidance for Industry and Food and Drug Administration Staff Content of ● Premarket Submissions for Management of Cybersecurity in Medical Devices
  • Guidance for Industry, FDA Reviewers and Compliance on Postmarket ● Management of Cybersecurity in Medical Devices

Mechanical and acoustic Testing

A benchtop mechanical testing study was performed to compare the pressure applied by the subject device with the pressure applied by the predicate device. Additionally, transport shipping testing was conducted in accordance with ASTM D4169.

Animal Study

Animal performance testing was not required to demonstrate safety and effectiveness of the device.

Clinical Studies

Clinical testing was not required to demonstrate the safety and effectiveness of the Koya Dayspring™ system. Instead, substantial equivalence is based upon benchtop performance testing.

VIII. CONCLUSIONS

The data included in this submission demonstrates that the Koya Dayspring™ is substantially equivalent to the legally marketed predicate device, Flexitouch Plus® PD32-G3 (K170216).