K Number
K230483
Device Name
Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15)
Manufacturer
Date Cleared
2023-09-16

(205 days)

Product Code
Regulation Number
868.5260
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To filter a patient's inspiratory and expiratory respiratory gasses to remove bacteria and viruses. For non-mechanically ventilated tracheostomy patients who are awake and alert or monitored by a trained healthcare provider or caregiver, where filtration of inspired and/or expired gases is desired. Use up to 24 hours. Environment of use - clinical settings including hospital, sub-acute, pre-hospital, and home. For adults with Tidal Volumes >300 ml and pediatrics with Tidal Volumes >80 ml. Do not use on neonate or infant patients.
Device Description
The Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) is a non-sterile, lightweight, single-patient use device for non-mechanically ventilated tracheostomy patients to filter viral, bacterial, and other particulate matter. The filter is intended to fit onto the 15mm hub of a tracheostomy tube. The filter is easy to apply and remove with a gentle twist motion.
More Information

Not Found

No
The device description and performance studies focus on physical filtration properties and mechanical characteristics, with no mention of AI or ML.

No
The device is described as a filter that removes bacteria and viruses from inspired and expired respiratory gases, indicating a preventative function rather than a direct therapeutic one to treat or cure a disease or condition.

No

The device is a filter intended to remove bacteria and viruses from respiratory gases, not to diagnose medical conditions.

No

The device description clearly states it is a "non-sterile, lightweight, single-patient use device" that "is intended to fit onto the 15mm hub of a tracheostomy tube." This describes a physical, hardware component, not a software-only device. The performance studies also focus on physical characteristics and filtration efficiency, not software performance.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The described device is a filter designed to remove bacteria and viruses from the air a patient breathes. It physically filters the air before it enters or leaves the patient's respiratory system.
  • Lack of Biological Sample Analysis: The device does not analyze any biological samples from the patient. It interacts with the air, not with bodily fluids or tissues.
  • Intended Use: The intended use is to filter respiratory gases, not to diagnose or monitor a medical condition through the analysis of biological samples.

Therefore, the Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) is a medical device, but it falls under a different classification than an IVD. It is a device used to modify the air being breathed, not to perform diagnostic tests on biological samples.

N/A

Intended Use / Indications for Use

For non-mechanically ventilated tracheostomy patients who are awake and alert or monitored by a trained healthcare provider or caregiver, where filtration of inspired gases is desired. Use up to 24 hours.

Environment of use - clinical settings including hospital, sub-acute, pre-hospital, and home. For adults with Tidal Volumes >300 ml and pediatrics with Tidal Volumes >80 ml. Do not use on neonate or infant patients.

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

CAH

Device Description

The Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) is a non-sterile, lightweight, single-patient use device for non-mechanically ventilated tracheostomy patients to filter viral, bacterial, and other particulate matter. The filter is intended to fit onto the 15mm hub of a tracheostomy tube. The filter is easy to apply and remove with a gentle twist motion.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Breathing gas pathway

Indicated Patient Age Range

Adults with Tidal Volumes >300 ml and pediatrics with Tidal Volumes >80 ml. Do not use on neonate or infant patients.

Intended User / Care Setting

Environment of use - clinical settings including hospital, sub-acute, pre-hospital, and home.

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)

Non-clinical performance testing was conducted.
Key results:

  • Conical Connector Compliance: Met the Standard (ISO 5356-1 Third Edition 2004-05-15)
  • Leak Testing: 0 ml/min at 1 psi for 2 minutes.
  • Dead Space: 6 ml (Better than predicate which was 45 ml)
  • Cytotoxicity: Non-cytotoxic (ISO 10993-5 Third edition 2018-08)
  • Skin Sensitization: Not a contact skin sensitizer (ISO 10993-10 Fourth Edition 2021-11)
  • Irritation: Non-Irritant (ISO 10993-23 First Edition 2021-11)
  • Particulate Matter Testing: 99.9% (ASTM F2101)
  • Bacterial Filtration Efficiency (BFE): >99.9% (ASTM F2101)
  • Accelerated Aging: Device met its performance specifications post-conditioning (ASTM 1980-16)

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

  • Particle Filtration Efficiency (PFE) @ 0.1 µm: >99.0%
  • Bacterial Filtration Efficiency (BFE): >99.9%
  • Viral Filtration Efficiency (VFE): >99.9%
  • Flow Resistance:

§ 868.5260 Breathing circuit bacterial filter.

(a)
Identification. A breathing circuit bacterial filter is a device that is intended to remove microbiological and particulate matter from the gases in the breathing circuit.(b)
Classification. Class II (performance standards).

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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.

September 16, 2023

Passy-Muir, Inc. % Prithul Bom Most Responsible Person Regulatory Technology Services, LLC 1000 Westgate Drive, Suite 510k Saint Paul, Minnesota 55114

Re: K230483

Trade/Device Name: Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) Regulation Number: 21 CFR 868.5260 Regulation Name: Breathing circuit bacterial filter Regulatory Class: Class II Product Code: CAH Dated: September 14, 2023 Received: September 14, 2023

Dear Prithul Bom:

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.

Bifeng Qian -S

Bifeng Qian, M.D., Ph.D. Assistant Director Division of Infection Control and Plastic and Reconstructive Surgery Devices Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

2

Indications for Use

510(k) Number (if known) K230483

Device Name

Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15)

Indications for Use (Describe)

For non-mechanically ventilated tracheostomy patients who are awake and alert or monitored by a trained healtheare provider or caregiver, where filtration of inspired gases is desired. Use up to 24 hours.

Environment of use - clinical settings including hospital, sub-acute, pre-hospital, and home. For adults with Tidal Volumes >300 ml and pediatrics with Tidal Volumes >80 ml. Do not use on neonate or infant patients.

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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Image /page/3/Picture/0 description: The image shows the logo for Passy Muir. The logo consists of the name "Passy Muir" in a stylized, cursive font in purple. To the right of the name is a purple square containing a white silhouette of a person's head and neck, with sound waves emanating from the mouth.

510(K) SUMMARY

K230483

  • DATE PREPARED: September 16, 2023
  • Passy-Muir, Inc. APPLICANT: 4521 Campus Dr., PMB 273 Irvine, CA 92612
  • MANUFACTURER: Passy-Muir, Inc. 4521 Campus Dr., PMB 273 Irvine, CA 92612
  • Donna Malter (RA/QA Manager) CONTACT PERSON: Email: dmalter@passymuir.com Tel: (949) 833-8255
  • PROPRIETARY NAME: Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15)
  • Filter, bacterial, breathing-circuit COMMON NAME:

REGULATION NUMBER: 21 CFR 868.5260

  • PRODUCT CODE: CAH
  • Class II DEVICE CLASS:
  • REVIEW PANEL: General Hospital Premarket Review: Surgical and Infection Control Devices (OHT4) Infection Control and Plastic Surgery Devices (DHT4B)
  • PREDICATE DEVICE: Altera Filter K192713 (Filter Only) by Meditera Tibbi Malzeme, San. ve Tic. A.S.

DEVICE DESCRIPTION: The Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) is a non-sterile, lightweight, single-patient use device for non-mechanically ventilated tracheostomy patients to filter viral, bacterial, and other particulate matter. The filter is intended to fit onto the 15mm hub of a tracheostomy tube. The filter is easy to apply and remove with a gentle twist motion.

PRINCIPLE OF OPERATION: Filtration is via the principle of electrostatic charges that attract and capture microbes in the media.

4

INTENDED USE: To filter a patient's inspiratory and expiratory respiratory gasses to remove bacteria and viruses.

INDICATIONS FOR USE:

For non-mechanically ventilated tracheostomy patients who are awake and alert or monitored by a trained healthcare provider or caregiver, where filtration of inspired and/or expired gases is desired. Use up to 24 hours.

Environment of use - clinical settings including hospital, sub-acute, pre-hospital, and home. For adults with Tidal Volumes >300 ml and pediatrics with Tidal Volumes >80 ml. Do not use on neonate or infant patients.

Technological Characteristics Comparison

COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE:

DescriptionSubject DevicePredicate Device (K192713)Comparison
DevicePassy Muir Tracheostomy
Viral & Bacterial Airway
Protection Filter (PM-APF15)Altera Filter - K192713 (Filter
Only) by Meditera Tibbi
Malzeme, San. Ve Tic. A.S.N/A
ModelPassy Muir Tracheostomy
Viral & Bacterial Airway
Protection Filter (PM-APF15)Not availableN/A
ClassificationClass II Device, CAH - Filter,
Bacterial, Breathing-Circuit
(21 CFR 868.5260)Class II Device, CAH - Filter,
Bacterial, Breathing-Circuit
(21 CFR 868.5260)Same
Intended UseTo filter a patient's
inspiratory and expiratory
respiratory gasses to remove
bacteria and viruses.To filter a patient's inspiratory
and expiratory respiratory
gasses to remove bacteria and
viruses.Same

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Image /page/5/Picture/0 description: The image shows the Passy Muir logo. The logo is purple and features the company name in a stylized font. To the right of the name is a purple square with rounded corners, inside of which is a white silhouette of a person's head and neck with sound waves coming from their mouth.

| Indications for Use | For non-mechanically
ventilated tracheostomy
patients who are awake and
alert or monitored by a
trained healthcare provider or
caregiver, where filtration of
inspired and/or expired gases
is desired. Use up to 24
hours.
Environment of use - clinical
settings including hospital,
sub-acute, pre-hospital, and
home. For adults with Tidal
Volumes >300 ml and
pediatrics with Tidal
Volumes >80 ml. Do not use
on neonate or infant patients. | [Filter Device] For use with
ventilators, anesthesia
machines and open flow
systems where filtration of
inspired and/or expired gases
is desired. Use up to 24 hours.
[HME Device] N/A
Environment of use - clinical
settings including hospital,
sub-acute, pre-hospital and
home or patients with Tidal
Volumes >300 ml | Similar
-Second
device in
K192713 is an
HME and not
relevant to this
submission |
|------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------|
| Principle of Operation | Filtration is via the principle
of electrostatic charges that
attract and capture microbes
in the media. | Filtration is via the principle of
electrostatic charges that
attract and capture microbes in
the media. | Same |
| Patient Population | Adults Tidal Volume

300 ml
Pediatrics Tidal Volume
80 ml. Do not use on
neonate or infant patients. | Adults Tidal Volume >300ml | Similar |
| Anatomical Site | Breathing gas pathway | Breathing gas pathway | Same |

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Image /page/6/Picture/0 description: The image contains the logo for Passy Muir. The logo consists of the name "Passy Muir" in a stylized, cursive font, with a registered trademark symbol next to it. To the right of the name is a purple square with rounded corners, inside of which is a white silhouette of a person's head and neck, with sound waves emanating from the mouth.

DescriptionSubject DevicePredicate Device (K192713)Comparison
Environments of UseHospitals, sub-acute,
pre-hospital, and homeHospitals, sub-acute,
pre-hospital, and homeSame
Compatibility with
environment and other
devicesIntended for use with open
tracheostomy tube with a
15mm conical connectorIntended for use with
ventilators, anesthesia gas
machines and open flow
systems that utilize a 15mm or
22mm conical connectorSimilar
PrescriptiveYesYesSame
PackagingNon-sterileNon-sterileSame
Single patient use,
disposableYes, up to 24 hoursYes, up to 24 hoursSame
Filter MediaMedia -polypropylene mediaMedia –polypropylene mediaSimiliar
Housing MaterialMedical grade ABSUnknownN/A
BiocompatibilityExternally Communicating,
Tissue, Limited
Cytotoxicity
Sensitization Irritation
Leachable and Extractables
with TRA
Acute Systemic Toxicity
Volatile Organic Compound
Testing
Particulate Matter TestingExternally Communicating,
Tissue, Limited
Cytotoxicity
Sensitization Irritation
Leachable and Extractables
with TRA
Acute Systemic Toxicity
Volatile Organic Compound
Testing
Particulate Matter TestingSame
Performance TestingFlow Resistance
99.0%Not availableN/A
Bacterial Filtration
Efficiency (BFE)*>99.9%99.998%Similar
Viral Filtration
Efficiency (VFE)*>99.9%99.96%Similar
Connector15mm conical connector ISO
5356-115mm and 22mm conical
connectors ISO 5356-115mm conical
connector
same
22mm N/A
Shelf LifeUnknown3 yearsN/A

*ASTM F2100. Bacterial and Viral Filtration Efficiency test method adapted from ASTM F2101.

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Image /page/7/Picture/0 description: The image is a logo for Passy Muir. The logo features the name "Passy Muir" in a stylized, cursive font in purple. To the right of the name is a purple square containing a white silhouette of a person's head and neck, with sound waves emanating from the mouth, suggesting speech or communication.

NON-CLINICAL TESTING OF SUBJECT DEVICE:

Test MethodTest PerformedAcceptance CriteriaResults
FDA Recognized
Consensus Standard No.
1-62, ISO 5356-1 Third
Edition 2004-05-15Conical Connector
ComplianceMeet the StandardMet the Standard
Pre-determined
Acceptance CriteriaLeak TestingNo leak at 1 psi for 2
minutesLeakage -
0 ml/min
Pre-determined
Acceptance CriteriaDead SpaceBetter than predicate
(45 ml)6 ml
FDA Recognized
Consensus Standard No.
2-245, ISO 10993-5 Third
edition 2018-08CytotoxicityNon-cytotoxicNon-cytotoxic
FDA Recognized
Consensus Standard No.
2-296, ISO 10993-10
Fourth Edition 2021-11Skin SensitizationNot a contact skin
sensitizerNot a contact
skin sensitizer
FDA Recognized
Consensus Standard No.
2-291, ISO 10993-23 First
Edition 2021-11IrritationNon-IrritantNon-Irritant
FDA Recognized
Consensus Standard No.
1-135, ISO 18562-2 First
Edition 2017-03Particulate Matter Testing99.9%
ASTM F2101Bacterial Filtration
Efficiency (BFE) %Bacterial filtration
efficiency is equivalent to
predicate>99.9%
FDA Recognized
Consensus Standard No.
14-497, ASTM 1980-16Accelerated AgingDevice meets its
performance
specifications post-
conditioningDevice met its
performance
specifications
post-
conditioning

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Image /page/8/Picture/0 description: The image contains the logo for Passy Muir. The logo consists of the name "Passy Muir" in a stylized, cursive font in purple. To the right of the name is a purple square containing a white silhouette of a person's head and neck, with sound waves emanating from the mouth, suggesting speech or communication.

CONCLUSION:

The conclusions drawn from the non-clinical performance testing demonstrate that the Passy Muir Tracheostomy Viral & Bacterial Airway Protection Filter (PM-APF15) is as safe, as effective, and perform as well as or better than the legally marketed predicate device.