(30 days)
Not Found
No
The description focuses on the physical and optical measurement of blood clotting properties and the calculation of parameters based on these measurements. There is no mention of AI or ML algorithms being used for analysis or interpretation.
No
The device is an in vitro diagnostic (IVD) device used to provide semi-quantitative indications of the hemostasis state of a venous blood sample. It is used to assess clinical conditions and aid in determining if a clotting dysfunction or coagulopathy is present, but explicitly states that results "should not be the sole basis for a patient diagnosis." It does not directly treat or prevent a disease or condition in a patient.
Yes
The "Intended Use / Indications for Use" section explicitly states, "The TEG 6s Hemostasis System is intended for in vitro diagnostic use to provide semi-quantitative indications of the hemostasis state of a venous blood sample." The device also measures various clotting characteristics (e.g., Clotting Time, Maximum Clot Strength) to aid clinicians in determining if a clotting dysfunction is present.
No
The device description clearly outlines a system that includes both hardware (TEG® 6s Hemostasis analyzer, disposable cartridges with microfluidic components, optical detection system, piezoelectric actuator) and software for data analysis and control. It is not solely software.
Based on the provided text, the device is indeed an IVD (In Vitro Diagnostic).
Here's why:
- Explicit Statement in Intended Use: The very first sentence of the "Intended Use / Indications for Use" section clearly states: "The TEG 6s Hemostasis System is intended for in vitro diagnostic use..."
- Explicit Statement in Device Description: The first sentence of the "Device Description" section also states: "The TEG® 6s Hemostasis System (TEG® Hemostasis analyzer and TEG® 6s Assay Cartridges) is intended for in vitro diagnostic use..."
- Analysis of Blood Samples: The device analyzes venous blood samples to provide information about their hemostasis state. This is a core characteristic of in vitro diagnostics, which are used to examine specimens taken from the human body.
- Provides Indications of Hemostasis State: The device provides "semi-quantitative indications of the hemostasis state of a venous blood sample." This information is used to aid in determining if a clotting dysfunction or coagulopathy is present, which is a diagnostic purpose.
- Used in conjunction with clinical information: While the results should not be the sole basis for diagnosis, they are intended to be evaluated with other clinical information, which is typical for diagnostic tests.
- Predicate Device is also an IVD: The predicate device listed (K150041; TEG 6s Hemostasis System: Citrated: K, KH, RT, FF Assay Cartridge) is the same device, and its K number indicates it has been cleared by the FDA as a medical device, likely as an IVD given its function.
Therefore, the text provides multiple clear indications that the TEG 6s Hemostasis System is an In Vitro Diagnostic device.
N/A
Intended Use / Indications for Use
The TEG 6s Hemostasis System is intended for in vitro diagnostic use to provide semi-quantitative indications of the hemostasis state of a venous blood sample. The Citrated: K, KH, RT, FF Assay Cartridge, to be used with the TEG 6s analyzer, contains four independent assays (CK, CKH, CRT, and CFF), described below.
The CK assay monitors the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional parameters Clotting Time (R), Speed of Clot Formation (K and Alpha angle) and Maximum Clot Strength (MA).
The CKH assay monitors the effects of heparin in 3.2% citrated whole blood specimens on the TEG 6s System. CKH is used in conjunction with CK, and heparin influence is determined by comparing Clotting Times (R) between the two tests.
The CRT assay monitors the hemostasis process via both the intrinsic and extrinsic pathways in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA). The CRT MA parameter is equivalent to the CK MA parameter but the final MA value is reached more quickly using the CRT assay.
The CFF assay monitors hemostasis of 3.2% citrated whole blood specimens in the TEG 6s System after blocking platelet contributions to clot strength. Clotting characteristics are described by the functional parameters Maximum Clot Strength (MA) and the Estimated Functional Fibrinogen Level (FLEV).
Results from the TEG 6s analysis should not be the sole basis for a patient diagnosis, but should be evaluated together with the patient's medical history, the clinical picture and, if necessary, further hemostasis tests. The indication for TEG 6s System use is with adult patients where an evaluation of their blood hemostasis properties is desired. Hemostasis evaluations are commonly used to assess clinical conditions in cardiovascular surgery and cardiology procedures to assess hemorrhage or thrombosis conditions before, during and following the procedure. The TEG 6s Hemostasis System can be used in the laboratory or at the point-of-care.
Product codes (comma separated list FDA assigned to the subject device)
JPA
Device Description
The TEG® 6s Hemostasis System (TEG® Hemostasis analyzer and TEG® 6s Assay Cartridges) is intended for in vitro diagnostic use to provide semi-quantitative indications of a blood sample's ability to form and maintain a clot. The TEG® 6s Hemostasis System records the kinetic changes in a sample of whole blood as the sample clots, retracts and/or lyses. The system output consists of a table of numerical values and graphs resulting from the hemostasis process over time. This information can be used by clinicians to aid in determining if a clotting dysfunction or coagulopathy is present.
To perform a test, a disposable TEG® 6s Assay Cartridge is inserted into the TEG® 6s Hemostasis analyzer. The instrument reads the bar code on the cartridge and identifies the type of cartridge for operator confirmation. Blood (collected in a 3.2% sodium citrate tube) or Quality Control (QC) material is added to the entry port on the cartridge and drawn into the cartridge under the TEG® 6s Hemostasis analyzer control. The amount of the sample drawn into the cartridge is determined by the pre-set volume of the blood chambers in the cartridge. Once in the cartridge, the sample is metered into as many as 4 separate analysis channels, depending upon the assays being performed. Reconstitution of reagents dried within the cartridge is accomplished by moving the sample back and forth through reagent chambers, under the control of microfluidic valves and bellows (pumps) within the cartridge. After each sample has been mixed with reagent, it is delivered to a test cell where it is monitored for viscoelastic changes due to coagulation. Excess sample material is moved under microfluidic control into an enclosed waste chamber within the cartridge.
The TEG® 6s technology is based on a disposable cartridge containing up to 4 independent measurement cells. Each cell consists of a short vertically-oriented injection molded tube (ring). Detection of clotting in the TEG® 6s Hemostasis System is performed optically. A piezoelectric actuator vibrates the measurement cell(s) through a motion profile composed of summed sinusoids at different frequencies. The movement of the measurement cells will induce motion in the sample meniscus, which will be detected by a photodiode. The resulting motion of the meniscus is monitored optically and analyzed by the instrument to calculate the resonant frequency and modulus of elasticity (stiffness) of the sample. By performing a Fast Fourier Transform (FFT) on meniscus motion data, the resonant frequencies can be determined. The analyzer monitors the harmonic motion of a hanging drop of blood in response to external vibration. As the sample transitions from a liquid state to a gel-like state during clotting, the modulus of elasticity (stiffness) and therefore resonant frequency increase. The TEG® 6s Hemostasis analyzer measures these variations in resonant frequency during clotting and lysis.
Resonance is the tendency of a material or structure to oscillate with greater amplitude at some frequencies than others. The exact frequencies at which resonance occurs will depend on the stiffness and mass of the sample. Stiffness, in turn, is a function of a material's modulus of elasticity and the boundary conditions to which the material is exposed, such as the geometry and materials of a test cell. By holding these boundary conditions and sample mass constant from sample to sample, the TEG® 6s Hemostasis System allows direct comparison of elasticity between samples. The output measurements are displayed in a table and on a graphical tracing that reflects the hemostasis profile of the clot formation.
In a typical test, blood that has been delivered to the measurement cell will not clot for several minutes. During this time the sample has no inherent stiffness except that provided by surface tension, and since this remains constant the measured resonant frequencies will not change. Once clotting begins, however, the elastic modulus and thus the resonant frequencies increase rapidly. During fibrinolysis, the process is reversed, with elastic modulus and resonant frequencies decreasing. In tests where clotting does not occur, the resonant frequency of the sample will not change. During coagulation, however, a clot will bind to the ring contained in the cartridge and the resonant frequency will rise with increasing firmness of the Clot. The TEC® 6s Hemostasis Analyzer collects meniscus motion data, tracks changing resonant frequencies and analyzes the frequency data to provide semi-quantitative parameters describing the clot.
The TEG® 6s Hemostasis System monitors the interaction of platelets within the fibrin mesh of the clot during clot formation and lysis, all in a whole-blood setting. The TEG® 6s Hemostasis System uses thromboelastography to provide continuous measurement of clot elasticity.
The CK assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CK assay consists of Kaolin which is used in the assay for activation of coagulation. It is combined with calcium chloride (CaCl2) to neutralize the sodium citrate in the blood. The clotting characteristics of the CK generated hemostasis profile are described by the functional parameters Clotting Time (R), Speed of Clot Formation (K and Alpha angle) and Maximum Clot strength (MA). Since it may take an or more for a non-activated whole blood sample to reach maximum amplitude MA, Kaolin is essential to reduce run time and variability associated with running non-activated whole blood samples.
The CKH assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. CKH is used in conjunction with CK, and heparin influence is determined by comparing Clotting Times (R) between the two tests. Calcium Chloride (CaCl2) is included to neutralize any sodium citrate in the blood. The CKH assay monitors the effects of heparin, a commonly used anticoagulant in surgical procedures. Even very low concentrations of heparin, fractions of IU/mL of blood, can noticeably increase the R time and can even completely anticoagulate the blood, making it difficult if not impossible to monitor developing coagulopathies that are masked by high levels of therapeutic heparin.
The CRT assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process after stimulation of both the intrinsic and extrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CRT assay consists of a reagent containing kaolin and tissue factor. It is combined with Calcium Chloride (CaCl2) to neutralize sodium citrate in the blood sample. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA). The CRT assay produces an accelerated clotting time which allows for an earlier MA results compared to the CK assay. Therefore, in the TEG® Hemostasis System, the CRT assay is simultaneously run along with the CK and CKH assays to provide a fast way to reach a stable value for MA (CRT) while still measuring the time- dependent parameters (CK).
The CFF assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process after blocking platelet contributions to clot strength in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CFF assay consists of tissue factor and abciximab. It is combined with Calcium Chloride (CaCl2) to neutralize sodium citrate in the blood sample. Tissue Factor is used for coagulation activation that would be classically described as extrinsic, with platelet aggregation inhibited by abciximab (a GPIIb/IIIa inhibitor), excluding its contribution to clot strength, and thereby measuring fibrinogen contribution to clot strength. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA), the Estimated Functional Fibrinogen Level (FLEV).
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
Adult patients
Intended User / Care Setting
Used in the laboratory or at the point-of-care.
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)
Electrical Safety and Electromagnetic Compatibility (EMC)
Electrical safety and EMC testing were conducted on the TEG® 6s analyzer. The system complies with IEC 61010-1, IEC 61010-2-010, IEC 61010-2-101, standards for safety and the IEC 60601-1-2, IEC/ EN61326-1, IEC/ EN61326-2-6, standards for EMC.
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.
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
§ 864.5425 Multipurpose system for in vitro coagulation studies.
(a)
Identification. A multipurpose system for in vitro coagulation studies is a device consisting of one automated or semiautomated instrument and its associated reagents and controls. The system is used to perform a series of coagulation studies and coagulation factor assays.(b)
Classification. Class II (special controls). A control intended for use with a multipurpose system for in vitro coagulation studies is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 864.9.
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January 15, 2025
Haemonetics Corporation Erica Molaro Senior Regulatory Affairs Specialist 125 Summer Street Boston, Massachusetts 02110
Re: K243858
Trade/Device Name: TEG 6s Hemostasis System Citrated: K. KH, RT, FF Assay Cartridge Regulation Number: 21 CFR 864.5425 Regulation Name: Multipurpose System For In Vitro Coagulation Studies Regulatory Class: Class II Product Code: JPA Dated: December 12, 2024 Received: December 16, 2024
Dear Erica Molaro:
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 (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 available 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
Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).
Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).
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 and Part 809); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safetyreporting-combination-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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.
All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E).
For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advice-comprehensive-regulatory-assistance/unique-deviceidentification-system-udi-system. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-devices/medical-devicesafety/medical-device-reporting-mdr-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-regulatory
2
assistance/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,
Image /page/2/Picture/3 description: The image contains the text "Min Wu-S". The text is written in a simple, sans-serif font. The letters are black, and the background is white. The text is centered in the image.
Min Wu, Ph.D. Branch Chief Division of Immunology and Hematology Devices OHT7: Office of In Vitro Diagnostics Office of Product Evaluation and Quality Center for Devices and Radiological Health
Enclosure
3
Indications for Use
510(k) Number (if known) K243858
Device Name
TEG 6s Hemostasis System Citrated: K, KH, RT, FF Assay Cartridge
Indications for Use (Describe)
The TEG 6s Hemostasis System is intended for in vitro diagnostic use to provide semi-quantitative indications of the hemostasis state of a venous blood sample. The Citrated: K, KH, RT, FF Assay Cartridge, to be used with the TEG 6s analyzer, contains four independent assays (CK, CKH, CRT, and CFF), described below.
The CK assay monitors the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional parameters Clotting Time (R), Speed of Clot Formation (K and Alpha angle) and Maximum Clot Strength (MA).
The CKH assay monitors the effects of heparin in 3.2% citrated whole blood specimens on the TEG 6s System. CKH is used in conjunction with CK, and heparin influence is determined by comparing Clotting Times (R) between the two tests. The CRT assay monitors the hemostasis process via both the intrinsic pathways in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA). The CRT MA parameter is equivalent to the CK MA parameter but the final MA value is reached more quickly using the CRT assay.
The CFF assay monitors hemostasis of 3.2% citrated whole blood specimens in the TEG 6s System after blocking platelet contributions to clot strength. Clotting characteristics are described by the functional parameters Maximum Clot Strength (MA) and the Estimated Functional Fibrinogen Level (FLEV).
Results from the TEG 6s analysis should not be the sole basis for a patient diagnosis, but should be evaluated together with the patient's medical history, the clinical picture and, if necessary, further hemostasis tests. The indication for TEG 6s System use is with adult patients where an evaluation of their blood hemostasis properties is desired. Hemostasis evaluations are commonly used to assess clinical conditions in cardiology procedures to assess hemorrhage or thrombosis conditions before, during and following the procedure. The TEG 6s Hemostasis System can be used in the laboratory or at the point-of-care.
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
| Submitter: | Haemonetics Corporation
125 Summer Street
Boston, MA 02110, United States |
|-----------------------|---------------------------------------------------------------------------------------------------|
| Contact: | Erica Molaro
Senior Regulatory Affairs Specialist
(201) 661-1493
emolaro@haemonetics.com |
| Date Prepared: | January 14, 2025 |
| I. Device Information | |
| Device Trade Name: | TEG® 6s Hemostasis System: Citrated: K, KH, RT, FF Assay Cartridge |
| Common Name: | Whole Blood Hemostasis System |
| Classification Name: | System, Multipurpose For In Vitro Coagulation Studies |
| Regulatory Class: | 2 |
| Regulation Number: | 21 CFR 864.5425 |
| Product Code: | JPA |
II. Legally Marketed Predicate Device
| Predicate # | Predicate Trade Name | Product Code |
|---|---|---|
| K150041 | TEG 6s Hemostasis System: Citrated: K, KH, RT, FF Assay | |
| Cartridge | JPA |
III. Device Description Summary
TEG® 6s System Description
The TEG® 6s Hemostasis System (TEG® Hemostasis analyzer and TEG® 6s Assay Cartridges) is intended for in vitro diagnostic use to provide semi-quantitative indications of a blood sample's ability to form and maintain a clot. The TEG® 6s Hemostasis System records the kinetic changes in a sample of whole blood as the sample clots, retracts and/or lyses. The system output consists of a table of numerical values and graphs resulting from the hemostasis process over time. This information can be used by clinicians to aid in determining if a clotting dysfunction or coagulopathy is present.
To perform a test, a disposable TEG® 6s Assay Cartridge is inserted into the TEG® 6s Hemostasis analyzer. The instrument reads the bar code on the cartridge and identifies the type of cartridge for operator confirmation. Blood (collected in a 3.2% sodium citrate tube) or Quality
5
Control (QC) material is added to the entry port on the cartridge and drawn into the cartridge under the TEG® 6s Hemostasis analyzer control. The amount of the sample drawn into the cartridge is determined by the pre-set volume of the blood chambers in the cartridge. Once in the cartridge, the sample is metered into as many as 4 separate analysis channels, depending upon the assays being performed. Reconstitution of reagents dried within the cartridge is accomplished by moving the sample back and forth through reagent chambers, under the control of microfluidic valves and bellows (pumps) within the cartridge. After each sample has been mixed with reagent, it is delivered to a test cell where it is monitored for viscoelastic changes due to coagulation. Excess sample material is moved under microfluidic control into an enclosed waste chamber within the cartridge.
TEG® 6s Measurement Technique
The TEG® 6s technology is based on a disposable cartridge containing up to 4 independent measurement cells. Each cell consists of a short vertically-oriented injection molded tube (ring). Detection of clotting in the TEG® 6s Hemostasis System is performed optically. A piezoelectric actuator vibrates the measurement cell(s) through a motion profile composed of summed sinusoids at different frequencies. The movement of the measurement cells will induce motion in the sample meniscus, which will be detected by a photodiode. The resulting motion of the meniscus is monitored optically and analyzed by the instrument to calculate the resonant frequency and modulus of elasticity (stiffness) of the sample. By performing a Fast Fourier Transform (FFT) on meniscus motion data, the resonant frequencies can be determined. The analyzer monitors the harmonic motion of a hanging drop of blood in response to external vibration. As the sample transitions from a liquid state to a gel-like state during clotting, the modulus of elasticity (stiffness) and therefore resonant frequency increase. The TEG® 6s Hemostasis analyzer measures these variations in resonant frequency during clotting and lysis.
Resonance is the tendency of a material or structure to oscillate with greater amplitude at some frequencies than others. The exact frequencies at which resonance occurs will depend on the stiffness and mass of the sample. Stiffness, in turn, is a function of a material's modulus of elasticity and the boundary conditions to which the material is exposed, such as the geometry and materials of a test cell. By holding these boundary conditions and sample mass constant from sample to sample, the TEG® 6s Hemostasis System allows direct comparison of elasticity between samples. The output measurements are displayed in a table and on a graphical tracing that reflects the hemostasis profile of the clot formation.
In a typical test, blood that has been delivered to the measurement cell will not clot for several minutes. During this time the sample has no inherent stiffness except that provided by surface tension, and since this remains constant the measured resonant frequencies will not change.
Once clotting begins, however, the elastic modulus and thus the resonant frequencies increase rapidly. During fibrinolysis, the process is reversed, with elastic modulus and resonant frequencies decreasing. In tests where clotting does not occur, the resonant frequency of the sample will not change. During coagulation, however, a clot will bind to the ring contained in the
6
cartridge and the resonant frequency will rise with increasing firmness of the Clot. The TEC® 6s Hemostasis Analyzer collects meniscus motion data, tracks changing resonant frequencies and analyzes the frequency data to provide semi-quantitative parameters describing the clot.
The TEG® 6s Hemostasis System monitors the interaction of platelets within the fibrin mesh of the clot during clot formation and lysis, all in a whole-blood setting. The TEG® 6s Hemostasis System uses thromboelastography to provide continuous measurement of clot elasticity.
| TEG 6s
Parameter | Definition | Parameter Relation to
Hemostasis |
|---------------------|----------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|
| R | R is the time from the start of the test
until initial fibrin formation. This
represents the enzymatic portion of
coagulation | Clotting time – Normal / reduced
/ increased speed of coagulation
initiation |
| K | K is the time after R needed to reach a
certain level of clot strength. This
represents clot kinetics | Normal / reduced / increased
speed of coagulation
amplification and propagation |
| Alpha α
(Angle) | Alpha is the angle representing the rate
of increase in the clot strength the
rapidity of fibrin build-up and cross-
linking | Normal / reduced / increased
speed of coagulation
amplification and propagation |
| MA | MA, or Maximum Amplitude, represents
the maximum firmness of the clot during
the test. | Normal / reduced /increased clot
elasticity/strength |
| FLEV | FLEV is an estimate of the fibrinogen
level in the blood sample. | Estimated Functional Fibrinogen
Level |
Table 1: TEG® 6s Parameters for TEG® 6s Citrated: K, KH, RT, FF Assay Cartridge
Citrated Kaolin (CK) assay
The CK assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CK assay consists of Kaolin which is used in the assay for activation of coagulation. It is combined with calcium chloride (CaCl2) to neutralize the sodium citrate in the blood.
The clotting characteristics of the CK generated hemostasis profile are described by the functional parameters Clotting Time (R), Speed of Clot Formation (K and Alpha angle) and Maximum Clot strength (MA). Since it may take an or more for a non-activated whole blood sample to reach maximum amplitude MA, Kaolin is essential to reduce run time and variability associated with running non-activated whole blood samples.
Citrated Kaolin with Heparinase (CKH) assay
The CKH assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s
7
Hemostasis System. CKH is used in conjunction with CK, and heparin influence is determined by comparing Clotting Times (R) between the two tests. Calcium Chloride (CaCl2) is included to neutralize any sodium citrate in the blood.
The CKH assay monitors the effects of heparin, a commonly used anticoagulant in surgical procedures. Even very low concentrations of heparin, fractions of IU/mL of blood, can noticeably increase the R time and can even completely anticoagulate the blood, making it difficult if not impossible to monitor developing coagulopathies that are masked by high levels of therapeutic heparin.
Citrated RapidTEG (CRT) assay
The CRT assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process after stimulation of both the intrinsic and extrinsic pathway in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CRT assay consists of a reagent containing kaolin and tissue factor. It is combined with Calcium Chloride (CaCl2) to neutralize sodium citrate in the blood sample. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA).
The CRT assay produces an accelerated clotting time which allows for an earlier MA results compared to the CK assay. Therefore, in the TEG® Hemostasis System, the CRT assay is simultaneously run along with the CK and CKH assays to provide a fast way to reach a stable value for MA (CRT) while still measuring the time- dependent parameters (CK).
Citrated Functional Fibrinogen (CFF) assay
The CFF assay is a semi-quantitative in vitro diagnostic assay for monitoring the hemostasis process after blocking platelet contributions to clot strength in 3.2% citrated whole blood specimens on the TEG® 6s Hemostasis System. The CFF assay consists of tissue factor and abciximab. It is combined with Calcium Chloride (CaCl2) to neutralize sodium citrate in the blood sample.
Tissue Factor is used for coagulation activation that would be classically described as extrinsic, with platelet aggregation inhibited by abciximab (a GPIIb/IIIa inhibitor), excluding its contribution to clot strength, and thereby measuring fibrinogen contribution to clot strength. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA), the Estimated Functional Fibrinogen Level (FLEV).
IV. Intended Use/Indications for Use
The TEG 6s Hemostasis System is intended for in vitro diagnostic use to provide semiquantitative indications of the hemostasis state of a venous blood sample. The Citrated: K, KH, RT, FF Assay Cartridge, to be used with the TEG 6s analyzer, contains four independent assays (CK, CKH, CRT, and CFF), described below.
The CK assay monitors the hemostasis process via the intrinsic pathway in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional
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parameters Clotting Time (R), Speed of Clot Formation (K and Alpha angle) and Maximum Clot Strength (MA).
The CKH assay monitors the effects of heparin in 3.2% citrated whole blood specimens on the TEG 6s System. CKH is used in conjunction with CK, and heparin influence is determined by comparing Clotting Times (R) between the two tests.
The CRT assay monitors the hemostasis process via both the intrinsic and extrinsic pathways in 3.2% citrated whole blood specimens on the TEG 6s System. Clotting characteristics are described by the functional parameter Maximum Clot Strength (MA). The CRT MA parameter is equivalent to the CK MA parameter but the final MA value is reached more quickly using the CRT assay.
The CFF assay monitors hemostasis of 3.2% citrated whole blood specimens in the TEG 6s System after blocking platelet contributions to clot strength. Clotting characteristics are described by the functional parameters Maximum Clot Strength (MA) and the Estimated Functional Fibrinogen Level (FLEV).
Results from the TEG 6s analysis should not be the sole basis for a patient diagnosis, but should be evaluated together with the patient's medical history, the clinical picture and, if necessary, further hemostasis tests. The indication for TEG 6s System use is with adult patients where an evaluation of their blood hemostasis properties is desired. Hemostasis evaluations are commonly used to assess clinical conditions in cardiovascular surgery and cardiology procedures to assess hemorrhage or thrombosis conditions before, during and following the procedure. The TEG 6s Hemostasis System can be used in the laboratory or at the point-of-care.
- V. Comparison to Predicate Device
Indications for Use Comparison
The TEG® 6s system consists of the TEG® 6s analyzer including analyzer software and assay cartridges. The assay cartridges predicate device is the TEG® 6s Hemostasis System Citrated: K, KH, RT, FF (07-601-US, K150041). The indications for use are of the same intent with the following inclusion:
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- Use location is defined as laboratory and point-of-care
Technology Comparison
There is no change to the technology, design of the device, reported parameters, or mechanics of how the cartridge is run on the TEG® 6s analyzer. No additional product development of the TEG® 6s system was required.
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| Table 2: Summary of Technological Characteristics for Substantial Equivalence: Similarities | ||
|---|---|---|
| TEG® 6s Citrated: K, KH, RT, FF | ||
| Cleared Device/Predicate [K150041] | TEG® 6s Citrated: K, KH, RT, FF Modified Device | |
| Technological Purpose | Monitoring the physical response of a | |
| clot to low levels of applied strain | ||
| (resonance frequency) | Same | |
| Measurement | Changes in physical clot elasticity over | |
| time | Same | |
| Matrix | 3.2% citrated venous whole blood | Same |
| Initial Warm Up Time | 5 minutes | Same |
| Analyzer Hardware | Fully integrated | |
| Thromboelastography analyzer | Same | |
| Analyzer Measuring Technique | Non-contact optical measurement of | |
| shear elasticity of a coagulating | ||
| sample | Same | |
| Measurement Output | Graphical tracings of resonant | |
| frequency per reagent type; table of | ||
| parameters | Same | |
| Physical Configuration Used for | ||
| Sample Measurement | Vertically-oriented cylindrical | |
| container (ring or tube) containing | ||
| sample with meniscus formed at | ||
| bottom; non-conact measurement of | ||
| meniscus amplitude of vibration | Same | |
| Physical Principle Underlying | ||
| Measuring Technique | Clotting process causes an increase in | |
| the modulus of elasticity, which | ||
| increases stiffness and increases the | ||
| force of the clot within the ring walls | ||
| when moving up and down in the ring | ||
| tube against the sample's own weight. | ||
| This increases the resonant frequency, | ||
| which increases the clot strength | ||
| amplitude. During clot dissolution | ||
| (lysis), the resonant frequency | ||
| decreases, corresponding to decreasing | ||
| clot strength amplitude. | Same | |
| Boundary Conditions | Physical ring tube dimensions define | |
| boundary conditions that are help | ||
| constant, allowing comparison of one | ||
| sample to the next. | Same | |
| Measuring Channel | Up to 4 | Same |
| Signal Generation | Multi-frequency harmonic oscillation | |
| of a small open-ended cylinder | ||
| containing the sample | Same | |
| Signal Transducer | Optical detection (silicon photodiode) | |
| of the motion of a free surface of the | ||
| sample. | Same | |
| Sensitivity to Applied Strains | Applied strains are very low, resulting | |
| in minimal interference with small | ||
| changes in clot formation. | Same | |
| Temperature Control | 20° to 50°C | Same |
| Sample Volume (per channel) | 20 μl | Same |
| Total Reaction Volume (single | ||
| channel) | 20 μl | Same |
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| | TEG® 6s Citrated: K, KH, RT, FF
Cleared Device/Predicate [K150041] | TEG® 6s Citrated: K, KH, RT,
FF Modified Device |
|---------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------|
| Analyzer Input Voltage | 12 volts DC, 60 watts max
(power supply) | Same |
| Environment | Stable and level surface.
Operating Temperature 10° to 32° C
Storage Temperature: -20° to +50°
C (instrument only)
Relative humidity 20 to 80%
(noncondensing) | Same |
| Operating Position | Level (adjustment not required) | Same |
| Sample Preparation | Performed under analyzer control
within the disposable cartridge | Same |
| Pipetting | Unmetered transfer pipette or
syringe; blood sample is added until it
fills to a level above the line marked
on the blood intake well of
the cartridge. | Same |
| Analyzer Software | Fully integrated Thromboelastography
analyzer | Same |
| Consumables | Carrier (acrylic plastic) with
microfluidics laminate and test rings
(acrylic plastic) | Same |
| Assay | CK, CKH, CRT, CFF | Same |
| Assay Reagents | CK - kaolin and CaCl2
CKH - kaolin and CaCl2 with
heparinase
CRT - tissue factor, kaolin and
CaCl2
CFF - abciximab (brand name
ReoPro), tissue factor and CaCl2 | Same |
| Assay Parameters Reported | CK: R, K, Angle, MA
CKH: R
CRT: MA
CFF: MA, FLEV | Same |
| Quality Controls | Abnormal QC | Cartridge Reagent QC - Level 1
Cartridge Reagent QC - Level 2 |
Table 3: Summary of Clinical Values Comparisons: Similarities
| | TEG® 6s Citrated: K, KH, RT, FF
Cleared Device/Predicate [K150041] | TEG® 6s Citrated: K, KH, RT,
FF Modified Device |
|----------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------|
| Clinical Values of Citrated:
Kaolin (CK) Parameter R (min) | Initiation phase of coagulation
triggered by enzymatic clotting factors
and culminating with the initial fibrin
formation. A prolonged R value is
indicative of slow clot formation, due
to coagulation factor deficiencies or
heparin. | Same |
| Clinical Value of Citrated:
Kaolin (CK) Parameter MA
(mm) | MA, or Maximum Amplitude,
Represents the maximum firmness of
the clot during the test. The MA
provides information about the | Same |
| | TEG® 6s Citrated: K, KH, RT, FF
Cleared Device/Predicate [K150041] | TEG® 6s Citrated: K, KH, RT,
FF Modified Device |
| | contribution of platelets/fibrin to the
overall strength of the clot. | |
| Clinical Value of Citrated:
Kaolin with Heparinase (CKH)
Parameter R (min) | Initiation phase of coagulation
triggered by enzymatic coagulation
factors and culminating with the initial
fibrin formation.
A prolonged R value is indicative of
slow clot formation, due to
coagulation factor deficiencies or
heparin. Inclusion of heparinase in the
blood chamber channel of the cartridge
provides ability to compare R (min)
without the effect of heparin on the
clot. | Same |
| Clinical Value of Citrated:
RapidTEG Parameter MA (mm) | RapidTEGTM MA is the point at
which clot strength reaches its
maximum and reflects the end result of
minimal platelet-fibrin interaction via
the GPIIb/IIIa receptors. Due to faster
coagulation activation, clot strength is
measured faster than
Citrated: Kaolin (K) activated
samples. Same results as CK
maximum amplitude (CK-MA).
The MA provides information about
the contribution of platelets/fibrin to
the overall strength of the clot. | Same |
| Clinical Value of Citrated:
Functional Fibrinogen Parameter
MA (mm) | The maximum amplitude of CFF
provides the functional fibrinogen
contribution to the clot strength.
Provides the overall contribution of
functional fibrinogen to clot
strength. In conjunction with CRT-
MA, this assay enables an
assessment of the relative
contributions of functional
fibrinogen and platelets to clot
strength. Results may be valuable for
guiding fibrinogen
supplementation or platelet
transfusion. | Same |
| Patient Population from
Intended Use | Hemostasis evaluations are
commonly used to assess clinical
conditions in cardiovascular surgery
and cardiology procedures to assess
hemorrhage or thrombosis conditions
before, during and following the
procedure. | Same |
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| Table 4: Summary of Technological Characteristics for Substantial Equivalence: Differences | ||
|---|---|---|
| TEG® 6s Citrated: K, KH, RT, FF | ||
| Cleared Device/Predicate [K150041] | TEG® 6s Citrated: K, KH, RT, | |
| FF Modified Device | ||
| Use Location | The TEG® 6s Hemostasis System | |
| with TEG® 6s Citrated: K, KH, RT, | ||
| FF assay can be used in the clinical | ||
| laboratory. | The TEG® 6s Hemostasis System | |
| with TEG® 6s Citrated: K, KH, RT, | ||
| FF assay can be used in the clinical | ||
| laboratory or at the point-of-care. |
Non-Clinical Test Summary and Conclusions
Electrical Safety and Electromagnetic Compatibility (EMC)
Electrical safety and EMC testing were conducted on the TEG® 6s analyzer. The system complies with IEC 61010-1, IEC 61010-2-010, IEC 61010-2-101, standards for safety and the IEC 60601-1-2, IEC/ EN61326-1, IEC/ EN61326-2-6, standards for EMC.
Conclusion
The information provided in this submission support a substantial equivalence determination for the TEG® 6s Hemostasis System: Citrated: K, KH, RT, FF and the predicate device.