K Number
K963933
Device Name
PSN-120 HOLLOW FIBER DIALYZER AND PSN-140 HOLLOW FIBER DIALYZER
Date Cleared
1997-11-24

(419 days)

Product Code
Regulation Number
876.5820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Hemodialysis with these dialyzers is indicated for patients with acute or chronic renal failure when conservative therapy is judged to be inadequate. It may also be indicated in the treatment of patients intoxicated with poisons or drugs.
Device Description
Model PSN-120 PSN Hemodialyzer Model PSN-140 PSN Hemodialyzer
More Information

CF Capillary Flow Dialyzers, CA Cellulose Acetate Hollow Fiber Dialyzers, HT Hollow Fiber Dialyzers

Not Found

No
The summary describes a hemodialyzer, a physical device for filtering blood. There is no mention of software, algorithms, or any computational processing that would suggest the use of AI or ML. The performance studies focus on material safety, sterilization, and functional integrity of the physical device.

Yes
The device is used for hemodialysis, which is a treatment for renal failure and certain intoxications, indicating a therapeutic purpose.

No
The device is a hemodialyzer used for the treatment of renal failure and drug intoxication, not for diagnosing conditions.

No

The device description explicitly lists "Model PSN-120 PSN Hemodialyzer" and "Model PSN-140 PSN Hemodialyzer," which are physical hemodialysis devices, not software. The performance studies also describe testing of physical components and sterilization processes.

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

Here's why:

  • Intended Use: The intended use describes a treatment for patients with renal failure or intoxication by removing substances from the blood. This is a therapeutic intervention performed directly on the patient's blood, not a diagnostic test performed on a sample in vitro (outside the body).
  • Device Description: The device is a hemodialyzer, which is a component used in the process of hemodialysis. Hemodialysis is a treatment, not a diagnostic test.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing a biological sample (blood, urine, tissue, etc.) to provide information about a patient's health status.
    • Detecting or measuring specific substances or markers in a sample.
    • Providing results that are used for diagnosis, monitoring, or prognosis.

The device is clearly a therapeutic medical device used for blood purification.

N/A

Intended Use / Indications for Use

Hemodialysis with these dialyzers is indicated for patients with acute or chronic renal failure when conservative therapy is judged to be inadequate. It may also be indicated in the treatment of patients intoxicated with poisons or drugs.

Product codes

78 FJI

Device Description

Model PSN-120 PSN Hemodialyzer
Model PSN-140 PSN Hemodialyzer

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

Not Found

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

Components of the subject PSN Hemodialyzers, with the exception of the fiber bundle, have previously met the biological requirements of the guidelines for safety screening of materials for USP XXI Class VI materials. The fiber bundle was tested as suggested by to ISO 10993-1: Biological Evaluation of Medical Devices - Part 1. guidelines. The validation of the sterilization cycle for the PSN Hemodialyzer is based upon the Association for the Advancement of Medical Instrumentation (AAMI) Guideline (ST-27-Industrial Ethylene Oxide (EO) Sterilization of Medical Devices) to ensure a sterility assurance level (SAL) of 1x106. Prior to release, sterilant residues of EO, ECH and EG are consistent with the proposed limits for the "blood ex vivo" device category as published in the June 23, 1978 Federal Register. Pyrogen testing of the subject bloodlines meets the requirements of Chapter 161, Transfusion and Infusion Assemblies and Similar Medical Devices of Supplement 2 of the USP. Particles are compared to USP 23 limits for Large Volume Injections (LVI) solutions. Functional testing for blood side integrity and conformance to manufacturing specifications are performed as in-process and/or final inspections prior to product release ensuring a quality product.

Key Metrics

Not Found

Predicate Device(s)

CF Capillary Flow Dialyzers, CA Cellulose Acetate Hollow Fiber Dialyzers, HT Hollow Fiber Dialyzers

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5820 Hemodialysis system and accessories.

(a)
Identification. A hemodialysis system and accessories is a device that is used as an artificial kidney system for the treatment of patients with renal failure or toxemic conditions and that consists of an extracorporeal blood system, a conventional dialyzer, a dialysate delivery system, and accessories. Blood from a patient flows through the tubing of the extracorporeal blood system and accessories to the blood compartment of the dialyzer, then returns through further tubing of the extracorporeal blood system to the patient. The dialyzer has two compartments that are separated by a semipermeable membrane. While the blood is in the blood compartment, undesirable substances in the blood pass through the semipermeable membrane into the dialysate in the dialysate compartment. The dialysate delivery system controls and monitors the dialysate circulating through the dialysate compartment of the dialyzer.(1) The extracorporeal blood system and accessories consists of tubing, pumps, pressure monitors, air foam or bubble detectors, and alarms to keep blood moving safely from the blood access device and accessories for hemodialysis (§ 876.5540) to the blood compartment of the dialyzer and back to the patient.
(2) The conventional dialyzer allows a transfer of water and solutes between the blood and the dialysate through the semipermeable membrane. The semipermeable membrane of the conventional dialyzer has a sufficiently low permeability to water that an ultrafiltration controller is not required to prevent excessive loss of water from the patient's blood. This conventional dialyzer does not include hemodialyzers with the disposable inserts (Kiil type) (§ 876.5830) or dialyzers of high permeability (§ 876.5860).
(3) The dialysate delivery system consists of mechanisms that monitor and control the temperature, conductivity, flow rate, and pressure of the dialysate and circulates dialysate through the dialysate compartment of the dialyzer. The dialysate delivery system includes the dialysate concentrate for hemodialysis (liquid or powder) and alarms to indicate abnormal dialysate conditions. This dialysate delivery system does not include the sorbent regenerated dialysate delivery system for hemodialysis (§ 876.5600), the dialysate delivery system of the peritoneal dialysis system and accessories (§ 876.5630), or the controlled dialysate delivery system of the high permeability hemodialysis system § 876.5860).
(4) Remote accessories to the hemodialysis system include the unpowered dialysis chair without a scale, the powered dialysis chair without a scale, the dialyzer holder set, dialysis tie gun and ties, and hemodialysis start/stop tray.
(b)
Classification. (1) Class II (performance standards) for hemodialysis systems and all accessories directly associated with the extracorporeal blood system and the dialysate delivery system.(2) Class I for other accessories of the hemodialysis system remote from the extracorporeal blood system and the dialysate delivery system, such as the unpowered dialysis chair, hemodialysis start/stop tray, dialyzer holder set, and dialysis tie gun and ties. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

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510(K) SUMMARY

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Submitter's name:Ann Marie Pahlman MPR A-2E
Address:1620 Waukegan Rd.
McGaw Park, IL 60080
NOV 24 1997
Phone:847 473-6078
Fax:847 473-6952
Contact:Ann Marie Pahlman or Robert Wilkinson
Date Prepared:September 20, 1996
Trade name:Polysynthane (PSN) Hemodialyzer
Common name:Hemodialyzer
Classification name:Hemodialysis System and Accessories per 21 CFR 876.5820
Equivalent predicate:CF Capillary Flow Dialyzers, CA Cellulose Acetate Hollow Fiber Dialyzers,
HT Hollow Fiber Dialyzers
Device Description:Model PSN-120 PSN Hemodialyzer
Model PSN-140 PSN Hemodialyzer
Intended Use:Intended specifically for use in patients with acute or chronic renal failure when
conservative therapy is judged to be inadequate. It may also be indicated in the
treatment of patients intoxicated with poisons or drugs.
Summary of the
technological
predicate device:The general function and materials of the subject PSN Hemodialyzers are the same
as the Baxter predicate Dialyzers. Differences in the subject PSN Hemodialyzers
to the predicate Baxter Dialyzers consist of a change in the fiber bundle material
and a slight change in clearance values for urea, creatinine and Vitamin B 12.
Clinical data:N/A
Conclusions drawn
from tests:Components of the subject PSN Hemodialyzers, with the exception of the fiber
bundle, have previously met the biological requirements of the guidelines for safety
screening of materials for USP XXI Class VI materials. The fiber bundle was tested
as suggested by to ISO 10993-1: Biological Evaluation of Medical Devices - Part 1.
guidelines. The validation of the sterilization cycle for the PSN Hemodialyzer is
based upon the Association for the Advancement of Medical Instrumentation
(AAMI) Guideline (ST-27-Industrial Ethylene Oxide (EO) Sterilization of Medical
Devices) to ensure a sterility assurance level (SAL) of 1x106. Prior to release,
sterilant residues of EO, ECH and EG are consistent with the proposed limits
for the "blood ex vivo" device category as published in the June 23, 1978
Federal Register.

1

14963933 Proj2

510(K) SUMMARY September 20, 1996 Polysynthane (PSN) Hemodialyzer Page 2 of 2

Pyrogen testing of the subject bloodlines meets the requirements of Chapter 161, Transfusion and Infusion Assemblies and Similar Medical Devices of Supplement 2 of the USP.

Particles are compared to USP 23 limits for Large Volume Injections (LVI) solutions.

Functional testing for blood side integrity and conformance to manufacturing specifications are performed as in-process and/or final inspections prior to product release ensuring a quality product.

Additional information requested by FDA: none to date

Official Correspondent:
Robert L. Wilkinson

Robert L. Wilkinson Director Regulatory Affairs

Prepared by:

Ann Marie Pahlman

Ann Marie Pahlman Manager Regulatory Affairs

9/23/96


Date

9/23/94


Date

2

Image /page/2/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the symbol. The logo is simple and recognizable, representing the department's role in promoting health and well-being in the United States.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Ann Marie Pahlman Manager, Regulatory Affairs Renal Division Baxter Healthcare Corporation 1620 Waukegan Road McGaw Park, Illinois 60085-6730 Re: K963933 PNS Hollow Fiber Dialyzer - Models 120 and 140 Dated: October 21, 1997 NOV 2 4 1997 Received: October 23, 1997 Regulatory class: II 21 CFR §876.5820/Product code: 78 FJI

Dear Ms. Pahlman:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, subject to the general controls provisions of the Act. 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.

If your device is classified (see above) into either class II (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21. Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic OS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification does not affect any obligation you might have under sections 531 through 542 of the Act for devices under Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of vour device to a legally marketed predication for your device and thus. permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (2) CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally. for question and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation wititled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

W.Liau Yu

Lillian Yin, Ph.D. Director, Division of Reproductive, Abdominal, Ear, Nose and Throat, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

510(k) Number (if known):

Device Name: PSN Hollow Fiber Dialyzer

Indications for Use:

ﻟﻤﺴﻠﺴ

Hemodialysis with these dialyzers is indicated for patients with acute or chronic renal failure when conservative therapy is judged to be inadequate. It may also be indicated in the treatment of patients intoxicated with poisons or drugs.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Robert D. Sutherlin/

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Devices

510(k) Number K 9

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use

(Optional Format 1-2-96)