K Number
K993272
Device Name
PURE WATER, INC.'S BICARB MIX, STORAGE AND DISTRIBUTION SYSTEM
Manufacturer
Date Cleared
2000-04-10

(193 days)

Product Code
Regulation Number
876.5820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Pure Water, Inc.'s Bicarb Mix, Storage and Distribution system is intended to be used in the mixing, storage and distribution of Bicarb liquid concentrate to be used in the treatment of Hemodialysis patients.
Device Description
Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System uses Reverse Osmosis, provides for batch mixing of Bicarb liquid concentrate, transfer to storage and delivery to point of use. The Bicarb Mix Tank allows Bicarb liquid concentrate to be mixed in batches then transferred to a Storage Tank. The Storage and Distribution components of the system serve to deliver Bicarb liquid concentrate to the point of use. Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System can be customized to best meet the needs of the user. Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System meets or exceeds all Association for the Advancement of Medial Instrumentation (AAMI) National Standards for Hemodialysis.
More Information

Not Found

No
The description focuses on the physical processes of mixing, storage, and distribution of a liquid concentrate using standard water purification and handling technologies (Reverse Osmosis, tanks, distribution components). There is no mention of any computational analysis, pattern recognition, or adaptive algorithms that would indicate the presence of AI/ML.

No
This device is for mixing, storage, and distribution of bicarb liquid concentrate, which is then used in the treatment of hemodialysis patients. It is not directly therapeutic but rather a system that aids in preparing a substance used for treatment.

No
The device is described as a system for mixing, storing, and distributing Bicarb liquid concentrate for hemodialysis patients, not for diagnosing any medical condition.

No

The device description clearly outlines hardware components such as tanks, distribution systems, and reverse osmosis technology, indicating it is a physical system, not software-only.

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

Here's why:

  • Intended Use: The intended use is for the "mixing, storage and distribution of Bicarb liquid concentrate to be used in the treatment of Hemodialysis patients." This describes a system for preparing and delivering a substance used in a medical treatment, not a device used to examine specimens derived from the human body to provide information for diagnosis, monitoring, or screening.
  • Device Description: The description focuses on the physical processes of mixing, storing, and distributing the Bicarb concentrate. It mentions Reverse Osmosis and tanks, which are components of a fluid handling system, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, detecting analytes, or providing diagnostic information.

The device is clearly intended to support the hemodialysis process by preparing and delivering the necessary Bicarb concentrate, which is a therapeutic substance, not a diagnostic one. The predicate devices also appear to be water purification systems for hemodialysis, further supporting its classification as a device used in the treatment process rather than for in vitro diagnosis.

N/A

Intended Use / Indications for Use

The Pure Water, Inc.'s Bicarb Mix, Storage and Distribution system is intended to be used for the mixing, storage and distribution of Bicarb liquid concentrate to be used in the treatment of Hemodialysis patients.

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

78 FIN, KPO

Device Description

Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System uses Reverse Osmosis, provides for batch mixing of Bicarb liquid concentrate, transfer to storage and delivery to point of use.
The Bicarb Mix Tank allows Bicarb liquid concentrate to be mixed in batches then transferred to a Storage Tank.
The Storage and Distribution components of the system serve to deliver Bicarb liquid concentrate to the point of use.
Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System can be customized to best meet the needs of the user.
Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System meets or exceeds all Association for the Advancement of Medial Instrumentation (AAMI) National Standards for Hemodialysis.

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

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.

K920186, K964539

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

§ 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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Image /page/0/Picture/1 description: The image shows a logo for "Pure Water". The logo is circular and contains an image of waves. The text "Pure Water" is written around the top of the circle.

305 W. Market St. Anderson, SC 29624 Phone: (864) 375-0105 Fax: (864) 226-1384

K993272

Page 1 of 1

510(k) Summary

Submitter Information:

Company Name:Pure Water, Inc.
Company Address:305 W. Market St.
Anderson, SC 29624
Company Phone:(864) 375-0105
Company Fax:(864) 226-1384
Contact Person:Rhonda S. McCoy
Prepared:September 27, 1999
Trade Name:Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System
Classification Name:Bicarb Mix, Storage and Distribution System for Hemodialysis
Equivalency:Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System is substantially equivalent to Better Water's Water Purification System for Hemodialysis (510(k) #: K920186) and ZyzaTech Water System, Inc.'s Water Purification Systems and Components and Portable Reverse Osmosis Systems (510(k) #: K964539), which are currently in commercial distribution.
Device Description:Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System uses Reverse Osmosis, provides for batch mixing of Bicarb liquid concentrate, transfer to storage and delivery to point of use.
The Bicarb Mix Tank allows Bicarb liquid concentrate to be mixed in batches then transferred to a Storage Tank.
The Storage and Distribution components of the system serve to deliver Bicarb liquid concentrate to the point of use.
Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System can be customized to best meet the needs of the user.
Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System meets or exceeds all Association for the Advancement of Medial Instrumentation (AAMI) National Standards for Hemodialysis.

:

1

Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized image of an eagle with three lines representing its wings. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR 1 0 2000

Ms. Rhonda S. McCoy Office Manager Pure Water, Inc. 305 W. Market Street Anderson, SC 29624

Re: K993272 Pure Water, Inc.'s Bicarb Mix, Storage and Distribution System Dated: January 19, 2000 Received: January 24, 2000 Regulatory Class: II 21 CFR §876.5820/Procode: 78 FIN and KPO

Dear Ms. McCoy:

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 legally marketed predicate devices marketed in interstate commerce pror 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 Cosmelic Act (Act). You may, therefore, market the device, 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 and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class III (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 equivalion assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS 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 submission 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 requlations.

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 your device to a legally marketed predicate device results in a classification 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 (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4591. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket nolification" (21CFR 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) 443-5597 or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

Daniel G. Schultz, M.D. Captain, USPHS Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure(s)

2

INDICATIONS FOR USE STATEMENT

The Pure Water, Inc.'s Bicarb Mix, Storage and Distribution system is intended to be The Furt Walk, Inc. 6 Dicare Inzi, Secrage and distribution of Bicarb liquid concentrate to be used in the treatment of Hemodialysis patients.

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

510(k) Number K993272

Bicarb Mix, Storage and Distribution 510(k) Submission September 27, 1999

Exhibit "QQ"