TRANSONIC FLOW-QC SET MODEL ADT1010

K021571 · Transonic Systems, Inc. · MQS · Aug 12, 2002 · Gastroenterology, Urology

Device Facts

• Record ID: K021571
• Device Name: TRANSONIC FLOW-QC SET MODEL ADT1010
• Applicant: Transonic Systems, Inc.
• Product Code: MQS · Gastroenterology, Urology
• Decision Date: Aug 12, 2002
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.5820
• Device Class: Class 2

Intended Use

The Transonic Flow-QC Set is indicated for use as part of an extracorporeal blood circuit for hemodialysis when the Transonic HD01 System will be use to make access flow, recirculation, and/or cardiac output measurements during the patient's hemodialysis treatment.

Device Story

Transonic Flow-QC Sets are hemodialysis extension tubing segments integrated into standard extracorporeal blood circuits. These sets provide consistent material and wall thickness for calibration of the Transonic HD01 Hemodialysis system; they also include an injection port for cardiac output measurements. Used in clinical hemodialysis settings by healthcare providers. The device facilitates accurate measurements by the HD01 system, enabling monitoring of access flow, recirculation, and cardiac output, which assists clinicians in managing hemodialysis therapy and patient vascular access health.

Clinical Evidence

Bench testing only. Device design and production follow ANSI/AAMI RD17-1994 standards. Finished products undergo physical testing and visual examination per Quality Control Test Procedures to ensure conformance to design specifications.

Technological Characteristics

Hemodialysis extension tubing set. Materials tested per ISO 10993. Design conforms to ANSI/AAMI RD17-1994. Non-powered, passive accessory for hemodialysis circuits.

Indications for Use

Indicated for patients undergoing hemodialysis treatment requiring access flow, recirculation, or cardiac output measurements using the Transonic HD01 System.

Regulatory Classification

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.

Predicate Devices

• Transonic Hemodialysis Flow Reverser (K002816)

Submission Summary (Full Text)

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510(k) Transonic Flow-QC® Sets

# 510(k) Summary of Safety and Effectiveness in Accordance with SMDA'90

April 17, 2002

Transonic Systems Inc.

| 34 Dutch Mill Rd |
|---------------------------|
| Ithaca, NY |
| Telephone: [phone] |
| Fax: [phone] |

| Contact: | Mark S. Alsberge |
|----------------------|----------------------------------------------------------------------------------------------------------------|
| Product Name: | Transonic Flow-QC® Set |
| Classification name: | Hemodialysis Accessories, Blood Circuit<br>Gastroenterology and Urology<br>Class II, 78KOC<br>21 CFR §876.5820 |

### SUBSTANTIAL EQUIVALENCE1 TO:

| 510 (k) Number | Name | Applicant |
|----------------|-----------------------------------------|------------------------|
| K002816 | Transonic Hemodialysis Flow<br>Reverser | Transonic Systems Inc. |

## Device Description:

In accordance with section 510(k) for the Federal Food, Drug, and Cosmetic Act, Transonic Systems Inc. intends to introduce into interstate commerce the Transonic Flow-QC® Sets which are Hemodialysis extension sets for connection into standard Hemodialysis circuits. These sets provide tubing segments of consistent material and wall thickness to which our HD01 Hemodialysis system can be calibrated. They also provide an injection port for making cardiac output measurements with the HD01 system.

¹ The term "substantially equivalent" as use herein is intended to be a delermination of substantial equivalence from an FDA regulatory point of view under the Federal Food, Drug, and Cosmelic Act and relates to the fact that the product can be marketed without premarket approval or reclassification. These products may be considered distinct from a patent point of view. The term "substantially equivalent" is not applicable to and diminish any patent daims related to this product or the technology used to manufacture the product.

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#### Material:

The Transonic Flow-QC® Sets are made of materials which have been tested in accordance with the ISO Standard 10993 and therefore suitable for the intended use of this product.

#### Substantial equivalence:

The Transonic Flow-QC® Sets is similar in materials, form and intended use to the Transonic Hemodialysis Flow Reverser currently marketed by Transonic Systems Inc. and cleared under K002816. The minor difference between Flow-QC Sets and the Transonic Hemodialysis Flow Reverser are that the Flow-QC Sets do not have a Flow reversing valve present in the Flow Reverser. This difference does not raise any new issues of safety or effectiveness regarding the Transonic Flow-QC® Sets.

#### Safety and Effectiveness:

All finished products are tested and must meet all required release specifications before distribution. The array of testing required for release include, but are not limited to; physical testing, visual examination (in process and finished product). The ANSVAAMI standard "American National Standard for Hemodialyzer Blood Tubing" RD17- 1994 was followed for the design and will continue to be followed for the production and quality assurance testing of this device.

The physical testing is defined by Quality Control Test Procedure documents. These tests are established testing procedures that ensure the products performance parameters conform to the product design specifications.

The testing instruction records for each of the individually required procedures are approved, released, distributed and revised in accordance with document control cGMP"s.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle or bird in flight, composed of three curved lines that suggest the bird's head and wings. The bird is positioned to the right of the text, which is arranged in a circular pattern around the bird. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA".

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 12 2002

Mr. Mark S. Alsberge VP Medical and Regulatory Affairs Transonic Systems, Inc. 34 Dutch Mill Road ITHACA NY 14850-9787

Re: K021571

Trade/Device Name: Transonic Flow-QC® Sets Regulation Number: 21 CFR 876.5820 Regulation Name: Hemodialysis system and accessories Regulatory Class: II Product Code: 78 MQS Dated: May 8, 2002

Received: May 14, 2002

Dear Mr. Alsberge:

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. The general controls provisions of the Act include requirements for annual registration. Iisting of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

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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), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:

| 8xx.1xxx | [phone] |
|----------------------------------|----------------|
| 876.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | [phone] |
| 892.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| Other | [phone] |

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers. International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours.

Nancy Crozdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) Number (if known): Device Name: Transonic Flow-QC® Sets Indications for Use:

The Transonic Flow-QC Set is indicated for use as part of an extracorporeal blood circuit for hemodialysis when the Transonic HD01 System will be use to make access flow, recirculation, and/or cardiac output measurements during the patient's hemodialysis treatment.

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Concurence of CDRH, Office of Device Evaulation (ODE)

*Prescription Use*

David A. Ingram

(Optional Format 3-10-98)

(Posted July 1, 1998)