MEDELA DOMINANT 35 C/I SECRETION AND SURGICAL ASPIRATOR

K043544 · Medela AG · BTA · Jan 7, 2005 · General, Plastic Surgery

Device Facts

• Record ID: K043544
• Device Name: MEDELA DOMINANT 35 C/I SECRETION AND SURGICAL ASPIRATOR
• Applicant: Medela AG
• Product Code: BTA · General, Plastic Surgery
• Decision Date: Jan 7, 2005
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4780
• Device Class: Class 2
• Attributes: Therapeutic, 3rd-Party Reviewed

Indications for Use

The Dominant 35 c/i is intended to be used for a variety of suctioning procedures including nasopharyngeal, tracheal, surgical, wound and thoracic drainage (must be used only in combination with a chest drainage unit with a built in flow adjustment valve). The intermittent suction mode is intended to be used for gastrointestinal suction procedures. The pump is highly suitable for gastrointestinal suction procedures and for all routine suctioning procedures involving surgical and bodily fluids, gases, blood, secretions, tissue (including bone) and infectious materials in operating theatres, emergency rooms, physicians offices, at the patients bedside and is also to perform wound and thoracic drainage. A comprehensive range of accessories makes the Dominant 35 c/i ideally suited to a wide range of medical applications.

Device Story

AC-powered suction pump; utilizes piston-cylinder system to generate vacuum for aspiration of fluids, gases, and tissues. Provides constant suction (35 L/min) or intermittent suction (8 L/min; 16s ON/8s OFF). Features vacuum gauge, self-bleeding membrane regulator, and overflow safety device. Operated by clinicians in OR, ER, or bedside via foot switches or panel controls. Jar holder maintains jar 20 cm above patient level. Output is vacuum pressure; healthcare providers monitor via gauge and adjust settings to facilitate drainage or fluid removal. Benefits include effective clearance of surgical/bodily fluids and support for thoracic/gastrointestinal procedures.

Clinical Evidence

No clinical data. Substantial equivalence based on technological characteristics and design similarities to predicate devices.

Technological Characteristics

AC-powered piston-cylinder suction pump. Includes self-bleeding membrane vacuum regulator, vacuum gauge (kPa/mmHg), and polysulfone safety device with overflow protection. Mobile stand with 10x25mm rails and antistatic castors. Constant mode (35 L/min) and intermittent mode (8 L/min).

Indications for Use

Indicated for aspiration and removal of surgical fluids, tissue (including bone), gases, bodily fluids (including vomit), or infectious materials from wounds, airway, or respiratory support systems. Used for nasopharyngeal, tracheal, surgical, gastrointestinal, wound, and thoracic drainage in constant or intermittent modes. For use in OR, ER, physician offices, or bedside.

Regulatory Classification

Identification

A powered suction pump is a portable, AC-powered or compressed air-powered device intended to be used to remove infectious materials from wounds or fluids from a patient's airway or respiratory support system. The device may be used during surgery in the operating room or at the patient's bedside. The device may include a microbial filter.

Predicate Devices

• Medela® Basic 30 & Dominant 50 Suction Pumps (K021368)
• Aeros MobIvac III Aspirator (K933902)

Submission Summary (Full Text)

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Applicant: Medela AG, Laettichstrasse 4b, CH-6341 Baar, Switzerland Contact Person: Bruno Gretler, Tel [phone] ext. 247; Fax [phone] [e-mail] Traditional 510(k) Submission for Medela® Dominant 35 c/i Suction Pump

K043544 1/2

JAN - 7 2005

## Section E - 510(k) Summary

Medela Powered Suction Pumps

Dominant 35 c/i

#### Sponsor's Name, Address and Contact Person 1

Sponsor: Medela AG Medical Equipment Laettichstrasse 4b 6341 Baar Switzerland [phone] ext. 228 Ph: Fax: [phone]

Contact Person Wemer Frei Manager Regulatory Affairs

Date Summary Prepared: October 10, 2004

#### 2 Name of Device

| Trade Name: | Medela® Dominant 35 c/i<br>Secretion & Surgical Aspirator |
|----------------------|---------------------------------------------------------------------------------------------------------|
| Common Name: | Powered Suction Pump |
| Classification Name: | PUMP, PORTABLE, ASPIRATION (MANUAL OR<br>POWERED)<br>(Classified Class II, per 21 CFR Section 878.4780) |

#### Name of the predicate Device(s) 3

- Medela® Basic 30 & Dominant 50 Suction Pumps, by Medela Inc. . K021368
- Aeros MobIvac III Aspirator, by Aeros Instruments, Inc. . K933902

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Medela AG, Laettichstrasse 4b, CH-6341 Baar, Switzerland Applicant: Contact Person: Bruno Gretler, Tel [phone] ext. 247; Fax [phone] [e-mail] Traditional 510(k) Submission for Medela® Dominant 35 c/i Suction Pump

# K643544 2/2

#### 4 Description of Device

The Dominant 35 c/i Powered Suction Pump is an advancement of the approved Medela® Basic 30 and Dominant 50 Series of Secretion and Surgical Aspirators, which are all based on the well-proven Medela pistoncylinder system.

The Dominant 35 c/i Powered Suction Pump provides the choice of two suction modes:

- -Constant Suction (c) with a flow rate of 35 liters/min (high flow)
- Intermittent Suction (i) with a flow rate of 8 liters/min (low flow) and default settings of 16 seconds ONTime / 8 seconds OFFTime.

The new Dominant 35 c/i is based on the Dominant 50 and has additionally fixed to it's housing a jar holder which quarantees that the iar is approximately 20 cm above patient level.

The Dominant 35 c/i is an AC-powered aspirator and incorporates an ACmotor with gearbox, pistons and cylinders, an operation panel, a vacuum gauge in kPa and mmHG, a self-bleeding membrane vacuum regulator, a safety device of polysulfone with overflow protection device and connection tubing, an electric cord and an instruction manual.

The standard version includes a mobile stand with fitting rails 10 x 25 mm and four antistatic castors, two with locking device. The internal and external foot "ON/OFF"-switches have been retained unchanged, but please note, that these switches are only active while working in the constant mode!

#### 5 Intended Use of the Device

The Dominant 35 c/i is intended to be used for a variety of suctioning procedures including nasopharyngeal, tracheal, surgical, wound and thoracic drainage (must be used only in combination with a chest drainage unit with a built in flow adjustment valve). The intermittent suction mode is intended to be used for gastrointestinal suction procedures.

The pump is highly suitable for gastrointestinal suction procedures and for all routine suctioning procedures involving surgical and bodily fluids, gases, blood, secretions, tissue (including bone) and infectious materials in operating theatres, emergency rooms, physicians offices, at the patients bedside and is also to perform wound and thoracic drainage. A comprehensive range of accessories makes the Dominant 35 c/i ideally suited to a wide range of medical applications.

The intended uses and the indications of the Medela Dominant 35 c/i powered suction pump, are the same as the intended uses and indications for the predicate devices Medela Basic 30 and Dominant 50 suction pumps (K021368) and/or to the AEROS Moblvac III (K933902).

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Medela AG, Laettichstrasse 4b, CH-6341 Baar, Switzerland Applicant: Contact Person: Bruno Gretler, Tel [phone] ext. 247; Fax [phone] [e-mail] Traditional 510(k) Submission for Medela® Dominant 35 c/i Suction Pump

K043544 3/2

#### Summary of Technological Characteristics 6

The Dominant 35 c/i is based on the Dominant 50, with an additional operation panel to choose either constant or intermittent mode and -- if desired - to change the time settings in the intermittent mode.

The technology of the Dominant 35 c/i powered suction pump is identical to the legally marketed (unmodified) devices and there are no technical differences which would raise new aspects regarding safety and effectiveness.

#### Conclusion 7

Based upon the information presented above, it is concluded that the proposed Medela® Dominant 35 c/i powered suction pump is safe and effective for the intended use.

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN - 7 2005

Medela AG c/o Mr. Stefan Preiss TÜV Product Service, Inc. 1775 Old Highway 8 New Brighton, Minnesota 55412

Re: K043544

Trade/Device Name: Dominant 35 c/i Regulation Number: 21 CFR 878.4780 Regulation Name: Powered suction pump Regulatory Class: II Product Code: BTA Dated: December 21, 2004 Received: December 23, 2004

Dear Mr. Preiss:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your becamed the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for associated in the May 28, 1976, the enactment date of the Medical Device Amendments, or to continer of the rights in accordance with the provisions of the Federal Food, Drug, de noos mat have been 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 r ou may ateresy interest 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 (Special Controls) or class III (PMA), 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 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 that x Driveral statutes and regulations administered by other Federal agencies. You must or any I 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 Of It Furt 607); adoling (21 (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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Page 2 - Mr. Stefan Preiss

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally premaince 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 If you attire of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act 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,

Muriam C. Provost

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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### Indications for Use

#### 510(k) Number (if known):

Dominant 35 c/i Device Name:

Indications For Use:

The Dominant 35 cfi Suction Pump is indicated for aspiration and removal of surgical fluids, tissue (including bone), gases, bodily fluids (including vomit) or infectious materials from wounds or from a patient's airway or respiratory support system, either during surgery or at the patients bedside. Generally the Dominant 35 c/i is intended to be used for a variety of suctioning procedures including nasopharyngeal, tracheal, surgical, gastrointestinal, wound and thoracic drainage (must be used only in combination with a chest drainage unit with a built in flow adjustment valve) in either "constant" or "intermittent" mode.

X Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Muriam C. Provost
(Division Sign-Off)

Division of General, Restorative, and Neurological Devices

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**510(k) Number** K043544