K Number
K022168
Device Name
ENVOY
Date Cleared
2002-08-01

(29 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Envoy is intended for use as a multiparameter monitoring system. The Envoy can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the Envoy to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital. Functions include display of multiparameter waveforms, vital signs, alarm & status messages. The Mennen Medical Envoy is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring. The following are examples of intended clinical applications: - Critical Care Patients - Cardiac Step-down/Telemetry Units - Emergency Departments - Intra-operative (Anesthesia) Monitoring - Post Anesthesia Care
Device Description
The Envoy is a multiparameter physiological patient monitor, capable of monitoring: - ECG/Heart Rate - invasive blood pressure - non-invasive blood pressure - respiration - pulse oximetry - two temperature channels - cardiac output - eTCO2 The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays. The Envoy vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the Envoy display unit. Vital signs and waveform information are displayed simultaneously on the Envoy Display Unit. Up to 8 traces can be displayed at any one time. The Envoy is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting. nor life sustaining device; nor is it implantable and therefore sterility is not a consideration. The Envoy is not a kit, does not contain any drug or biological products and is not for prescription use. The SpO2 module is the source of all pulse oximetry data in the Envoy bedside monitor. SpO2 is measured to determine a monitored patient's arterial oxygen saturation and pulse rate. Arterial oxygen saturation is the percentage of oxygenated hemoglobin in relation to the total hemoglobin. For example, if 95 percent of the hemoglobin molecules in the arterial red blood cells combine with oxygen, the blood has an oxygen saturation of 95 percent. The Sp02 numeric value represents the percentage of hemoglobin molecules that have combined with oxygen molecules to form oxyhemoglobin. The SpO2 module is housed in the Envoy module rack, where it occupies a single slot. The Envoy bedside monitor measures oxygen saturation using the Pulse Oximetry method. This continuous, non-invasive method measures the light absorption in the patient's tissue (for example, a finger of the hand or foot) to a receiver on the other side.
More Information

Not Found

No
The document describes a standard multiparameter physiological patient monitor and does not mention any AI or ML capabilities in its intended use, device description, or performance studies.

No
The device is described as a multiparameter monitoring system that displays vital signs and patient information; it is explicitly stated that it is not a life-supporting or life-sustaining device.

Yes

Explanation: The device is described as a "multiparameter monitoring system" that "can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2." This indicates that it measures and displays physiological parameters, which are then used by healthcare professionals to diagnose patient conditions. The input specifically states its intended clinical applications include "Critical Care Patients," "Cardiac Step-down/Telemetry Units," and "Emergency Departments," all of which involve monitoring for diagnostic purposes. While the device itself doesn't make a diagnosis, it provides essential data that healthcare professionals use for diagnosis.

No

The device description explicitly states that the Envoy consists of a main processing unit, a mountable color monitor, and a module rack housing various plug-in vital signs modules. It also mentions specific hardware components like the SpO2 module and describes how it acquires data from the patient's tissue using light absorption. This indicates the device includes significant hardware components beyond just software.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Envoy's Function: The Envoy is described as a multiparameter physiological patient monitor. It measures vital signs directly from the patient's body (e.g., ECG from the heart, blood pressure from the circulatory system, SpO2 from tissue).
  • Lack of Sample Analysis: The description explicitly states that the SpO2 module measures light absorption in the patient's tissue. This is a direct measurement on the patient, not an analysis of a sample taken from the patient.
  • No Mention of Lab Testing: The intended use and device description focus on real-time patient monitoring in a hospital setting, not on laboratory analysis of biological samples.

Therefore, the Envoy falls under the category of a physiological monitoring device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Envov is intended for use as a multiparameter monitoring system.

The Envoy can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the Envoy to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical Envoy is intended for sale as a system for remote monitoring and recording patient information or any in-hospital application requiring remote patient monitoring.

The following are examples of intended clinical applications:

  • Critical Care Patients
  • Cardiac Step-down/Telemetry Units
  • Emergency Departments
  • Intra-operative (Anesthesia) Monitoring
  • Post Anesthesia Care

Product codes

DSI, DQA

Device Description

The Envoy is a multiparameter physiological patient monitor, capable of monitoring:

  • ECG/Heart Rate
  • invasive blood pressure
  • non-invasive blood pressure
  • respiration
  • pulse oximetry
  • two temperature channels
  • cardiac output
  • eTCO2

The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays. The Envoy vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the Envoy display unit. Vital signs and waveform information are displayed simultaneously on the Envoy Display Unit. Up to 8 traces can be displayed at any one time.

The Envoy is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting. nor life sustaining device; nor is it implantable and therefore sterility is not a consideration.

The Envoy is not a kit, does not contain any drug or biological products and is not for prescription use.

Functional Description of the new SpO2 module (OEM Masimo technology):
The SpO2 module is the source of all pulse oximetry data in the Envoy bedside monitor.

SpO2 is measured to determine a monitored patient's arterial oxygen saturation and pulse rate. Arterial oxygen saturation is the percentage of oxygenated hemoglobin in relation to the total hemoglobin. For example, if 95 percent of the hemoglobin molecules in the arterial red blood cells combine with oxygen, the blood has an oxygen saturation of 95 percent. The Sp02 numeric value represents the percentage of hemoglobin molecules that have combined with oxygen molecules to form oxyhemoglobin.

The SpO2 module is housed in the Envoy module rack, where it occupies a single slot.

The Envoy bedside monitor measures oxygen saturation using the Pulse Oximetry method. This continuous, non-invasive method measures the light absorption in the patient's tissue (for example, a finger of the hand or foot) to a receiver on the other side.

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, pediatric and neonatal

Intended User / Care Setting

Hospital environment

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

Testing
The Envoy SpO2 Masimo module has been subject to extensive safety and performance testing. Final testing for the system included various performance tests designed to ensure that the device meets all functional requirements and performance specifications. Safety testing and EMC testing were performed by an independent testing laboratory to ensure that the device complies to applicable industry and safety standards.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

The Envoy SpO2 Masimo module has been subject to extensive safety and performance testing. Final testing for the system included various performance tests designed to ensure that the device meets all functional requirements and performance specifications. Safety testing and EMC testing were performed by an independent testing laboratory to ensure that the device complies to applicable industry and safety standards.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

MENNEN MEDICAL ENVOY PATIENT MONITOR (K001120).

Reference Device(s)

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

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

AUG 01 2002

K022468

Food and Drug Administration ENVOY Patient Monitor - Device Modification: Special 510(k) for new SpO2 module (Masimo)

Image /page/0/Picture/4 description: The image shows the logo for Mennen Medical. The logo consists of a lowercase letter 'm' inside of a black circle. To the right of the logo is the word 'mennenmedical' in lowercase letters.

Mennen Medical Ltd., 4 Hayarden Street, Yavne PO Box 102, Rehovot 76100 Israel Tel .: +972-8-9323333

Fax: +972-8-9328510

Date revised 24nd July, 2002

Topic: 510(k) Safety and Effectiveness Summary as per 21 CFR Section 807.92(c) Envoy Patient Monitor - Device Modification: Special 510k for new SpO2 module (Masimo)

Establishment Name, Registration Number and Address:

Name:Mennen Medical Ltd.
Registration Number9611022
Operator Number:9011766
Address:4 Hayarden Street, Yavne, 81228, Israel
Postal Address:PO Box 102,
Rehovot, 76100, Israel

Tel: +972-8-9323333 Fax: +972-8-9328510

(See Note on page 11 re the new address of Mennen Medical Ltd.)

Asher Kassel, Director of Regulatory Affairs Contact person:

Food and Drug Administration To: Center for Devices and Radiological Health Document Mail Center (HFZ-401) 9200 Corporate Boulevard Rockville MD, 20850

Attn .: Document Control Clerk From: Asher Kassel, Director of Regulatory Affairs

Product Name:

ENVOY Proprietary: Common: Physiological Patient Monitor Mennen Medical Part Number: 550-010-000 (full system) 554-000-010 (CPU only)

New SpO2 module (Masimo) P/N: 551-139-000

1

ENVOY Patient Monitor - Device Modification: Special 510(k) for new SpO2 module (Masimo)

FDA Classification of Envoy Patient Monitor:

Classification Name:Arrhythmia Detector and Alarm
Classification Number:21 CFR 870.1025
Classification:Class III
Product Code:74 DSI

FDA Classification of SpO2 Module:

Classification Name:Oximeter
Classification Number:21 CFR 870.2700
Classification:Class II
Product Code:74 DQA

Performance Standards:

None promulgated

Voluntary Standards:

UL 2601-1, IEC 60601-1 for electrical safety for medical equipment AAMI/ EC 11 - Diagnostic electrocardiograph devices (1991) AAMI/ EC 13 - Cardiac monitors, heart-rate meters, alarms (1992) AAMI/ ES 1 - Safe current limits for electromedical apparatus (1993) IEC 60601-1: General Requirement for Safety for Medical Electrical Systems - part 1, (1988); Amendment 1 -1991-11 Amendment 2 -- 1995-03 IEC 60602-2-27: Medical electrical equipment, Part 2, (1994) Requirements for safety of electrocardiograph monitoring equipment. ISO 9919: Pulse oximeters for medical use requirements (1991)

Predicate Device:

MENNEN MEDICAL ENVOY PATIENT MONITOR (K001120).

2

ENVOY Patient Monitor - Device Modification: Special 510(k) for new SpO2 module (Masimo)

Device Description - Envoy Patient Monitor:

The Envoy is a multiparameter physiological patient monitor, capable of monitoring:

  • · ECG/Heart Rate
  • invasive blood pressure
  • · non-invasive blood pressure
  • · respiration
  • · pulse oximetry
  • two temperature channels
  • cardiac output
  • eTCO2

The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays. The Envoy vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the Envoy display unit. Vital signs and waveform information are displayed simultaneously on the Envoy Display Unit. Up to 8 traces can be displayed at any one time.

The Envoy is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting. nor life sustaining device; nor is it implantable and therefore sterility is not a consideration.

The Envoy is not a kit, does not contain any drug or biological products and is not for prescription use.

Functional Description of the new SpO2 module (OEM Masimo technology):

The SpO2 module is the source of all pulse oximetry data in the Envoy bedside monitor.

SpO2 is measured to determine a monitored patient's arterial oxygen saturation and pulse rate. Arterial oxygen saturation is the percentage of oxygenated hemoglobin in relation to the total hemoglobin. For example, if 95 percent of the hemoglobin molecules in the arterial red blood cells combine with oxygen, the blood has an oxygen saturation of 95 percent. The Sp02 numeric value represents the percentage of hemoglobin molecules that have combined with oxygen molecules to form oxyhemoglobin.

The SpO2 module is housed in the Envoy module rack, where it occupies a single slot.

The Envoy bedside monitor measures oxygen saturation using the Pulse Oximetry method. This continuous, non-invasive method measures the light absorption in the patient's tissue (for example, a finger of the hand or foot) to a receiver on the other side.

3

ENVOY Intended Use:

The Envoy is intended for use as a multiparameter physiological patient monitoring system.

The Envoy can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the Envoy to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages,

The Mennen Medical Envoy is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • · Emergency Departments
  • · Intra-operative (Anesthesia) Monitoring
  • · Post Anesthesia Care

4

ENVOY Patient Monitor – Device Modification: Special 510(k) for new SpO2 module (Masimo)

Summary of the technological characteristics of the new SpO2 module (OEM Masimo technology):

The following tables summarize data on the Mennen Medical Envoy Envoy SpO2 Masimo module (modified device):

| Envoy

SpO2 Masimo module
Part Number:551-139-000
Monitored
Parameters:SpO2 Oxygen saturation Pulse waveform Pulse rate volume
Module size:Single slot
Height: 10.0cm (4.0 in)
Width: 4.0 cm (1.6 in)
Depth: 14.0 cm (5.5 in)

| Envoy

SpO2 Masimo module
Saturation range:1% to 100% Sp02
SpO2 Accuracy:Adults: 70 % - 100 % ± 2 digits
Neonates: 70 % - 100 % ± 3 digits
Pulse Rate range:25 to 240 BPM ±3 BPM
Low saturation
alarm limits:50% to 100%
Data Stotrage
(in mainframe):O2 saturation and Pulse Rate
Alarm event markers
Photoplethysmography waveform

5

ENVOY Patient Monitor - Device Modification: Special 510(k) for new SpO2 module (Masimo)

Envoy
SpO2 Masimo module
Features:Red & Infrared light Tissues absorption method
Waveform display
Pulse rate derived from SpO2 with independent alarm limits
Pulse sound distinct in tone and pitch from QRS tone
Variation in the pulse sound pitch with SpO2 value
Signal strength display
Technical Alarms:"Cable out" and "Relocate probe"

The major difference between the Envoy SpO2 Nellcor module and the Envoy SpO2 Masimo module is the addition of Masimo proprietary SET technology. SET signal processing is a Masimo developed technology that provides accurate monitoring during:

  • Patient Motion or Movement ●
  • Low Perfusion (low signal amplitude) .
  • Intense Ambient Light (lighting or sunlight) .
  • Electro surgical Instrument Interference .

Conclusion of comparison of technological characteristics:

We consider the Envoy Sp2 Masimo module to be substantially equivalent to the Envoy SpO2 Nellcor module and we submit that any differences between the two modules:

  • fall within the scope of a Special 510(k) Device Modification .
  • do not raise any new issues of safety and effectiveness .

Testing

The Envoy SpO2 Masimo module has been subject to extensive safety and performance testing. Final testing for the system included various performance tests designed to ensure that the device meets all functional requirements and performance specifications. Safety testing and EMC testing were performed by an independent testing laboratory to ensure that the device complies to applicable industry and safety standards.

6

INDICATIONS FOR USE

The Envov is intended for use as a multiparameter monitoring system.

The Envoy can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the Envoy to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical Envoy is intended for sale as a system for remote monitoring and recording patient information or any in-hospital application requiring remote patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • · Emergency Departments
  • · Intra-operative (Anesthesia) Monitoring
  • · Post Anesthesia Care

7

ENVOY Patient Monitor – Device Modification: Special 510(k) for new SpO2 module (Masimo)

Signature:
Asher Kassel

Asher Kassel Director of Regulatory Affairs MENNEN MEDICAL LTD.

Tel: Fax: +972-8-9328510 E-mail: asher@mmi.co.il

8

Image /page/8/Picture/0 description: The image is a black and white logo for the Department of Health & Human Services USA. The logo features a stylized image of a human figure with three faces in profile, one behind the other. The figure is surrounded by a circular border with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" written around it.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 01 2002

Mr. Asher Kassel Director of Regulatory Affairs Mennen Medical Limited 4 Hayarden Street, Yavne P.O. Box 102 Rehovot 76100 ISRAEL

Re: K022168

Trade/Device Name: ENVOY Patient Monitor Regulation Number: 21 CFR 870.2700, 870.1025 Regulation Name: Oximeter, Arrhythmia detector and alarm Regulatory Class: III Product Code: DQA, DSI Dated: July 2, 2002 Received: July 3, 2002

Dear Mr. Kassel:

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, 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.

9

Page 2 – Mr. Kassel

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.

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 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 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4646. 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 notification" (21CFR 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.qov/cdrh/dsma/dsmamain.html

Sincerely,
B. Altrud

Timothy A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

10

INDICATIONS FOR USE

The Envoy is intended for use as a multiparameter monitoring system.

The Envoy can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the Envoy to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical Envoy is intended for sale as a system for remote monitoring and recording patient information or any in-hospital application requiring remote patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • Emergency Departments .
  • Intra-operative (Anesthesia) Monitoring ●
  • Post Anesthesia Care

H. Wishman
(Division Sign-Off)

ntal, Infection Control, eneral Hospital De 510(k) Number

Image /page/10/Picture/15 description: The image shows a check mark and the words "Prescription Use". The check mark is located to the left of the words. The check mark is above a horizontal line.