K Number
K031362
Device Name
LAC-MAC LIMITED INNERBLOC VARIOUS O.R. DRAPE BASED ON THE REPEL, PLUS AND GORE SURGICAL BARRIER FABRIC MATERIALS
Manufacturer
Date Cleared
2003-05-30

(99 days)

Product Code
Regulation Number
878.4370
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Lac-Mac Limited InnerBloc® O.R. Drapes based on the RePeL PLUS™ and GORE® Surgical Barrier Fabric Materials, are reusable protective patient coverings for isolating sites of surgical incisions from microbial or other contamination. For manufacturing, processing, or repackaging, these drapes must be reprocessed and packaged.
Device Description
Lac-Mac Limited InnerBloc® Various O.R. Drapes based on the RePeL PLUSTM and Gore® Surgical Barrier Fabric Materials
More Information

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Not Found

No
The summary describes surgical drapes made of specific materials and their intended use for isolating surgical sites. There is no mention of any computational or analytical functions, let alone AI/ML.

No
The device is a surgical drape intended to isolate surgical sites from contamination, not to treat a disease or condition.

No

Explanation: The device is described as a "reusable protective patient covering for isolating sites of surgical incisions from microbial or other contamination." Its purpose is to physically protect, not to diagnose or provide information about a patient's medical condition. It does not mention any function related to detection, measurement, or analysis for diagnostic purposes.

No

The device description clearly states it is a physical product (drapes) made of specific fabric materials, not software.

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

Here's why:

  • Intended Use: The intended use is to provide a physical barrier to isolate surgical incision sites from contamination. This is a physical function, not a diagnostic one.
  • Device Description: The description refers to "reusable protective patient coverings," which aligns with a physical barrier function.
  • Lack of Diagnostic Elements: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting biomarkers, or providing diagnostic information about a patient's health status.

IVD devices are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening. This device does not perform any of those functions.

N/A

Intended Use / Indications for Use

The Lac-Mac Limited InnerBloc® O.R. Drapes based on the RePeL PLUS™ and GORE® Surgical Barrier Fabric Materials, are reusable protective patient coverings for isolating sites of surgical incisions from microbial or other contamination. For manufacturing, processing, or repackaging, these drapes must be reprocessed and packaged.

Product codes

KKX

Device Description

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Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

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Anatomical Site

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Indicated Patient Age Range

Not Found

Intended User / Care Setting

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Description of the training set, sample size, data source, and annotation protocol

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Description of the test set, sample size, data source, and annotation protocol

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Summary of Performance Studies

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Key Metrics

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Predicate Device(s)

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Reference Device(s)

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Predetermined Change Control Plan (PCCP) - All Relevant Information

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§ 878.4370 Surgical drape and drape accessories.

(a)
Identification. A surgical drape and drape accessories is a device made of natural or synthetic materials intended to be used as a protective patient covering, such as to isolate a site of surgical incision from microbial and other contamination. The device includes a plastic wound protector that may adhere to the skin around a surgical incision or be placed in a wound to cover its exposed edges, and a latex drape with a self-retaining finger cot that is intended to allow repeated insertion of the surgeon's finger into the rectum during performance of a transurethral prostatectomy.(b)
Classification. Class II (special controls). The device, when it is an ear, nose, and throat surgical drape, a latex sheet drape with self-retaining finger cot, a disposable urological drape, a Kelly pad, an ophthalmic patient drape, an ophthalmic microscope drape, an internal drape retention ring (wound protector), or a surgical drape that does not include an antimicrobial agent, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

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Image /page/0/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three lines forming its body and wings. The eagle is enclosed in a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter.

MAY 3 0 2003

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

·Lac Mac Limited C/O Mr. Jeffrey O. Stull 10907 Wareham Court Austin, Texas 78739

Re: K031362

Trade/Device Name: Lac-Mac Limited InnerBloc® Various O.R. Drapes based on the RePeL PLUSTM and Gore® Surgical Barrier Fabric Materials Regulation Number: 878.4370 Regulation Name: Surgical Drape and Drape Accessories Regulatory Class: II Product Code: KKX Dated: May 16, 2003 Received: May 22, 2003

Dear Mr. Stull:

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 vour 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.

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Page 2 - Mr. Stull

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 vour 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 (301) 594-4618. 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Susan Runse

Susan Runner, DDS, MA Interim Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Lac-Mac Limited, InnerBloc® O.R. Drapes based RePeL PLUS™ and GORE® Surgical Barrier Fabric Materials

16031362 K##### Reference:

Statement of Intended Use

The Lac-Mac Limited InnerBloc® O.R. Drapes based on the RePeL PLUS™ and GORE® Surgical Barrier Fabric Materials, are reusable protective patient coverings for isolating sites of surgical incisions from microbial or other contamination. For manufacturing, processing, or repackaging, these drapes must be reprocessed and packaged.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Chin S. Lim

(Division Sign-Off) Division of Anesthesiology, General Hospital Infection Control, Dental D

510(k) Number: K031362