K Number
K041348
Device Name
PORTEX ULTRAPERC PERCUTANEOUS DILATION TRACHEOSTOMY KIT_WITH SERIAL DILATORS OR SINGLE STAGE DILATOR, BLUE LINE ULTRA
Manufacturer
Date Cleared
2004-07-13

(54 days)

Product Code
Regulation Number
868.5800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Portex Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra Tracheostomy Tube and Introducer and components of these kits that allow for tracheal access for airway management for use in adults only.
Device Description
The Portex "Ultra Perc" single use Percutaneous Dilation Tracheostomy Kits allow the percutaneous insertion of the Police Sublic Fere "Single discriptions of the stage) circumferencial dilatational Seldinger guidewire technique. Kits are supplied with a Portex Blue Line Ultra Tracheostomy Tube and introducer. The kits are intended for use in a controlled setting such as an Intensive Care Unit or operating room with the assistance of trained personnel. A minimum of 2 operators are required - one to maintain the patient's airway, anaesthesia, breathing and circulation, and the other to perform the procedure. The Portex Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra The Forex Forealizer, are available in sizes 7.0, 8.0 and 9.0mm only.
More Information

Not Found

No
The device description and other sections do not mention any AI or ML components or capabilities. The device is a physical kit for a medical procedure.

Yes

The device is used for tracheal access for airway management, which directly impacts a patient's physiological function (breathing) and is used in a controlled clinical setting.

No

The device is described as a tracheostomy kit used for the percutaneous insertion of a tracheostomy tube for airway management, which is a therapeutic procedure, not a diagnostic one.

No

The device description clearly indicates it is a kit containing physical components like dilators, a tracheostomy tube, and an introducer, which are hardware.

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

Here's why:

  • Intended Use: The intended use is for "tracheal access for airway management". This is a surgical procedure performed directly on the patient's body.
  • Device Description: The device is a kit for performing a percutaneous tracheostomy, which involves inserting a tube into the trachea. This is a physical intervention, not a diagnostic test performed on a sample outside the body.
  • Lack of IVD Characteristics: The description does not mention any analysis of biological samples (blood, urine, tissue, etc.) or any diagnostic purpose. IVDs are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening.

Therefore, this device is a surgical/interventional device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Portex "Ultra Perc" Perculaneous Dilation Trachcostomy kit with Serial Dilators or Single Stage Dilator. The Line Ultra Tracheostomy Tube and Introducer are indicated to create a percutaneous difiational tracheostomy using guidewire dilators and components of this kit that allow for tracheal access for airway management.

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

JOH

Device Description

The Portex "Ultra Perc" single use Percutancous Dilation Trachcostomy Kits allow the perculancous insertion of I he Police Sublic Fere "Single discriptions of the stage) circumferencial dilatational Seldinger guidewire technique. Kits are supplied with a Portex Blue Line Ultra Tracheostomy Tube and introducer. The kits are intended for use in a controlled setting such as an Intensive Care Unit or operating room with the assistance of trained personnel. A minimum of 2 operators are required - one to maintain the patient's airway, anaesthesia, breathing and circulation, and the other to perform the procedure. The Portex Perculaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra The Forex Forealizer, are available in sizes 7.0, 8.0 and 9.0mm only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Trachea

Indicated Patient Age Range

adults only

Intended User / Care Setting

controlled setting such as an Intensive Care Unit or operating room with the assistance of trained personnel. A minimum of 2 operators are required - one to maintain the patient's airway, anaesthesia, breathing and circulation, and the other to perform the procedure.

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)

Performance data for the proposed device is shown in section 8.0 Performance. Clinical data is provided in Appendix 2

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.

K022212, K040014, K030381, K980466, K011210, K8802+7

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

§ 868.5800 Tracheostomy tube and tube cuff.

(a)
Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a surgical opening of the trachea to facilitate ventilation to the lungs. The cuff may be a separate or integral part of the tracheostomy tube and is, when inflated, intended to establish a seal between the tracheal wall and the tracheostomy tube. The cuff is used to prevent the patient's aspiration of substances, such as blood or vomit, or to provide a means for positive-pressure ventilation of the patient. This device is made of either stainless steel or plastic.(b)
Classification. Class II.

0

Smiths Medical: Portex Percutaneous Dilation Tracheostomy kit with Secial Dilators or Single Stage Dilators, Blue Line Ultra Tracheostomy Tube and Introducer 510(K) Notification

KD41348

JUL 1 3 2004 SECTION 5.0 : 510K SUMMARY

DATE SUBMITTED: 6th May 2004

SUBMITTER:Smiths Medical
Hythe
Kent
England, CT21 6JL

CONTACT PERSON:

Mr Barry Smith Regulatory Affairs Manager Smiths Medical, Hythe, Kent, England. CT21 5BN Phone 00 44 (0) 1303 26055 1 Fax 00 44 (0)1303 264679 e-mail: barry.smith(@smiths-medical.com

DEVICE NAME:

Portex "Ultraperc" Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra Tracheostomy Tube and Introducer.

COMMON NAME AND CLASSIFICATION:

Percutaneous Dilation Tracheostomy kit with Serial Dilators. Class II BTO, 21 CFR 868.5800

PREDICATE DEVICES:

  • Portex Ltd: Portex Perculaneous Dilation Trachcostomy Kit with Scrial Dilators. already marketed in the 1. USA under K022212
  • Portex Ltd: Portex Perculancous Dilation Trachcostomy Kit with Single Stage Dilator already marketed in 2. the USA under K040014
  • Portex Ltd: Blue Line Ultra Tracheostomy Tube kits, already marketed in the USA under K030381 ﻢ ﺍﻟﻤﺮﺍﺟﻊ ﺍﻟﻤﺮﺍﺟﻊ ﺍﻟﻤﺮﺍﺟﻊ
  • Portex Inc. Perculaneous Dilatory tracheostomy Kit with Speciality tracheostomy Tube (Perfit) already 4. marketed in the USA under K980466
  • Rusch Percuquick set for percutaneous dilation tracheostomy already marketed in the USA under K011210 5.
  • Shiley Low Pressure Cuffed tracheostomy tube already marketed in the USA under K8802+7 ().

1

Smiths Medical: Portex Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilators, Blue Line Ultra Trachcostomy Tube and Introducer 510(K) Notification

SECTION 5.0 : 510K SUMMARY

DEVICE DESCRIPTION:

The Portex "Ultra Perc" single use Percutancous Dilation Trachcostomy Kits allow the perculancous insertion of I he Police Sublic Fere "Single discriptions of the stage) circumferencial dilatational Seldinger guidewire technique.

Kits are supplied with a Portex Blue Line Ultra Tracheostomy Tube and introducer.

The kits are intended for use in a controlled setting such as an Intensive Care Unit or operating room with the assistance of trained personnel. A minimum of 2 operators are required - one to maintain the patient's airway, anaesthesia, breathing and circulation, and the other to perform the procedure.

The Portex Perculaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra The Forex Forealizer, are available in sizes 7.0, 8.0 and 9.0mm only.

INTENDED USE:

The Portex "Ultra Perc" Perculaneous Dilation Trachcostomy kit with Serial Dilators or Single Stage Dilator. The Line Ultra Tracheostomy Tube and Introducer are indicated to create a percutaneous difiational tracheostomy using guidewire dilators and components of this kit that allow for tracheal access for airway management.

TECHNOLOGICAL CHARICTERISTICS OF PROPOSED VERSUS PREDICATE DEVICES:

  • The proposed device is equivalent to Predicate devices 1 & 2- Portex Ltd: Portex Percutaneous Dilation . Tracheostomy Kits already marketed in the USA under K022212 and K040014 and Predicate 3 - Portex Ltd. I racheostomy Tube kits already marketed in the USA under K03038 lin all aspects except for the following:
    • Tracheostomy tube Introducer. The proposed device has a Tracheostomy tube Introducer that o allows for the placement of the Blue Line Ultra Tracheostomy tube into the patients trachea. The curvature and materials of the Introducer will be compared with the Single Stage Dilator of Predicate 2 and the obturator of Predicate 3. The handle will be compared to he Single Stage Dilator of Predicate 2 and the Obturator/Introducer of Predicate 4

PERFORMANCE / CLINICAL DATA:

Performance data for the proposed device is shown in section 8.0 Performance. Clinical data is provided in Appendix 2

CONCLUSION:

Comparison of the proposed device to the predicate devices supports the conclusion that the proposed device is substantially equivalent in safety and effectiveness in its intended use to existing legally marketed devices.

2

Image /page/2/Picture/1 description: The image shows the seal of the U.S. Department of Health and Human Services. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 1 3 2004

Mr. Barry Smith Regulatory Affairs Manager Smiths Medical, International Limited Military Road Hythe, Kent, CT21 5BN ENGLAND

Re: K041348

Trade/Device Name: Portex "Ultraperc" Percutaneous Dilation Tracheostomy Kit Regulation Number: 868.5800 Regulation Name: Tracheostomy Tube and Tube Cuff Regulatory Class: II Product Code: JOH Dated: May 6, 2004 Received: May 20, 2004

Dear Mr. Smith:

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.

3

Page 2 -Mr. Smith

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), please contact the Office of Compliance at (301) 594-4646. 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,

Clus

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Smiths Medical : Portex Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single al : Fortex Ferentaneous Ultra Tracheostomy Tube and Introducer 510(K) Notification

SECTION 4.0: STATEMENT OF INDICATIONS FOR USE

Document 1

DEVICE NAME:

Portex "Ultraperc" Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue Line Ultra Tracheostomy Tube and Introducer.

INDICATIONS OF USE:

The Portex Percutaneous Dilation Tracheostomy kit with Serial Dilators or Single Stage Dilator, Blue The Forex Ferentaneous Dhatton Tracheostenly mindicated to create a percuraneous dillational Lifte Unia Tractievslonly Tube and introducer and components of these kits that allow for tracheal access for airway management for use in adults only.

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

Over-The-Counter Use NO (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Aun Syberot

(Division Sign-Division of Anesthesiology, General Hospital, Infection Control, De

510(k) Number