K Number
K052169
Device Name
IMC SURGICAL DRAPES
Date Cleared
2005-11-17

(100 days)

Product Code
Regulation Number
878.4370
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This device is intended to be used as protective coverings used to isolate incision sites and protect against contamination during surgical procedures.
Device Description
Surgical Drapes including various sizes and configurations of table covers, flat drape sheets, Lap drapes, cardiovascular drapes, head & neck drapes, general use drapes, cysto drapes, c-section drapes, orthopedic drapes and specialty drapes.
More Information

Not Found

No
The device description and performance studies focus on the physical properties and intended use of surgical drapes, with no mention of AI or ML.

No
The device, surgical drapes, are intended for protective coverings and isolation during surgery, not for treating or rehabilitating a medical condition.

No
Explanation: The device is described as surgical drapes intended as "protective coverings used to isolate incision sites and protect against contamination during surgical procedures." This function is protective and does not involve diagnosing, treating, or preventing disease, which are typically associated with diagnostic devices.

No

The device description clearly states it is comprised of physical surgical drapes, which are hardware components. There is no mention of software as the primary or sole component.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to "isolate incision sites and protect against contamination during surgical procedures." This is a physical barrier function performed on the patient during a surgical procedure.
  • Device Description: The description lists various types of surgical drapes, which are physical coverings.
  • Lack of IVD Characteristics: An IVD device is used to examine specimens from the human body (like blood, urine, tissue) in vitro (outside the body) to provide information for diagnosis, monitoring, or screening. This device does none of that.

The information provided clearly describes a surgical device used in vivo (on the body) during a procedure, not an IVD used in vitro to analyze specimens.

N/A

Intended Use / Indications for Use

International Medsurg Connection's Surgical Drape is intended to be used as Patient protective coverings used to isolate incision sites and protect against contamination during surgical procedures.

This device is intended to be used as protective coverings used to isolate incision sites and protect against contamination during surgical procedures.

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

KKX

Device Description

Surgical Drapes including various sizes and configurations of table covers, flat drape sheets, Lap drapes, cardiovascular drapes, head & neck drapes, general use drapes, cysto drapes, c-section drapes, orthopedic drapes and specialty drapes.

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

Not Found

Intended User / Care Setting

Not Found

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)

All material used in the fabrication of the IMC Surgical Drapes were evaluated for:

TestStandard
CytotoxicityISO 10993 - Part 5
Skin IrritationISO 10993 - Part 10
Skin SensitivityISO 10993 - Part 11
Systemic ToxicityISO 10993 - Part 11
Flammability16 CFR Part 1610
Hydrostatic PressureAATCC 127
Impact PenetrationAATCC 42
LintIST 160.1
Tensile StrengthASTM D5034

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.

Not Found

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.

K050538

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

§ 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.

0

10.0 SUMMARY OF THE SAFETY AND EFFECTIVENESS

International Medsurg Connection Surgical Drape

| Manufacturer: | International Medsurg Connection, Inc.
935 N Plum Grove Road, Suite F
Schaumburg, Illinois 60173-4770 |
|-----------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Regulatory Contact: | Manny Gupta
Vice President / General Manager
International Medsurg Connection, Inc.
935 N Plum Grove Road, Suite F
Schaumburg, Illinois 60173-4770 |
| Telephone: | 847-619-9929 |
| Date Summary Prepared | August 5, 2005 |
| Product Trade Name: | IMC Surgical Drapes - Multiple |
| Common Name: | Surgical Drape. |
| Classification: | Class II |
| Predicate: | IMC Drapes, Reference K050538
owned by International Medsurg
Connection. |
| Description: | Surgical Drapes including various sizes
and configurations of table covers, flat
drape sheets, Lap drapes,
cardiovascular drapes, head & neck
drapes, general use drapes, cysto
drapes, c-section drapes, orthopedic
drapes and specialty drapes. |

Intended Use:

International Medsurg Connection's Surgical Drape is intended to be used as Patient protective coverings used to isolate incision sites and protect against contamination during surgical procedures.

Substantial Equivalence:

The International Medsurg Connection Surgical Drapes are substantially equivalent to IMC Drapes sold by International Medsurg Connection, Reference K050538.

INTERNATIONAL MEDSURG CONNECTION, INC. 510K NOTIFICATION

1

K052169

They provide the following characteristics: Intended use is the same Similar configurations Similar materials

Summary of testing:

All material used in the fabrication of the IMC Surgical Drapes were evaluated for:

TestStandard
CytotoxicityISO 10993 - Part 5
Skin IrritationISO 10993 - Part 10
Skin SensitivityISO 10993 - Part 11
Systemic ToxicityISO 10993 - Part 11
Flammability16 CFR Part 1610
Hydrostatic PressureAATCC 127
Impact PenetrationAATCC 42
LintIST 160.1
Tensile StrengthASTM D5034

2

ATTACHMENT E DRAPES LIST

Catalog NumberDescription
Table Covers
270-2500Mayo Stand Cover
270-2510Mayo Stand Cover, X-Large
270-2309Table Cover, Reinforced
270-2311Table Cover, Reinforced
270-2316Table Cover, Reinforced
270-2313Table Cover, Heavy Duty with Extension
Flat Drape Sheets
270-2410Half Drape
270-2412Medium Drape
270-2416Three Quarter Drape, Reinforced
270-2417Large Drape
270-2419Full Drape
Lap Drapes
270-3003Laparotomy Drape
270-3008Laparotomy Drape (with pouches)
270-3005Trans Laparatomy Drape
270-3009Ped Laparatomy Drape
270-3103Major Abdominal Laparoscopic Drape
270-9101Laparoscopy Drape
270-9103LAVH Drape
270-3751SLaparoscopic Perineal Drape
Cardiovascular Drapes
270-4001Cardio / CV Drape
270-4006CV Split Drape
270-4007Bilateral Split Drape
Head & Neck Drapes
270-7001EENT Split Drape
270-7002Thyroid Drape
270-7003Thyroid T-Drape
270-7008Head Bar Drape
270-7009Head Turban Drape
General Use Drapes
270-2460Legging
270-2461Legging
270-2405Utility Drape
270-2408Utility Drape Extra Large
270-4002Top Drape
27-4206SBottom Drape
27-4207SSide Drape
270-2498Split Drape
270-2600SAbdominal Drape
Cysto Drapes
270-5090SCysto T-Drape
270-5091SCysto Drape
270-9001Lithotomy Drape
270-9103Lithotomy Drape
DRAPES LIST
C-Section Drapes
270-6101C-Section Drape
270-6102C-Section Drape
Orthopedic Drapes
270-8101Arthroscopy Drape
270-8102Arthroscopy Drape
270-8002Extremity Drape
270-8003Extremity Drape
270-8005Hand Drape
270-8301Ortho Split Drape
270-8004Bilaterial Limb Drape
270-8201Hip Drape
270-8401SShoulder Drape with pouch
270-2499U-Drape
Specialty Drapes
270-8412Beach Drape
270-2540SChest/Breast Drape
270-6003Circumcision Drape

3

ATTACHMENT E DRAPES LIST

:

4

Image /page/4/Picture/1 description: The image is a black and white circular seal. The seal features an emblem of a stylized bird with three curved lines representing its wings or body. Encircling the emblem is text that reads "HEALTH & HUMAN SERVICES - USA" in a circular arrangement. The text is in uppercase and appears to be a standard sans-serif font.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 1 7 2005

Mr. Manny Gupta Vice President/General Manager International Medsurg Connection, Incorporated 935 North Plum Glove Road, Suite F Schaumburg, Illinois 60173-4770

Re: K052169

Trade/Device Name: IMC Surgical Drapes-Various Types, Sizes and Configurations, Per Attached List Regulation Number: 878.4370 Regulation Name: Surgical Drape and Drape Accessories Regulatory Class: II Product Code: KKX Dated: November 8, 2005 Received: November 9, 2005

Dear Mr. Gupta:

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.

5

Page 2 - Mr. Gupta

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 (OS) 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 (240) 276-0115. 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/industry/support/index.html.

Sincerely vours.

Siren Jump

B

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

6

Indications for Use

510K Number :K052169
------------------------

Device name: IMC Surgical Drapes - Various types, sizes and configurations, per attached List.

Indication For Use:

This device is intended to be used as protective coverings used to isolate incision sites and protect against contamination during surgical procedures.

This submission includes drapes that will be sold both sterile and non-sterile. Non-sterile drapes are to be sold to OEMs for EtO sterilization according to ISO 11135. Sterile drapes are to be sold directly to users after EtO sterilization validation to ISO 11135.

Prescription Use X (Partb21 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)

Shula H. Murphy, M.D. 1/16/05
(Division Sign-off)

Division of anesthesiology, General Hospital. Infection Control Dental Devices