K Number
K061679
Device Name
WALLACE ARTIFICIAL INSEMINATION CATHETER
Date Cleared
2006-10-13

(120 days)

Product Code
Regulation Number
884.4530
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Wallace SIS/AI Catheter is intended to be used in artificial insemination procedures intended for insertion of the catheter and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/Al Catheter is also intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection abnormalities within uterine cavities.
Device Description
The Wallace Artificial Insemination Catheter (K964848) is a single-use, sterile, disposable device that was originally submitted and cleared with the intended use for insertion of catheters and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/AI Catheter for the purpose of this submission is intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection of abnormalities within uterine cavities. The catheter is also intended to be used in artificial insemination (AI) procedures. The Catheter has two opposing smooth side eyes and a rounded smooth closed distal tip. It has an overall length of 18cm and consists of a flexible-end inner catheter and a detachable outer sheath attached to the inner catheter by a luer lock. The inner catheter is 16 gauge with a uniform lumen throughout its length. When the outer sheath luer is attached to the hub of the catheter, the inner catheter protrudes from the outer sheath by 5cm. The outer sheath has a series of 1cm graduations at the distal end, the graduations are used to assess the depth of the insertion. An inner tube with an outer sheath that covers 2/3 segments of the inner sheath with marks of the distance from the distal part of the catheter and a cover rigid protective tube.
More Information

Not Found

No
The device description and intended use focus on the physical characteristics and function of a catheter for artificial insemination and saline infusion sonography. There is no mention of AI or ML in the description, performance studies, or key metrics. The "AI" in the device name appears to refer to "Artificial Insemination".

No.
The device is used for artificial insemination procedures and for detecting abnormalities within uterine cavities via Saline Infusion Sonography; these are not therapeutic treatments.

Yes

The device is intended to be used in Saline Infusion Sonography (SIS) procedures for the "detection of abnormalities within uterine cavities," which clearly indicates a diagnostic purpose.

No

The device description clearly details a physical catheter with specific dimensions, materials, and components (inner catheter, outer sheath, luer lock, graduations), indicating it is a hardware medical device.

Based on the provided text, the Wallace SIS/AI Catheter is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: IVD devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Wallace SIS/AI Catheter is a physical device inserted into the uterine cavity. Its function is to:
    • Introduce washed spermatozoa for artificial insemination.
    • Introduce saline solution for Saline Infusion Sonography (SIS) to visualize the uterine cavity using ultrasound.
  • No Specimen Analysis: The device itself does not analyze any biological specimens. It facilitates procedures that may lead to diagnostic information (SIS), but it's the imaging modality (ultrasound) and the interpretation of the images that provide the diagnostic information, not the catheter's analysis of a specimen.

Therefore, the Wallace SIS/AI Catheter is a medical device used in procedures, but it does not fit the definition of an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Wallace SIS/AI Catheter is intended to be used in artificial insemination procedures intended for insertion of the catheter and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/Al Catheter is also intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection abnormalities within uterine cavities.

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

MQF, LKF

Device Description

The Wallace Artificial Insemination Catheter (K964848) is a single-use, sterile, disposable device that was originally submitted and cleared with the intended use for insertion of catheters and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/AI Catheter for the purpose of this submission is intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection of abnormalities within uterine cavities. The catheter is also intended to be used in artificial insemination (AI) procedures.

The Catheter has two opposing smooth side eyes and a rounded smooth closed distal tip. It has an overall length of 18cm and consists of a flexible-end inner catheter and a detachable outer sheath attached to the inner catheter by a luer lock. The inner catheter is 16 gauge with a uniform lumen throughout its length. When the outer sheath luer is attached to the hub of the catheter, the inner catheter protrudes from the outer sheath by 5cm. The outer sheath has a series of 1cm graduations at the distal end, the graduations are used to assess the depth of the insertion.

An inner tube with an outer sheath that covers 2/3 segments of the inner sheath with marks of the distance from the distal part of the catheter and a cover rigid protective tube.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Saline Infusion Sonography (SIS), Saline Infusion Sonohysterography (SIS), Saline Ultrasound Infusion

Anatomical Site

Uterine cavity

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)

The results from the field testing and evaluation of this product by the end-user demonstrate that the Wallace Artificial Insemination and SIS Catheter are suitable for their intended use.

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.

K964848, K842231, K020951, K970492, K890869, K041094, K040238

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

§ 884.4530 Obstetric-gynecologic specialized manual instrument.

(a)
Identification. An obstetric-gynecologic specialized manual instrument is one of a group of devices used during obstetric-gynecologic procedures to perform manipulative diagnostic and surgical functions (e.g., dilating, grasping, measuring, and scraping), where structural integrity is the chief criterion of device performance. This type of device consists of the following:(1) An amniotome is an instrument used to rupture the fetal membranes.
(2) A circumcision clamp is an instrument used to compress the foreskin of the penis during circumcision of a male infant.
(3) An umbilical clamp is an instrument used to compress the umbilical cord.
(4) A uterine curette is an instrument used to scrape and remove material from the uterus.
(5) A fixed-size cervical dilator is any of a series of bougies of various sizes used to dilate the cervical os by stretching the cervix.
(6) A uterine elevator is an instrument inserted into the uterus used to lift and manipulate the uterus.
(7) A gynecological surgical forceps is an instrument with two blades and handles used to pull, grasp, or compress during gynecological examination.
(8) A cervical cone knife is a cutting instrument used to excise and remove tissue from the cervix.
(9) A gynecological cerclage needle is a looplike instrument used to suture the cervix.
(10) A hook-type contraceptive intrauterine device (IUD) remover is an instrument used to remove an IUD from the uterus.
(11) A gynecological fibroid screw is an instrument used to hold onto a fibroid.
(12) A uterine sound is an instrument used to determine the depth of the uterus by inserting it into the uterine cavity.
(13) A cytological cervical spatula is a blunt instrument used to scrape and remove cytological material from the surface of the cervix or vagina.
(14) A gynecological biopsy forceps is an instrument with two blades and handles used for gynecological biopsy procedures.
(15) A uterine tenaculum is a hooklike instrument used to seize and hold the cervix or fundus.
(16) An internal pelvimeter is an instrument used within the vagina to measure the diameter and capacity of the pelvis.
(17) A nonmetal vaginal speculum is a nonmetal instrument used to expose the interior of the vagina.
(18) A fiberoptic nonmetal vaginal speculum is a nonmetal instrument, with fiberoptic light, used to expose and illuminate the interior of the vagina.
(b)
Classification. (1) Class II (special controls). The device, when it is an umbilical clamp with or without a cutter, a uterine tenaculum which is sterile and does not use suction and is intended for single use, a nonmetal vaginal speculum, or a fiberoptic nonmetal vaginal speculum, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 884.9.(2) Class I for the amniotome, uterine curette, cervical dilator (fixed-size bougies), cerclage needle, IUD remover, uterine sound, and gynecological biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 884.9.

0

Irvine Scientific

K061679
June 7, 2006
Page 1 of 3

510(k) SUMMARY AS REQUIRED BY SECTION 807.92(c)

| Submitted by: | Irvine Scientific Sales Co., Inc.
2511 Daimler Street
Santa Ana, CA 92705-5588 | | | | OCT 13 2006 |
|-----------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------|--|--|-------------|
| | Telephone: (800) 437-5706
Facsimile: (949) 261-6522
Contact: Wendell Lee, Pharm.D.
Vice President
Regulatory Affairs/Quality Systems | | | | |
| | Date Submitted: June 7, 2006 | | | | |
| Device Identification: | | | | | |
| Trade Name: | | Wallace SIS/AI Catheter | | | |
| Trade or Proprietary Name: | | Wallace Artificial Insemination Catheter | | | |
| Device Classification Name: | | Assisted Reproductive Catheter (21 CFR § 884.6110, Class II, Product Code 85 MQF) | | | |
| | | Cannula, Manipulator/Injector, Uterine,
(Unclassified, Class II, Product Code 85 LKF) | | | |

Description:

The Wallace Artificial Insemination Catheter (K964848) is a single-use, sterile, disposable device that was originally submitted and cleared with the intended use for insertion of catheters and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/AI Catheter for the purpose of this submission is intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection of abnormalities within uterine cavities. The catheter is also intended to be used in artificial insemination (AI) procedures.

Wallace SIS/AI Catheter

1

June 7, 2006

The Catheter has two opposing smooth side eyes and a rounded smooth closed distal tip. It has an overall length of 18cm and consists of a flexible-end inner catheter and a detachable outer sheath attached to the inner catheter by a luer lock. The inner catheter is 16 gauge with a uniform lumen throughout its length. When the outer sheath luer is attached to the hub of the catheter, the inner catheter protrudes from the outer sheath by 5cm. The outer sheath has a series of 1cm graduations at the distal end, the graduations are used to assess the depth of the insertion.

An inner tube with an outer sheath that covers 2/3 segments of the inner sheath with marks of the distance from the distal part of the catheter and a cover rigid protective tube. Please refer to photographs of the catheter presented in Appendix E of this submission.

Intended Use:

The SIS/AI Catheter for the purpose of this submission is intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection of abnormalities within uterine cavities. The catheter is also intended to be used in artificial insemination (AI) procedures.

Technological Characteristics:

Catheters are routinely used in Saline Infusion Sonography in diagnostic Obstetrics and Gynecological procedures. The catheter is used to deliver a saline solution into the patient for the intended purposes. The catheter was originally cleared for market with the intended use of introduction of washed spermatozoa into the uterine cavity. The proposed intended use of the Wallace Artificial Insemination and SIS Catheter is equivalent to the identified predicate devices. The comparison to the predicate device is as follows:

2

June 7, 2006

K.06/679
Page 3 of 3

ApplicantProduct NameK #Address
ACKRAD
LaboratoriesHysterosalpingorgraphy SetK84223170 Jackson Dr.
Cranford, NJ 07016
ACKRAD
LaboratoriesH/S Catheter Set
Hysterosalpingography or
hysterosonographyK02095170 Jackson Dr.
Cranford, NJ 07016
ACKRAD
LaboratoriesIntrauterine Insemination
and SonohysterographyK97049270 Jackson Dr.
Cranford, NJ 07016
C.R. Bard, INC.Bard Hysterosalpingography
CathetersK8908695 Federal St. P.O. Box
5069 Billerica, MA
01822
Bioteque
America, Inc.HSG Catheter Set
Infusion of contrast dye or
sterile salineK041094340 East Maple Ave.,
#204-C
Langhorne PA 19047
Modern Medical
Equipment MFG.
LTD.Softseal HSG Catheter
SonohysterographyK0402381705 Dabney Rd.
Richmond, VA 23230
Marlow Surgical
Technologies,
Inc.Wallace Artificial
Insemination CatheterK9648481810 Joseph Lloyd
Parkway
Willoughby, OH 44094

Conclusion:

The results from the field testing and evaluation of this product by the end-user demonstrate that the Wallace Artificial Insemination and SIS Catheter are suitable for their intended use.

3

Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of a human figure.

Food and Drug Administration 9200 Corporate Blvd. Rockville MD 20850

OCT 1 3 2006

Wendell Lee, Pharm.D. Vice President Regulatory Affairs/Quality Systems Irvine Scientific Sales Co., Inc. 2511 Daimler Street SANTA ANA CA 92705-5588

Re: K061679

Trade/Device Name: Wallace SIS/AI Catheter Regulation Number: 21 CFR §884.6110 Regulation Name: Assisted reproduction catheters Regulatory Class: II Product Code: MQF and LKF Dated: September 5, 2006 Received: September 6, 2006

Dear Dr. Lee:

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 (Premarket Approval), 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.

Image /page/3/Picture/10 description: The image is a circular logo with the text "FDA Centennial" in the center. Above the text is "1906-2006". The letters "FDA" are in a bold, stylized font. The logo is surrounded by a circular border with text, but the text is too blurry to read. There are three stars below the word "Centennial".

noting Public J

4

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 one of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxx(Obstetrics/Gynecology)240-276-0115
21 CFR 894.xxx(Radiology)240-276-0120
Other240-276-0100

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 (240) 276-3150

or at its Internet address http://www.fda.gov/cdrl/industry/support/index.html.

Sincerely yours.

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

INDICATIONS FOR USE STATEMENT (page 1 of 1)

510(K) Number: KO60 1679

Device Name: Wallace SIS/Al Catheter

Indications for Use:

The Wallace SIS/AI Catheter is intended to be used in artificial insemination procedures intended for insertion of the catheter and introduction of washed spermatozoa into the uterine cavity. The Wallace SIS/Al Catheter is also intended to be used in Saline Infusion Sonography (SIS), also known as Saline Infusion Sonohysterography (SIS) and Saline Ultrasound Infusion procedures in the detection abnormalities within uterine cavities.

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

Over-The-Counter Use (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)

Daniel A. Seymour

(Division Sign-Off) Division of Reproductive and Radiological Devic 510(k) Number

Wallace SIS/AI Catheter