K Number
K100700
Manufacturer
Date Cleared
2010-12-13

(276 days)

Product Code
Regulation Number
876.5980
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The MED-RX Pediatric Feeding Tube and Accessories are disposable, single use enteral feeding devices featuring non-luer enteral only connectors. The MED-RX Pediatric Feeding Tube is intended to be used for nasogastric enteral feeding, as directed by a physician. The MED-RX Enteral Extension Set is an accessory to the MED-RX Pediatric Feeding Tube, to be used to deliver fluids from the nutritional source to an existing non-luer pediatric feeding tube. The MED-RX Pediatric Feeding Tube and Accessories are for hospital use, pediatric patient use only, and are not intended for use beyond 30 days.

Device Description

The MED-RX Pediatric Feeding Tube is intended to be used for nasogastric/oralgastric enteral feeding as directed by a physician. Accessories to be offered alongside the MED-RX Pediatric Feeding Tubes include MED-RX Enteral Extension Sets of various configurations. The MED-RX Enteral Extension Set is intended to be used to deliver fluids from the nutritional source to an existing non-luer pediatric feeding tube. The MED-RX Pediatric Feeding Tubes and Enteral Extension Sets feature non-luer enteral only connectors to decrease the risk of accidental misconnection. All devices are sterile, single-use, and latex free. The MED-RX Pediatric Feeding Tube and Accessories are for pediatric use only. Accessories may be sold with MED-RX Pediatric Feeding Tubes or separately.

AI/ML Overview

The provided document is a 510(k) premarket notification for a medical device (MED-RX Pediatric Feeding Tube and Accessories). It describes non-clinical performance and biocompatibility testing to demonstrate substantial equivalence to predicate devices, rather than a study proving the device meets clinical acceptance criteria with respect to AI/algorithm performance. Therefore, many of the requested points, such as those related to AI/algorithm performance, ground truth, expert review, and MRMC studies, are not applicable to this document.

However, I can extract information related to the device's non-clinical acceptance criteria and the summary results of those tests.

1. A table of acceptance criteria and the reported device performance

TestAcceptance CriteriaReported Device Performance
Feeding Tube Tensile Strength TestWithstand tensile force of: 2 lbf (OD ≤ 2 mm), 4 lbf (OD > 2 mm)PASS, PASS
Extension Set Tensile Strength TestWithstand tensile force of 4 lbfPASS
Leakage under PressureNo leakage or separation under 50 kPaPASS
Leakage under VacuumNo leakage or separation under vacuumPASS
Connector SeparationWithstand tensile force of 3.37 lbf (15 N)PASS
Device CompatibilityIncompatible with other recognized non-luer medical devicesPASS
Latex ContentContain less than 0.04% natural rubber latexLess than 0.04%
Sterility Assurance LevelValidated to a Sterility Assurance Level of 1 x 10⁻⁶ (ANSI/AMMI/ISO 11135:1994)Validated to 1 x 10⁻⁶
EO Sterilization ResidualsPass (ISO 10993-7: 2008)Pass
Bacterial EndotoxinsPass (ANSI/AAMI ST72:2002)Pass
CytotoxicityNon-toxic (ISO 10993-5: 2009)Non-toxic
Intracutaneous ReactivityNon-irritant (ISO 10993-10: 2010)Non-irritant
Guinea Pig Maximization SensitizationNo sensitization response (ISO 10993-10:2002)No sensitization response

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

The document does not specify the exact sample sizes (number of units tested) for each non-clinical test. It states "The MED-RX Pediatric Feeding Tubes and MED-RX Enteral Extension Sets have successfully completed all required performance testing."
The data provenance is not explicitly stated in terms of country of origin of the data or retrospective/prospective nature. These are non-clinical bench tests performed by the manufacturer and a contract lab (Wuxi AppTec for Latex Content).

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

Not applicable. This document describes non-clinical, physical, and biocompatibility testing, not a study involving expert human review or ground truth derived from clinical experts.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

Not applicable. As above, this pertains to non-clinical testing.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This document does not describe a study involving human readers or AI assistance.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

Not applicable. This document does not describe an algorithm or AI device.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

For the non-clinical tests, the "ground truth" or reference for passing/failing is defined by established regulatory standards (e.g., ISO, ANSI/AAMI standards) and specific quantitative criteria (e.g., tensile force in lbf, pressure in kPa, latex percentage).

8. The sample size for the training set

Not applicable. There is no "training set" as this is a non-AI/algorithm device submission.

9. How the ground truth for the training set was established

Not applicable. There is no "training set" or corresponding ground truth as this is a non-AI/algorithm device submission.

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K100700 Page 1 of 4

SECTION 5 - 510(K) SUMMARY

DEC 1 3 2010

Date of Summary: November 26, 2010

Benlan Inc 2760 Brighton Road Oakville, ON L6H 5T4

Tel (905) 829-5004 Fax (905) 829-5006

Official Contact:Cheryl Brown – QA / RA Manager
Proprietary Name:MED-RX Pediatric Feeding Tube and Accessories
Common Name:Feeding Tube or NG/OG Tube
Classification Name:Gastrointestinal tube and accessories
Class:Class II
Product Code:FPD
Predicate Devices:Vygon Nutrisafe 2 (K060944)NeoChild SafeChild Infant Feeding Tube and Accessories (K082710)

Device Description

The MED-RX Pediatric Feeding Tube is intended to be used for nasogastric/oralgastric enteral feeding as directed by a physician. Accessories to be offered alongside the MED-RX Pediatric Feeding Tubes include MED-RX Enteral Extension Sets of various configurations. The MED-RX Enteral Extension Set is intended to be used to deliver fluids from the nutritional source to an existing non-luer pediatric feeding tube. The MED-RX Pediatric Feeding Tubes and Enteral Extension Sets feature non-luer enteral only connectors to decrease the risk of accidental misconnection. All devices are sterile, single-use, and latex free. The MED-RX Pediatric Feeding Tube and Accessories are for pediatric use only. Accessories may be sold with MED-RX Pediatric Feeding Tubes or separately.

Indications for Use

The MED-RX Pediatric Feeding Tube and Accessories are disposable, single use enteral feeding devices featuring non-luer enteral only connectors. The MED-RX Pediatric Feeding Tube is intended to be used for nasogastric enteral feeding, as directed by a physician. The MED-RX Enteral Extension Set is an accessory to the MED-RX Pediatric Feeding Tube, to be used to deliver fluids from the nutritional source to an existing non-luer pediatric feeding tube. The MED-RX Pediatric Feeding Tube and Accessories are for hospital use, pediatric patient use only, and are not intended for use beyond 30 days.

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K100700 Page

Page 2 of 4

Substantial Equivalence:

The information provided in the premarket notification demonstrates that the proposed device is substantially equivalent to legally marketed devices. The proposed MED-RX Pediatric Feeding Tube and Accessories is substantially equivalent to the Vygon Nutrisafe 2 (K060944) and the NeoChild SafeChild Infant Feeding Tubes and Accessories (K082710). Both the proposed and the predicate devices have the same intended use for nasogastric enteral feeding as directed by a physician. A comparison of features and principles of operation between the proposed device and predicate devices is provided in Table 1.

Table 1: Comparison between MED-RX Pediatric Feeding Tube, Vygon Nutrisafe 2 (K060944), and NeoChild SafeChild Infant Feeding Tube and Accessories (K082710)

AttributeProposed Device:MED-RX Pediatric FeedingTube and AccessoriesPredicate Device:Vygon Nutrisafe 2(K060944)Predicate Device:NeoChild SafeChild(K082710)
Indications for UseFor nasogastric/oralgastricenteral feeding as directedby a physicianSameSame
IntendedPopulationPediatricsSameSame
IntendedEnvironment ofUseHospitalSameHospital, home, orenvironments wherefeeding tube isrequired
SystemConfigurationTube with integralradiopaque line, depthmarkings, and non-luerenteral only connectorSameSame
MaterialsPVC, polyurethane, variousmedical grade plasticsSameSame
ConnectorNon-luer enteral only slip fitconnectorNon-luer enteralonly threadedconnectorNon-IV enteralconnector
PackagingPouch, sealedSameSame
SterilityEOEOEO
Single UseYesYesYes

Summary of Differences

There are no significant differences between the proposed MED-RX Pediatric Feeding Tube and Accessories and the predicate devices, Vygon Nutrisafe 2 (K060944) and NeoChild SafeChild Infant Feeding Tube and Accessories (K082710). Similarities between the proposed device and the predicate devices include identical indications for use and intended populations. Both the proposed device and the predicate device feature non-luer enteral only connectors and are manufactured from equivalent materials. The MED-RX Pediatric Feeding Tube and Accessories, the Vygon Nutrisafe 2, and the NeoChild SafeChild Infant Feeding Tube and Accessories are single-use, sterile devices, packaged in peelable paper/poly pouches. All devices are sterilized using ethylene oxide. Any minor differences between the proposed device and the predicate

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K10 0700 Page 3 of 4

have been evaluated to have no impact on safety or effectiveness of the MED-RX Pediatric Feeding Tube and Accessories, and therefore the devices can be considered equivalent.

Non-Clinical Test Summary

Verification of functional performance of the MED-RX Pediatric Feeding Tubes and Accessories has been performed and successfully completed. The MED-RX Pediatric Feeding Tubes and MED-RX Enteral Extension Sets were subject to numerous performance tests including tensile strength of the bonded joints and of the tubes, and resistance to liquid leakage under pressure and under vacuum. The MED-RX Pediatric Feeding Tube and Accessories were also tested for connector separation, device compatibility with other non-luer medical devices, and for determination of flow rate. The MED-RX Pediatric Feeding Tubes and MED-RX Enteral Extension Sets have successfully completed all required performance testing, as summarized in Table 2.

Table 2: Summary of Performance Test Results

TestPass/Fail CriteriaResult
Feeding Tube Tensile Strength TestWithstand tensile force of:2 lbf (OD ≤ 2 mm)4 lbf (OD > 2 mm)PASSPASS
Extension Set Tensile Strength TestWithstand tensile force of 4 lbfPASS
Leakage under PressureNo leakage or separation under 50 kPaPASS
Leakage under VacuumNo leakage or separation under vacuumPASS
Connector SeparationWithstand tensile force of 3.37 lbf (15 N)PASS
Device CompatibilityIncompatible with other recognized non-luer medical devicesPASS

Latex Content

The MED-RX Transfer Sets were tested for natural rubber latex content using a Modified Lowry Method. The devices were found to contain less than 0.04% latex and are therefore considered to not contain natural rubber latex. The testing was completed by Wuxi AppTec.

Summary of Sterilization

Each of the MED-RX Pediatric Feeding Tubes and Accessories is individually packaged using a medical grade peelable synthetic polymer reinforced paper with a film backing, and sterilized using ethylene oxide. Please see Table 3 for a summary.

Table 3: Sterilization Summary
----------------------------------------
Test DescriptionStandardResults
Method of ValidationANSI/AMMI/ISO 11135:1994Validated to a Sterility AssuranceLevel of 1 x 10-6
EO Sterilization ResidualsISO 10993-7: 2008Pass
Bacterial EndotoxinsANSI/AAMI ST72:2002Pass

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K10 0700 Page 4 of 4

Summary of Biocompatibility Tests

Biocompatibility testing was successfully completed on sterile finished devices. The MED-RX Pediatric Feeding Tubes and Accessories are classified as surface contacting devices with prolonged mucosal membrane contact. A summary of the testing completed and the relevant standards are listed in Table 4.

Table 4: Biocompatibility Test Summary

Test DescriptionStandardResults
ISO MEM Elution withL-929 Mouse FibroblastCells (Cytotoxicity)ISO 10993-5: 2009Product code 54-3680RU, 54-8242RU, and 54-7069U are considered non-toxic.
Intracutaneous ReactivityTestISO 10993-10: 2010Product code 54-3680RU, 54-8242RU, and 54-7069U are considered a non-irritant.
Guinea Pig MaximizationSensitization Test (Methodof Biomaterial Extracts)ISO 10993-10:2002Product code 54-3680RU, 54-8242RU, and 54-7069U did not elicit a sensitization response.

{4}------------------------------------------------

Image /page/4/Picture/0 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread, representing the department's mission to protect the health of all Americans.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G609 Silver Spring, MD 20993-0002

Ms. Cheryl Brown QA/RA Manager Benlan, Inc. 2760 Brighton Road OAKVILLE ONTARIO · CANADA L6H 5T4

DEC 1 3 2010

Re: K100700

Trade/Device Name: MED-RX Pediatric Feeding Tube and Accessories Regulation Number: 21 CFR §876.5980 Regulation Name: Gastrointestinal tube and accessories Regulatory Class: II Product Code: FDP Dated: December 10, 2010 Received: December 10, 2010

Dear Ms. Brown:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

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); medical device reporting of medical device-related

{5}------------------------------------------------

Page 2

adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Hubert Lenoir MD

erbert P. Lerner, M.D., Director (Acting) Division of Reproductive, Gastro-Renal and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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SECTION 4 -- INDICATIONS FOR USE

510(K) Number (If Known): K100700

DEC 1 3 2010

Device Name: MED-RX Pediatric Feeding Tube and Accessories

Indications For Use:

The MED-RX Pediatric Feeding Tube and Accessories are disposable, single use enteral feeding devices featuring non-luer enteral only connectors. The MED-RX Pediatric Feeding Tube is intended to be used for nasogastric enteral feeding, as directed by a physician. The MED-RX Enteral Extension Set is an accessory to the MED-RX Pediatric Feeding Tube, to be used to deliver fluids from the nutritional source to an existing non-luer pediatric feeding tube. The MED-RX Pediatric Feeding Tube and Accessories are for hospital use, pediatric patient use only, and are not intended for use beyond 30 days.

Prescription Use:
(Part 21 CFR 801 Subpart D)
AND/OR
Over-the-Counter Use
(21 CFR 801 Subpart C)
N/A

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED.

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Reproductive, Gastro-Renal, and
Urological Devices
510(k) NumberK 100700

Page 1 of ।

§ 876.5980 Gastrointestinal tube and accessories.

(a)
Identification. A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use).(b)
Classification. (1) Class II (special controls). The barium enema retention catheter and tip with or without a bag that is a gastrointestinal tube and accessory or a gastronomy tube holder accessory is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I (general controls) for the dissolvable nasogastric feed tube guide for the nasogastric tube. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 876.9.