K Number
K112426
Device Name
XIAN FRIENDSHIP DISPOSABLE NERVE STIMULATOR PROBES
Date Cleared
2012-04-02

(223 days)

Product Code
Regulation Number
874.1820
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Xian Friendship Disposable Nerve Stimulator Probes is used to perform localized stimulation of neural tissue and to locate, identify and monitor cranial motor nerves, peripheral nerves and spinal nerve roots during surgery. Xian Friendship Disposable Nerve Stimulator Probes are sterile (EtO), single-patient-use device.
Device Description
Stimulator probes are used as the medium to deliver electrical stimulation to tissue during intraoperative neurological monitoring. The probes are available in three electrical configurations such as monopolar, bipolar and concentric forms according to the required application. The probes are supplied sterile and are for single use only. The probes are connected to an electrical stimulator using a flexible lead wire(s) and a "touch-proof' safety connector(s) on the distal end. Stimulator probes are used by the surgeon to locate and identify motor nerves and spinal nerve roots and to assess nerve function. Bipolar probes may also be used to record nerve action potentials directly from the nerve. The probes are designed with a plastic handle and stainless steel active electrode shaft insulated to the tip. The probe shaft may be bent to allow viewing access under a microscope. Concentric Probes is designed with an outer anode pole and center cathode pole separated by insulation. Tip diameter approx 1mm. Monopolar electrodes require a separate stimulator return electrode and the Monopolar probe is insulated to the tip with only a stimulating "ball" or "tip" exposed. Bipolar probe has a fully insulated probe shaft with two 1 mm exposed flush tips. The anode and cathode tips can spread up to 3 mm apart and will penetrate tissue for stimulation current to flow.
More Information

Not Found

No
The device description focuses on the physical characteristics and electrical configurations of the probes used for nerve stimulation, with no mention of AI or ML capabilities. The performance studies described are bench tests for mechanical and electrical performance, not related to algorithmic performance.

No.
The device is used for diagnostic purposes (locating, identifying, and monitoring nerves) during surgery, not for treating a disease or condition.

Yes

The device is used to "locate, identify and monitor cranial motor nerves, peripheral nerves and spinal nerve roots during surgery," and "to assess nerve function" by delivering electrical stimulation. This process of identifying and assessing nerve function falls under diagnostic purposes.

No

The device description clearly details physical components like probes, handles, shafts, and connectors, indicating it is a hardware device, not software-only.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information about a person's health. This testing is done outside of the body (in vitro).
  • Device Function: The Xian Friendship Disposable Nerve Stimulator Probes are used during surgery to directly stimulate neural tissue within the body. They are used to locate, identify, and monitor nerves in real-time during the procedure.
  • Lack of Specimen Analysis: The device does not analyze any specimens taken from the patient. It delivers electrical stimulation and potentially records nerve action potentials directly from the nerve itself.

Therefore, based on the intended use and device description, this device falls under the category of a surgical instrument used for intraoperative monitoring, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Xian Friendship Disposable Nerve Stimulator Probes is used to perform localized stimulation of neural tissue and to locate, identify and monitor cranial motor nerves, peripheral nerves and spinal nerve roots during surgery.

Xian Friendship Disposable Nerve Stimulator Probes are sterile (EtO), single-patient-use device.

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

ETN

Device Description

Stimulator probes are used as the medium to deliver electrical stimulation to tissue during intraoperative neurological monitoring. The probes are available in three electrical configurations such as monopolar, bipolar and concentric forms according to the required application. The probes are supplied sterile and are for single use only.

The probes are connected to an electrical stimulator using a flexible lead wire(s) and a "touch-proof' safety connector(s) on the distal end.

Stimulator probes are used by the surgeon to locate and identify motor nerves and spinal nerve roots and to assess nerve function. Bipolar probes may also be used to record nerve action potentials directly from the nerve.

The probes are designed with a plastic handle and stainless steel active electrode shaft insulated to the tip. The probe shaft may be bent to allow viewing access under a microscope.

Concentric Probes is designed with an outer anode pole and center cathode pole separated by insulation. Tip diameter approx 1mm.

Monopolar electrodes require a separate stimulator return electrode and the Monopolar probe is insulated to the tip with only a stimulating "ball" or "tip" exposed.

Bipolar probe has a fully insulated probe shaft with two 1 mm exposed flush tips. The anode and cathode tips can spread up to 3 mm apart and will penetrate tissue for stimulation current to flow.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cranial motor nerves, peripheral nerves and spinal nerve roots

Indicated Patient Age Range

Not Found

Intended User / Care Setting

surgeon / intraoperative context

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)

Bench testing for mechanical and electrical performance was conducted to verify that the device meets design specifications and performance characteristics in accordance with Xian Friendship Disposable Nerve Stimulator Probe's internal specifications. In addition, bench testing was also performed to demonstrate that the Xian Friendship Disposable Nerve Stimulator Probe is substantially equivalent to the predicate devices.

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.

K062996, K031003, K103128

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

§ 874.1820 Surgical nerve stimulator/locator.

(a)
Identification. A surgical nerve stimulator/locator is a device that is intended to provide electrical stimulation to the body to locate and identify nerves and to test their excitability.(b)
Classification. Class II.

0

K112426

APR - 2 2012

510(k) Summary (rev.02) (per 21 CFR 807.92.(c))

1. Submitter's information

.

Company NameXi'an Friendship Medical Electronics Co., Ltd.
Company AddressNo.9 Gao Xin 1st Road, High-Tech Development Zone, Xi'an, Shaanxi, 710075 P.R.China
Contact PersonZhai Tao (Sales Department Manager)
Phone Numbers86 29 88225200 Ext. 602
Fax Numbers86 29 88236285
georgezhai2616@163.com
Date Prepared3/27/2012
Trade nameXian Friendship Disposable Nerve Stimulator Probes
Devices type1. Disposable Monopolar Direct Nerve Stimulator Probe
  1. Disposable Flush Tip Direct Nerve Stimulator Probe
  2. Disposable Ball Tip Direct Nerve Stimulator Probe
  3. Disposable Direct Concentric Nerve Stimulator Probe
  4. Disposable Bipolar Direct Nerve Stimulator Probe
  5. Disposable Hook Nerve Probe(Double Hook/ Triple Hook) |
    | Common Name: | Surgical Nerve Stimulator/Locator |
    | Classification | Stimulator, Nerve (21. CFR 874.1820) |
    | Product Code: | ETN, |
    | Classification: | Class II (Performance Standards) |
    | Panel: | Ear, Nose and Throat Devices |

3. Predicate Device

Company510(k) numberDevice Name
Axon Systems, Inc.K062996Axon Systems Disposable
Stimulator Probes
Medtronic Xomed, Inc.K031003Stimulus/Dissection Instruments
Ball-Tip Probes
Cadwell Laboratories, Inc.K103128Cadwell Disposable Stimulator
Probes

4. Devices Description

Stimulator probes are used as the medium to deliver electrical stimulation to tissue during intraoperative neurological monitoring. The probes are available in three electrical

.

1

configurations such as monopolar, bipolar and concentric forms according to the required application. The probes are supplied sterile and are for single use only.

The probes are connected to an electrical stimulator using a flexible lead wire(s) and a "touch-proof' safety connector(s) on the distal end.

Stimulator probes are used by the surgeon to locate and identify motor nerves and spinal nerve roots and to assess nerve function. Bipolar probes may also be used to record nerve action potentials directly from the nerve.

The probes are designed with a plastic handle and stainless steel active electrode shaft insulated to the tip. The probe shaft may be bent to allow viewing access under a microscope.

Concentric Probes is designed with an outer anode pole and center cathode pole separated by insulation. Tip diameter approx 1mm.

Monopolar electrodes require a separate stimulator return electrode and the Monopolar probe is insulated to the tip with only a stimulating "ball" or "tip" exposed.

Bipolar probe has a fully insulated probe shaft with two 1 mm exposed flush tips. The anode and cathode tips can spread up to 3 mm apart and will penetrate tissue for stimulation current to flow.

5. Indications for Use

Xian Friendship Disposable Nerve Stimulator Probes is used to perform localized stimulation of neural tissue and to locate, identify and monitor cranial motor nerves, peripheral nerves and spinal nerve roots during surgery.

Xian Friendship Disposable Nerve Stimulator Probes are sterile (EtO), single-patient-use device.

હ. Technological characteristics

Xian Friendship Disposable Nerve Stimulator Probes consist of an insulated probe shaft of various lengths mounted to plastic handle. The probe shaft is electrically connected to a DIN 42802"touch-proof' safety connector on the other end. The probe is supplied in a sterile pouch. Materials used are the same as in the predicate devices.

Xian Friendship Disposable Nerve Stimulator Probes are substantially equivalent to the predicate devices with regard to the design, construction, material, mechanical and electrical performance and application. More detail information on the Table 1.

2

Features & DescriptionPredicate DeviceSubject Device
Product nameAxon Systems Disposable
Stimulator ProbesStimulus/Dissection
Instruments, Ball-Tip
ProbesCadwell Disposable
Stimulator ProbesXian Friendship Disposable
Nerve Stimulator Probes
510(K) clearance
numbersK062996K031003K103128
ManufactureAxon Systems, Inc.Medtronic Xomed, Inc.Cadwell Laboratories, Inc.Xi'an Friendship Medical
Electronics Co., Ltd.
Intend for useTo locate, identify and
monitor cranial motor
nerves, peripheral
nerves and spinal nerve
roots during surgery.The Stimulus-Dissection
Instruments are indicated
for tissue dissection and
stimulation of cranial and
peripheral motor nerves
for location and
identification during
surgery, including spinal
nerve roots.Cadwell Disposable
Stimulator Probe is used to
perform localized
stimulation of neural tissue
and to locate, identify and
monitor cranial motor
nerves, peripheral nerves
and spinal nerve roots
during surgery.Xian Friendship Disposable
Nerve Stimulator Probes is
used to perform localized
stimulation of neural tissue
and to locate, identify and
monitor cranial motor nerves,
peripheral nerves and spinal
nerve roots during surgery.
Xian Friendship Disposable
Nerve Stimulator Probes are
sterile (EtO),
single-patient-use device.
ConfigurationMonopolar probe
Bipolar probe
Concentric probeThe Cadwell Disposable
Stimulator Probe is a
single patient use device.Monopolar probe
Bipolar probe
Concentric probe
Tripolar probe

able 1 Product Comparison Table(1

Section 5-3(rev.02)

:

3

fable 1 Product Comparison Table(2)

Features & DescriptionPredicate DeviceSubject Device
Shape of tipstandard tip,
ball,
Flush TipStandard tip,
Ball,
Flush Tip
Hook
ConnectorDIN 42802"touch-proof' safetySame as "Predicate Device"
ShaftStainless steel
SST 304Stainless steel
SST 304
Shaft
InsulationPTFEPTFE
Material
HandleMedical Grade ABSMedical Grade ABS
Lead WireTin Plated CoppeTin Plated Coppe
Lead Wire
InsulationMedical Grade PVCMedical Grade PVC
Single Patient UseSterile-Single Patient UseSterile-Single Patient Use
Method of SterilizationEtOEtO
Packaging1059B coating TYVEK layer+ PE/PET Medical film pouchSame as "Predicate Device"
Shelf life36 months36 months

.

Section 5-4(rev.02)

4

7. Summary of Performance Data

Bench testing for mechanical and electrical performance was conducted to verify that the device meets design specifications and performance characteristics in accordance with Xian Friendship Disposable Nerve Stimulator Probe's internal specifications. In addition, bench testing was also performed to demonstrate that the Xian Friendship Disposable Nerve Stimulator Probe is substantially equivalent to the predicate devices.

8. Safety & Effectiveness

Xian Friendship Disposable Nerve Stimulator Probes are substantially equivalent to the predicate devices. No new questions of safety or effectiveness are raised or evident.

5

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/5/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle. The logo is black and white.

Public Health Service

APR - 2 2012

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

Xian Friendship Medical Electronics Co., Ltd. c/o Mr. Chu Xiaoan Beijing Easy Link Company Rm 1606, Bldg. 1 Jianxiang Yuan No. 209 Bei Si Hu Zhong Rd. Haidian Dis Beijing, 100083, P.R. China

Re: K112426

Trade/Device Name: Xian Friendship Disposable Nerve Stimulator Probes Regulation Number: 21 CFR 874.1820 Regulation Name: Surgical Nerve Stimulator/Locator Regulatory Class: Class II Product Code: ETN Dated: March 28, 2012 Received: March 28, 2012

Dear Mr. Chu Xiaoan:

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.

6

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 (reporting of medical device-related 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/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Rea U. Thon MD
Melvin R. Feldhaus, M.D.

Malvina B. Eydelman, M.D. Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Section 4.0 Indications for Use Statement

INDICATIONS FOR USE

Applicant:Xi'an Friendship Medical Electronics Co., Ltd.
510(k) Number (if known): *K112426
Device Name:Xian Friendship Disposable Nerve Stimulator Probes

Indications For Use:

Xian Friendship Disposable Nerve Stimulator Probes is used to perform localized stimulation of neural tissue and to locate, identify and monitor cranial motor nerves, peripheral nerves and spinal nerve roots during surgery.

Disposable Nerve Stimulator Probes are sterile (EtO), Xian Friendship single-patient-use device.

Prescription Use X (Part 21 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)

Z. McAlts

(Division Sign-Off) Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

Prescription Use
(Per 21 CFR 801.109)

510(k) Number K112426

Section 4-1