K Number
K130404
Device Name
TIBURON SURGICAL DRAPE
Date Cleared
2013-07-05

(136 days)

Product Code
Regulation Number
878.4370
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Cardinal Health Tiburon® surgical drapes are devices made of natural or synthetic materials intended to be used as a protective patient covering to isolate a site of surgical incision from microbial and other contamination. The drape is sterilized using ethylene oxide and is intended for single external use only. This drape is classified as Level 4 per AAM Standard PB70 liquid barrier performance and classification of protective apparel and drapes intended for use in health-care facilities.
Device Description
The Cardinal Health Tiburon® surgical drapes described in this submission are single use disposable sheets designed to provide an absorbent sterile barrier during surgical procedures. The drapes cover the patient and are made of absorbent nonwoven fabric backed with a protective film that stops fluid strikethrough. The drapes are provided in various sizes and shapes to meet the surgical procedure. The sterile product will be sold as an individually ethylene oxide sterilized wrapped drape that is placed in a polyolefin - based vented pouch and heat sealed prior to sterilization and are intended for external use only. These drapes are comprised of a fabric that is an blue absorbent polyolefin spun melt nonwoven fabric adhesively bonded to a polyolefin blue film. Cardinal Health Tiburon® surgical drapes meet the Level 4 requirements of the AAM Liquid Barrier Classifications. This submission covers ten different models of Cardinal Health surgical drapes in Table 1. The catalog numbers listed in this submission are representative of all drape models. All models utilize the same material technology.
More Information

Not Found

No
The device description and performance studies focus on the physical properties and barrier performance of a surgical drape, with no mention of AI or ML.

No.
Surgical drapes are intended to provide a sterile barrier during surgery to prevent contamination, not to treat a disease or condition.

No

Explanation: The device, Cardinal Health Tiburon® surgical drapes, is designed to provide a protective barrier during surgery to prevent contamination. Its function is to isolate the surgical site, not to diagnose a condition or disease.

No

The device description clearly states it is a physical surgical drape made of fabric and film, intended for single external use as a protective patient covering. It is sterilized and sold as a physical product.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, or tissue) to provide information about a person's health. This testing is done outside of the body (in vitro).
  • Device Description: The description clearly states that the Cardinal Health Tiburon® surgical drapes are "protective patient covering[s]" and "single use disposable sheets designed to provide an absorbent sterile barrier during surgical procedures." They are used on the patient's body during surgery.
  • Intended Use: The intended use is to "isolate a site of surgical incision from microbial and other contamination." This is a physical barrier function, not a diagnostic test performed on a specimen.

The device is a surgical drape, which is a type of medical device used in surgical procedures for infection control and barrier protection.

N/A

Intended Use / Indications for Use

Cardinal Health Tiburon® surgical drapes are devices made of natural or synthetic materials intended to be used as a protective patient covering to isolate a site of surgical incision from microbial and other contamination. The drape is sterilized using ethylene oxide and is intended for single external use only. This drape is classified as Level 4 per AAM Standard PB70 liquid barrier performance and classification of protective apparel and drapes intended for use in health-care facilities.

Product codes

KKX

Device Description

The Cardinal Health Tiburon® surgical drapes described in this submission are single use disposable sheets designed to provide an absorbent sterile barrier during surgical procedures. The drapes cover the patient and are made of absorbent nonwoven fabric backed with a protective film that stops fluid strikethrough. The drapes are provided in various sizes and shapes to meet the surgical procedure. The sterile product will be sold as an individually ethylene oxide sterilized wrapped drape that is placed in a polyolefin - based vented pouch and heat sealed prior to sterilization and are intended for external use only. These drapes are comprised of a fabric that is an blue absorbent polyolefin spun melt nonwoven fabric adhesively bonded to a polyolefin blue film. Cardinal Health Tiburon® surgical drapes meet the Level 4 requirements of the AAM Liquid Barrier Classifications.

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

Cardinal Health Tiburon® surgical drapes performance has been tested in accordance with the applicable requirements recommended in the FDA's Guidance on Premarket Notification [510(k)] Submissions for Surgical Gowns and Surgical Drapes, Infection Control Devices Branch Division of General and Restorative Devices, August, 1993 in this submission. In addition to performance testing in accordance with industry recognized standards; these drapes were evaluated according to ISO 10993 and are considered toxicologically acceptable for its intended use. Cardinal Health Tiburon® surgical drapes were tested in compliance with the requirements of Level 4 liquid barrier performance of AAMI Standard PB70 liquid barrier performance and classification of protective apparel and drapes intended for use in healthcare facilities.

Key Metrics

Not Found

Predicate Device(s)

K031287

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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

K130404

5 2013 JUL

Image /page/0/Picture/2 description: The image shows the logo for Cardinal Health. The logo consists of a stylized graphic above the company name. The graphic is composed of several curved lines that converge, resembling a bird in flight or an abstract representation of movement. The text "CardinalHealth" is written in a bold, sans-serif font, with the first letter of each word capitalized.

1430 Waukegan Road McGraw Park, IL 60085

www.cardinal.com

510(k) SUMMARY Surgical Drape

Manufacturer:

Cardinal Health 200, LLC 1430 Waukegan Road McGaw Park, IL 60085

Tiburon® surgical drape

Class II per 21 CFR § 878.4370

Lavenia Ford 1430 Waukegan Road McGaw Park, IL 60085

(847) 887-3323

April 17, 2013

Surgical Drape

Surgical Drape

Telephone Number:

Date summary Prepared:

Regulatory Affairs Contact:

Trade Name:

Classification:

Classification Name:

Common Name:

Product Code: KKX

Predicate Device:

KKK

3M Health Care Steri-Drape™ Fabric Surgical Drape K031287

Description:

The Cardinal Health Tiburon® surgical drapes described in this submission are single use disposable sheets designed to provide an absorbent sterile barrier during surgical procedures. The drapes cover the patient and are made of absorbent nonwoven fabric backed with a protective film that stops fluid strikethrough. The drapes are provided in various sizes and shapes to meet the surgical procedure. The sterile product will be sold as an individually ethylene oxide sterilized wrapped drape that is placed in a polyolefin - based vented pouch and heat sealed prior to sterilization and are intended for external use only.

These drapes are comprised of a fabric that is an blue absorbent polyolefin spun melt nonwoven fabric adhesively bonded to a polyolefin blue film.

Cardinal Health Tiburon® surgical drapes meet the Level 4 requirements of the AAM Liquid Barrier Classifications.

1

This submission covers ten different models of Cardinal Health surgical drapes in Table 1. The catalog numbers listed in this submission are representative of all drape models. All models utilize the same material technology.

Extensive performance testing has been completed on the Cardinal Health Tiburon® surgical drape. The physical properties of surgical drape have been characterized after sterilization. Completion of the performance tests demonstrated that the surgical drape provides an adequate sterile barrier after sterilization.

Indications for Use:

Cardinal Health Tiburon® surgical drapes are devices made of natural or synthetic materials intended to be used as a protective patient covering to isolate a site of surgical incision from microbial and other contamination. The drape is sterilized using ethylene oxide and is intended for single external use only.

This drape is classified as Level 4 per AAMI Standard PB70 Liquid Barrier Performance and Classification of Protective Apparel and Drapes Intended for Use in Health-care Facilities.

| | Indications for Use Catalog Number List | Catalog
Number | SF = spunbond/film
PE= Polyethylene |
|-----|-------------------------------------------------|-------------------|--------------------------------------------------|
| | Product Description | | Drape Materials |
| No. | | Sterile | |
| 1 | Three-quarter Drape Sheet | 9349 | SF base panel |
| 2 | Laparotomy Drape | 29410 | SF base panel with SF reinforcement |
| 3 | General Endoscopy Drape | 9458 | SF base panel with SF reinforcement |
| 4 | Cardiovascular Split Drape II | 9158 | SF base panel with SF reinforcement |
| 5 | Arthroscopy Drape for Dropped Leg
Procedures | 9414 | SF base panel with SF reinforcement |
| 6 | Arthroscopy Hip Drape with Pouch | 29439 | SF base panel with SF reinforcement |
| 7 | Beach Chair Shoulder Drape | 29369 | SF base panel with PE pouch and elastomeric film |
| 8 | Pediatric Drape | 29492 | SF base panel with SF reinforcement |
| 9 | LAVH Drape | 29474 | SF base panel with SF reinforcement |
| 10 | Split Sheet Drape | 29436 | SF base panel with SF reinforcement |

Table # 1 - Product Catalog numbers

Substantial Equivalence

The Cardinal Health Tiburon® surgical drapes are substantially equivalent to the predicate device. 3M Health Care Steri-Drape™ Fabric Surgical Drape. Both devices have the same intended use, similar material composition, similar film and nonwoven components, same sterilization modality (ethylene oxide) and compatibility with that modality, similar drape configurations/dimensions, similar labeling content, and comparable physical performance attributes (including strength, basis weight, flammability).

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Table #2 - Overall Comparison of Predicate and Proposed Device

. . . .

11 - 11 - 11

.

| Element of
Comparison | PREDICATE
3M Steri-Drape™ Surgical Drape
(K031287) | PROPOSED
Cardinal Health Tiburon® surgical
drape | Comparison
to Predicate |
|-----------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------|
| Indications for
Use | 3M Steri-Drape™ Surgical Fabric Drapes
are used to create a sterile field for a
surgical procedure. They are provided
sterile using ethylene oxide or gamma
radiation and intended for external use
only.

3M Steri-Drape™ non-sterile fabric
drapes are provided to other
manufacturers for further processing
using ethylene oxide. 3M provides
information on compatibility with ethylene
oxide processing. | Cardinal Health Tiburon® surgical drapes
are devices made of natural or synthetic
materials intended to be used as a
protective patient covering to isolate a site
of surgical incision from microbial and
other contamination. The drape is sterile
using ethylene oxide and is intended for
single external use only.

These drapes are classified as Level 4
per AAMI Standard PB70 liquid barrier
performance and classification of
protective apparel and drapes intended
for use in health-care facilities. | Substantially
Equivalent |
| Material
Composition | Drape fabric, with a blue absorbent
nonwoven on top and a blue film on the
underside. | Drape fabric, with a blue absorbent
nonwoven on top and a blue film on the
underside. | Substantially
Equivalent |
| Lamination | Unknown | Adhesive | Unknown |
| Sterilization
Modality | Ethylene Oxide or Gamma Irradiation | Ethylene Oxide | Substantially
Equivalent |
| Configurations/
Dimensions | Various sizes and shapes | Various sizes and shapes | Substantially
Equivalent |
| Material
Compatibility
with Ethylene
Oxide | Compatible | Compatible | Substantially
Equivalent |
| Biocompatibility | Unknown | Non-cytotoxic
Non-sensitizing
Non-irritating | Unknown |
| Labeling | Label content:
Catalog number drape description visible
Drape Dimensions and drawing on label
Lot number visible
No barrier AAMI level listed
Site of manufacturing listed
Labeled as sterile
Labeled as single use only | Label content:
Catalog number drape description visible
Drape Dimensions and drawing on label
Lot number visible
AAMI level listed
Company address listed
Labeled as sterile
Labeled as single use only
AAMI PB70 Barrier Level 4 | Substantially
Equivalent |
| Barrier
Properties | Unknown | AAMI PB70 Barrier Level 4 | Unknown |

.

:

:

3

Summary of Testing

Cardinal Health Tiburon® surgical drapes performance has been tested in accordance with the applicable requirements recommended in the FDA's Guidance on Premarket Notification [510(k)] Submissions for Surgical Gowns and Surgical Drapes, Infection Control Devices Branch Division of General and Restorative Devices, August, 1993 in this submission. In addition to performance testing in accordance with industry recognized standards; these drapes were evaluated according to ISO 10993 and are considered toxicologically acceptable for its intended use. Cardinal Health Tiburon® surgical drapes were tested in compliance with the requirements of Level 4 liquid barrier performance of AAMI Standard PB70 liquid barrier performance and classification of protective apparel and drapes intended for use in healthcare facilities.

Conclusions:

Based on the results of the biocompatibility and physical performance testing, Cardinal Health Tiburon® surgical drape is safe for its intended use. The Cardinal Health Tiburon® surgical drape is substantially equivalent to the predicate device, 3M Health Care Steri-Drape ™ Fabric Drape, in terms of general intended use, physical performance testing, material composition modality and compatibility, drape configurations/dimensions, and labeling, and safety and effectiveness.

4

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/4/Picture/1 description: The image shows the logo for the Department of Health & Human Services (HHS). The logo features a stylized eagle with three stripes representing the three levels of government: federal, state, and local. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

July 5, 2013

Cardinal Health 200, LLC Ms. Lavenia Ford Regulatory Affairs Manager 1430 Waukegan Road MCGAW PARK, IL 60085-6786

Re: K130404

Trade/Device Name: Cardinal Health Tiburon® Surgical Drape Regulation Number: 21 CFR 878.4370 Regulation Name: Surgical drape Regulatory Class: II Product Code: KKX Dated: April 8, 2013 Received: April 10, 2013

Dear Ms. Ford:

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

5

Page 2 - Ms. Ford

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.goy/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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.

Image /page/5/Picture/7 description: The image shows a document with the text "Sincerely yours" at the top. Below this, there is a signature and the name "Tejashri Purohit Sheth, M.D." followed by the title "Clinical Deputy Director". The acronym "DAGRID" is also present, along with the word "FOR" at the bottom right.

Kwame Ulmer M.S. Acting Division Director Division of Anesthesiology, General Hospital Respiratory, Infection Control and Dental Device Office of Device Evaluation Center for Devices and Radiological Health

6

Image /page/6/Picture/0 description: The image shows the logo for Cardinal Health. The logo consists of a stylized graphic above the company name. The graphic is composed of several curved lines that converge at a point, resembling a stylized bird in flight or a medical symbol. The text "CardinalHealth" is written in a bold, sans-serif font, with the two words joined together.

.

Indications for Use

510(k) Number (if known): K130404

Device Name: Cardinal Health Tiburon® surgical drape

Cardinal Health Tiburon® surgical drapes are devices made of natural or synthetic materials intended to be used as a protective patient covering to isolate a site of surgical incision from microbial and other contamination. The drape is sterilized using ethylene oxide and is intended for single external use only.

This drape is classified as Level 4 per AAM Standard PB70 liquid barrier performance and classification of protective apparel and drapes intended for use in health-care facilities.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use X (21 CFR 801 Subpart C)

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

Elizabeth The Glax Millence of CDRH, Office of Devices Evaluation (ODE)
2013.06.28 2222888993-04'00'

Division Sign-Off Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) K130404

7

Table 1 - Product Catalog numbers

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:

| | Indications for Use Catalog Number List | | SF = spunbond/film
PE= Polyethylene | |
|-----|-------------------------------------------------|-------------------|--------------------------------------------------|--|
| | Product Description | Catalog
Number | Drape Materials | |
| No. | | Sterile | | |
| 1 | Three-quarter Drape Sheet | 9349 | SF base panel | |
| 2 | Laparotomy Drape | 29410 | SF base panel with SF reinforcement | |
| 3 | General Endoscopy Drape | 9458 | SF base panel with SF reinforcement | |
| 4 | Cardiovascular Split Drape II | 9158 | SF base panel with SF reinforcement | |
| 5 | Arthroscopy Drape for Dropped Leg
Procedures | 9414 | SF base panel with SF reinforcement | |
| 6 | Arthroscopy Hip Drape with Pouch | 29439 | SF base panel with SF reinforcement | |
| 7 | Beach Chair Shoulder Drape | 29369 | SF base panel with PE pouch and elastomeric film | |
| 8 | Pediatric Drape | 29492 | SF base panel with SF reinforcement | |
| 9 | LAVH Drape | 29474 | SF base panel with SF reinforcement | |
| 10 | Split Sheet Drape | 29436 | SF base panel with SF reinforcement | |

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the submit and the subject of the states of the states