(287 days)
The Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube is intended to provide gastric access for enteral feeding, medication and decompression through an established gastrointestinal stoma tract.
The Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube is indicated for use in percutaneous placement of an enteral feeding tube in adult and pediatric patients that require enteral feeding, medication administration or decompression through an established gastrointestinal stoma tract.
The Entuit The Thrive Balloon Retention Gastrostony Feeding Tube is constructed primarily of silicone. The device consists of a tri-port funnel which is overmolded onto a previously extruded bi-lumen shaft. A retention bolster is molded separately and placed over the shall. At the proximal end, a silicone balloon is bonded to the shaft using silicone RTV. The tip of the shaft is filled with radiopaque barium RTV. In use, the balloon end of the catheter is inserted through a gastrointestinal stoma tract and into the stomach lumen. The balloon is then inflated to the rated volume using sterile or distilled water and the bolster adjusted down to the skin to secure the device in place.
The acceptance criteria and study proving the device meets them are described below:
1. Acceptance Criteria and Reported Device Performance
| Test | Acceptance Criteria | Reported Device Performance |
|---|---|---|
| - Flow rate- Balloon Burst Volume- Balloon Volume Maintenance- Balloon Concentricity- Balloon Over Shaft Size- Balloon Integrity- Balloon Integrity in simulated gastric fluid | All tests were conducted in accordance with ASTM F2528-06 (Procedures A through G). Where specific acceptance criteria were not defined in the standard, the candidate device's performance was required to be equivalent to or better than the predicate device. | The candidate device met all performance requirements. Where acceptance criteria were not defined in the standard, the candidate device performed equivalent to or better than the predicate device. |
2. Sample Size Used for the Test Set and Data Provenance
The document does not explicitly state the sample size used for the test set or the data provenance (e.g., country of origin, retrospective or prospective). The testing appears to be primarily bench testing of the physical device.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
This information is not applicable as the study involved bench testing of a medical device against a technical standard (ASTM F2528-06), not a diagnostic study requiring human expert interpretation for ground truth.
4. Adjudication Method for the Test Set
This information is not applicable as the study involved bench testing against a technical standard, not a diagnostic study requiring human expert adjudication.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size
No MRMC comparative effectiveness study was mentioned. The study described is bench testing comparing the performance of the submitted device to a predicate device and a technical standard.
6. If a Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study Was Done
This question is not applicable as the device is a physical medical device (gastrostomy feeding tube), not an AI algorithm. The performance evaluation was standalone in the sense that the device's technical specifications were tested in a controlled environment.
7. The Type of Ground Truth Used
The ground truth for the device's performance was established by adherence to a recognized international standard, ASTM F2528-06 (Procedures A through G), for medical gastrostomy tubes. For aspects where the standard did not define specific criteria, the predicate device's performance served as the benchmark for equivalence.
8. The Sample Size for the Training Set
This information is not applicable as the device is a physical medical device, not an AI model that requires a training set.
9. How the Ground Truth for the Training Set Was Established
This information is not applicable as the device is a physical medical device, not an AI model that requires a training set with established ground truth.
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K130611 pg 1 of 3
Image /page/0/Picture/1 description: The image shows the word "xeridiem" with a circular logo to the left of the word. The logo is a circle with two arrows pointing in opposite directions. The word "xeridiem" is in a bold, sans-serif font. There is a registered trademark symbol to the right of the word.
DEC 1 9 2013
510(k) Summary
As required by 21 CFR 807.92, this "510(k) Summary" provides a basis for the substantial equivalence determination of the device listed below.
General Information
| Date Prepared: | April 5, 2013 |
|---|---|
| Submitter Name: | Xeridiem Medical Devices |
| [formerly Manufacturing and Research, Inc.] | |
| Submitter Address: | 4700 S. Overland Dr. |
| Tucson, Az 85714 | |
| Contact Person: | Michelle Lott, RAC |
| Phone Number: | (520) 882-7794 |
| Fax Number: | (520) 882-6894 |
Device Information
| Trade Name: | Entuit TM Thrive Balloon Retention Gastrostomy Feeding Tube |
|---|---|
| Common Name: | Gastrostomy Tube |
| Classification Name: | Tubes, gastrointestinal (and accessories)[21 CFR 876.5980, Product Code KNT] |
| Classification Panel: | Gastroenterology/Urology |
Predicate Device Information
| Trade Name: | EndoVive™ Standard Replacement Gastrostomy Tube (K083684) |
|---|---|
| Common Name: | Gastrostomy Tube |
| Classification Name: | Tubes, gastrointestinal (and accessories)[21 CFR 876.5980, Product Code KNT] |
| Classification Panel: | Gastroenterology/Urology |
Device Description
The Entuit The Thrive Balloon Retention Gastrostony Feeding Tube is constructed primarily of silicone. The device consists of a tri-port funnel which is overmolded onto a previously extruded bi-lumen shaft. A retention bolster is molded separately and placed over the shall. At the proximal end, a silicone balloon is bonded to the shaft using silicone RTV. The tip of the shaft is filled with radiopaque barium RTV. In use, the balloon end of the catheter is inserted through a gastrointestinal stoma tract and into the stomach lumen. The balloon is then inflated to the rated volume using sterile or distilled water and the bolster adjusted down to the skin to secure the device in place.
Entuit Thrive Balloon Retention Gastrostomy Feeding Tube Xeridiem 510(k) Application - K130611 Appendix B Page 1 of 3
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K130611 pg 2 of 3
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Intended Use/Indications for Use
The Entuil™ Thrive Balloon Retention Gastrostomy Feeding Tube is intended to provide gastric access for enteral feeding, medication and decompression through an established gastrointestinal stoma traci.
The Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube is indicated for use in perculaneous placement of an enteral feeding tube in adult and pediatric patients that require enteral feeding, medication administration or decompression through an established gastrointestinal stoma tract.
Technological Characteristics
The table below provides a general summary of the technological characteristics of the Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube compared to the predicate device.
| Technological Characteristics | ||
|---|---|---|
| EntuitTM Thrive BalloonRetention Gastrostomy FeedingTube (Submitted device) | EndoViveTM StandardReplacement Gastrostomy Tube(Predicate Device)K083684 | |
| Product Range(FR size) | 12 - 24 FR | 12 - 28 FR |
| Product Range(Length) | 10 cm | 10 cm |
| Product Range(Balloon Size) | 5 cc for 12 - 18 FR devices20cc for 20 - 24 FR devices | 4 cc for 12 FR device6 cc for 14 - 28 FR devices |
| Funnel | Similar - Silicone with 3 ports: one for feeding, one for medication and the other for balloon inflation. Adapter added to medication port plug. | Silicone with 3 ports: one for feeding, one for medication and the other for balloon inflation |
| Bolster | Silicone 40 durometer in straight configuration - different bolster profile | Silicone 60 durometer in two configurations: one straight and one right angle |
| Inflation valve | Similar - Thermoplastic housing with silicone valve (low profile valve) | Thermoplastic housing with silicone valve |
| Balloon | Same materials as K083684, different balloon profile | Silicone pancake shaped balloon |
| Shaft | Same as K083684 | Silicone 65 durometer |
| Barium stripe | Barium sulfate without colorant | Barium sulfate with blue colorant |
| Kit Contents | No accessory devices included with device | Inflation syringe, gauze and lubricating jelly |
| Packaging System/Materials | Same as K083684 | Tyvek Pouch. Polybag. IFU, Corrugate Case & Shipper |
Entuit TM Thrive Balloon Retention Gastrostomy Feeding Tube Xeridiem 510(k) Application - K130611 Appendix B Page 2 of 3
સ્ક
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K130611
pg 3 of 3
Performance Characteristics
The table below provides a general summary of the performance testing that was conducted for the Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube.
| Test | Method | Conclusion |
|---|---|---|
| -Flow rate-Balloon Burst Volume-Balloon Volume Maintenance-Balloon Concentricity-Balloon Over Shaft Size-Balloon Integrity-Balloon Integrity in simulated gastric fluid | All in accordance to ASTMF2528-06(Procedures A through G) | Candidate device met allperformance requirements.Where acceptance criteriawere not defined in thestandard, the candidate deviceperformed equivalent to orbetter than the predicatedevice. |
Test Method Conclusion
In all instances the Entuit ™ Thrive Balloon Retention Gastrostomy Feeding Tube performed as intended.
Substantial Equivalence - Comparison to Predicate Device
Among the information and summary tables presented in the 510(k) submission to support substantial equivalence of the Entuit ™ Thrive Balloon Retention Gastrostomy Feeding Tube to the legally marketed predicate device are: 1.) device description, 2.) indications for use, 3.) device comparison tables, 4.} material information, 5.) bench test results, and 6.) labeling. In particular, bench testing demonstrates that there was no difference in the performance, safety, or effectiveness between the Fintuit 11 Thrive Balloon Retention Gastrostomy Feeding Tube and the EndoVive " Standard Replacement Gastrostomy Tube.
The Entuit "M Thrive Balloon Relention Gastrostomy Feeding Tube is substantially equivalent to the EndoVive™ Standard Replacement Gastrostomy Tube (K083684).
The subject device and predicate device have the same intended use and similar indications. (echnological characteristics and principles of operation. The minor differences in technological characteristics have been identified and do not present any new issues of safety or effectiveness. Thus, the Entuit ™ Thrive Balloon Retention Gastrostomy Feeding Tube is substantially equivalent to the Endo Vive " Standard Replacement Gastrostomy Tube (K083684).
Entuit 7M Thrive Balloon Retention Gastrostomy Feeding Tube Xeridiem 510(k) Application - K130611 Appendix B Page 3 of 3
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DEPARTMENT OF HEALTH & HUMAN SERVICES
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Public Health Service
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
December 19, 2013
Xeridiem Medical Devices . Michelle Lott RA/QA Director, RAC 4700 S. Overland Drive Tucson, AZ 85714
Re: K130611
Trade/Device Name: Entuit™ Thrive Balloon Retention Gastronomy Feeding Tube Regulation Number: 21 CFR& 876.5980 Regulation Name: Gastrointestinal tube and accessories Regulatory Class: II Product Code: KNT Dated: November 27, 2013 Received: November 29, 2013
Dear Michelle Lott,
. .
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 (reporting of
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Page 2 - Michelle Lott
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/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/ReportalProblem/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,
Glenn Bell-S
for
Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
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Image /page/5/Picture/0 description: The image shows the logo for Xeridiem Medical Devices. The logo consists of a circular symbol with arrows pointing inward, followed by the company name "xeridiem" in a bold font, with the words "MEDICAL DEVICES" underneath in a smaller font. Below the logo is the company's address, which is 4700 South Overland Drive, Tucson, Arizona 85714, along with their phone number 520-882-7794 and website www.xeridiem.com.
Indications for Use
510(k) Number (if known): K130611
Device Name: Entuit TM Thrive Balloon Retention Gastrostomy Feeding Tube
Indications For Use:
The Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube is intended to provide gastric access for enteral feeding; medication and decompression through an established gastrointestinal stoma tract.
The Entuit™ Thrive Balloon Retention Gastrostomy Feeding Tube is indicated for use in percutaneous placement of an enteral feeding tube in adult and pediatric patients that require enteral feeding, medication administration or decompression through an established gastrointestinal stoma tract.
Prescription Use AND/OR Over-The-Counter Use X = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = (21 CFR 801 Subpart C) (Part 21 CFR 801 Subpart D)
(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)
Glenn B. Bell -S
Page 1 of
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§ 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.