K Number
K133232
Device Name
PREVENA INCISION MANAGEMENT SYSTEM WITH CUSTOMIZABLE DRESSING, PREVENA INCISION MANAGEMANT SYSTEM WITH PEEL& PLACE DRES
Date Cleared
2014-03-24

(154 days)

Product Code
Regulation Number
878.4780
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Prevena Incision Management System is intended to manage the environment of surgical incisions that continue to drain following sutured or stapled closure by maintaining a closed environment and removing exudate via the application of negative pressure wound therapy.
Device Description
Negative pressure wound therapy system for application to surgically closed incisions.
More Information

Not Found

No
The summary describes a negative pressure wound therapy system and does not mention any AI or ML components or functionalities.

Yes
The device is described as "intended to manage the environment of surgical incisions" and "removing exudate via the application of negative pressure wound therapy," which directly relates to treating a medical condition (surgical incisions with drainage).

No

Explanation: The device description and intended use clearly state that the Prevena Incision Management System is for managing the environment of surgical incisions by maintaining a closed environment and removing exudate via negative pressure wound therapy. This is a therapeutic function, not a diagnostic one (identifying or characterizing a disease or condition).

No

The device description explicitly states it is a "Negative pressure wound therapy system for application to surgically closed incisions," which implies hardware components are involved in applying negative pressure and managing exudate. The performance studies section also mentions a "systematic literature review of studies involving the Prevena Incision Management System," further suggesting a physical system, not just software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states that the system is for managing the environment of surgical incisions by applying negative pressure to remove exudate. This is a therapeutic and wound management function, not a diagnostic one.
  • Device Description: The description confirms it's a negative pressure wound therapy system applied to incisions.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples (like blood, urine, tissue, etc.) or providing diagnostic information about a patient's condition. IVDs are designed to provide information for diagnosis, monitoring, or screening.

The Prevena Incision Management System is a medical device used for wound therapy and management, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

The Prevena Incision Management System is intended to manage the environment of surgical incisions that continue to drain following sutured or stapled closure by maintaining a closed environment and removing exudate via the application of negative pressure wound therapy.

Product codes

OMP

Device Description

Negative pressure wound therapy system for application to surgically closed incisions.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

surgical incisions

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

KCI conducted a systematic literature review of studies involving the Prevena Incision Management System (Prevena Therapy), and is adding a bibliography of published studies to the labeling.

Summary of non-clinical tests conducted for determination of substantial equivalence: No non-clinical tests were necessary.

Summary of clinical tests conducted for determination of substantial equivalence or of clinical information: No clinical tests were necessary. A systematic literature review of published clinical studies was conducted.

Conclusions drawn: The Prevena Incision Management System and its predicate are substantially equivalent in terms of safety, function and indications for use. The safety and effectiveness of the Prevena Incision Management System is adequately supported by the substantial equivalent information and data provided in this Premarket Notification.

Key Metrics

Not Found

Predicate Device(s)

Prevena Incision Management System with Customizable Dressing (K123878), Prevena Incision Management System with Peel & Place Dressing (K100821)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4780 Powered suction pump.

(a)
Identification. A powered suction pump is a portable, AC-powered or compressed air-powered device intended to be used to remove infectious materials from wounds or fluids from a patient's airway or respiratory support system. The device may be used during surgery in the operating room or at the patient's bedside. The device may include a microbial filter.(b)
Classification. Class II.

0

K133232
page 1 of 2

510(k) SUMMARY Prevena Incision Management System

.


Submitter information [21 CFR 807.929(a)(1)]
NameKCI USA, Inc. (Kinetic Concepts, Inc.)
Address6203 Farinon Drive
San Antonio, TX 78249
Phone number210-255-6137
Fax number210-255-6727
Establishment
Registration
Number1625774
Name of contact
personBrian Young, VP Global Regulatory & Clinical Affairs
Date preparedMarch 21, 2014
Name of the device [21 CFR 807.92(a)(2)]
Trade or proprietary
name• Prevena Incision Management System with Peel & Place Dressing
• Prevena Incision Management System with Customizable Dressing
Common or usual
nameNegative Pressure Wound Therapy System
Classification nameNegative Pressure Wound Therapy Powered Suction Pump (and components)
Classification panelGeneral and Plastic Surgery
Regulation878.4780
Product Code(s)OMP
Legally marketed
device(s) to which
equivalence is
claimed
[21 CFR 807.92(a)(3)]Prevena Incision Management System with Customizable Dressing (K123878)
Prevena Incision Management System with Peel & Place Dressing (K100821)
Device description
[21 CFR 807.92(a)(4)]Negative pressure wound therapy system for application to surgically closed
incisions.
Indications for use
[21 CFR 807.92(a)(5)]The Prevena Incision Management System is intended to manage the
environment of surgical incisions that continue to drain following sutured or
stapled closure by maintaining a closed environment and removing exudate via
the application of negative pressure wound therapy.
Summary of the
technological
characteristics of the
device compared to
the predicate device
[21 CFR 807.92(a)(6)]There have been no technological changes to the predicate device for the
purpose of the proposed labeling change.
Dressing systems:Same as predicate: One composite dressing or multiple
dressing components
Therapy unit:Same as predicate: Software controlled pump for delivery
of negative pressure wound therapy and removal of
wound fluid

1

Performance Data [21 CFR 807.92(b)]

KCI conducted a systematic literature review of studies involving the Prevena Incision Management System (Prevena Therapy), and is adding a bibliography of published studies to the labeling.

Summary of non-clinical tests conducted for determination of substantial equivalence [21 CFR 807.92(b)(1)]

No non-clinical tests were necessary.

Summary of clinical tests conducted for determination of substantial equivalence or of clinical information [21 CFR 807.92(b)(2)]

No clinical tests were necessary. A systematic literature review of published clinical studies was conducted.

Conclusions drawn [21 CFR 807.92(b)(3)]

The Prevena Incision Management System and its predicate are substantially equivalent in terms of safety, function and indications for use. The safety and effectiveness of the Prevena Incision Management System is adequately supported by the substantial equivalent information and data provided in this Premarket Notification.

2

Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles an eagle or bird-like figure.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

March 24, 2014

Kinetic Concepts Incorporated Mr. Brian Young Vice President, Global Regulatory & Clinical Affairs 6203 Farinon Drive San Antonio, Texas 78249

Re: K133232/S003

Trade/Device Name: Prevena Incision Management System Regulation Number: 21 CFR 878.4780 Regulation Name: Powered suction pump Regulatory Class: Class II Product Code: OMP Dated: February 19, 2014 Received: February 21, 2014

Dear Mr. Young:

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 medical

3

Page 2 - Mr. Brian Young

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.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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,

David Krause -S

for

Binita S. Ashar, M.D., M.B.A., F.A.C.S. Acting Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

INDICATIONS FOR USE

510(k) Number (if known): _K133232 Device Name: Prevena Incision Management System Indications for Use:

The Prevena Incision Management System is intended to manage the environment of surgical incisions that continue to drain following sutured or stapled closure by maintaining a closed environment and removing exudate via the application of negative pressure wound therapy.

Over-The-Counter Use Prescription Use X AND/OR (Part 21 CFR 801 Subpart D) (21 CFR 801 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Jiyoung Dang -S

Page _1 of _1

(Posted November 13, 2003)

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