K Number
K140673
Device Name
INSERTION TOOL
Date Cleared
2014-04-16

(29 days)

Product Code
Regulation Number
870.1330
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Insertion Tool is used to facilitate the introduction of a guidewire during general intravascular procedures.
Device Description
The Insertion Tool is a sterile accessory device indicated to facilitate the introduction of a guidewire into the lumen of a guiding catheter, without damage to the guidewire's distal tip. It is designed to accommodate guidewires with diameters from 0.010" to 0.018" and is composed of a rigid funnel known as the hub which is attached to a stainless steel hypotube. The interior of the hub is designed to allow a guidewire with multiple bends at the distal tip to be directed easily into the smaller diameter stainless steel hypotube.
More Information

Not Found

No
The device description and performance studies focus on mechanical properties and compatibility, with no mention of AI/ML terms or functionalities.

No.
The device facilitates the introduction of a guidewire, which is a procedural aid, but the device itself does not directly treat or diagnose a disease or condition.

No

Explanation: The device, an Insertion Tool, is described as an accessory used to facilitate the introduction of a guidewire. Its function is mechanical (guiding and protecting the guidewire), not to diagnose a medical condition or disease.

No

The device description explicitly states it is a sterile accessory device composed of a rigid funnel (hub) and a stainless steel hypotube, indicating it is a physical hardware device.

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

Here's why:

  • Intended Use: The intended use is to "facilitate the introduction of a guidewire during general intravascular procedures." This describes a tool used in vivo (within the body) for a medical procedure, not a device used in vitro (outside the body) to examine specimens from the body for diagnostic purposes.
  • Device Description: The description details a physical tool designed to handle guidewires, which are used within blood vessels. It does not mention any components or functions related to analyzing biological samples.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological specimens (blood, urine, tissue, etc.)
    • Detecting or measuring substances in specimens
    • Providing diagnostic information about a patient's health status
    • Reagents, calibrators, or controls

The device is clearly a surgical accessory used to aid in a medical procedure performed on a patient.

N/A

Intended Use / Indications for Use

The Insertion Tool is used to facilitate the introduction of 0.010" through 0.018" guidewires into the lumen of a catheter without damage to the guidewire distal tip. It may also be used to introduce the guidewire through the manifold of an over-the-wire type balloon dilation catheter. This is accomplished by passing the metal tube portion of the Insertion Tool through the hemostatic seal of the Y-Adapter or catheter manifold and then using this channel to introduce the guidewire.
The Insertion Tool is used to facilitate the introduction of a guidewire during general intravascular procedures.

Product codes

DQX

Device Description

The Insertion Tool is a sterile accessory device indicated to facilitate the introduction of a guidewire into the lumen of a guiding catheter, without damage to the guidewire's distal tip.

It is designed to accommodate guidewires with diameters from 0.010" to 0.018" and is composed of a rigid funnel known as the hub which is attached to a stainless steel hypotube. The interior of the hub is designed to allow a guidewire with multiple bends at the distal tip to be directed easily into the smaller diameter stainless steel hypotube.

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

Design Verification and Design Validation Testing was performed to support a determination of substantial equivalence. The results of these tests provide reasonable assurance that the proposed modified device has been designed and tested to assure conformance to the requirements for its intended use. No new safety or performance issues were raised during the device testing.

The following Design Verification bench tests were completed:
ID Guidewire Compatibility (Hub to Shaft ID)
Hub Tensile Strength Test

The following Design Validation tests were completed:
Guidewire Insertion 0.018" Straight Tip
Guidewire Insertion 0.014" J-Tip
Guidewire Insertion Y-Adaptor Compatibility

Key Metrics

Not Found

Predicate Device(s)

K922410, K123214

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.1330 Catheter guide wire.

(a)
Identification. A catheter guide wire is a coiled wire that is designed to fit inside a percutaneous catheter for the purpose of directing the catheter through a blood vessel.(b)
Classification. Class II (special controls). The device, when it is a torque device that is manually operated, non-patient contacting, and intended to manipulate non-cerebral vascular guide wires, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

0

F

ాల

Insertion Tool

510(k) Summary

APR 1 6 2014

per 21 CFR §807.92

·

| Submitter's Address | Boston Scientific Corporation
One Scimed Place
Maple Grove, MN 55311 | | |
|---------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------|--------------|
| Contact Name and Information | Lisa Mee
Senior Regulatory Affairs Specialist
Phone: 763-494-1185
Fax: 763-494-2222
e-mail: lisa.mee@bsci.com | | |
| Date Prepared | 14 Mar 2014 | | |
| Proprietary Name | Insertion Tool | | |
| Common Name | Insertion Tool/Needle | | |
| Product Code | DQX - wire, guide, catheter | | |
| Classification | Class II, 21 CFR Part 870.1330 - Cardiovascular | | |
| Predicate Device(s) | SCIMED AVENUE TM Coronary Guidewire
Encore TM 26 Advantage Kit | K922410 | Jul 23, 1992 |
| | | K123214 | Nov 13, 2012 |
| Device Description | The Insertion Tool is a sterile accessory device indicated to facilitate the introduction of a guidewire into the lumen of a guiding catheter, without damage to the guidewire's distal tip.

It is designed to accommodate guidewires with diameters from 0.010" to 0.018" and is composed of a rigid funnel known as the hub which is attached to a stainless steel hypotube. The interior of the hub is designed to allow a guidewire with multiple bends at the distal tip to be directed easily into the smaller diameter stainless steel hypotube. | | |
| Intended Use | The Insertion Tool is used to facilitate the introduction of 0.010" through 0.018" guidewires into the lumen of a catheter without damage to the guidewire distal tip. It may also be used to introduce the guidewire through the manifold of an over-the-wire type balloon dilation catheter. This is accomplished by passing the metal tube portion of the Insertion Tool through the hemostatic seal of the Y-Adapter or catheter manifold and then using this channel to introduce the guidewire. | | |
| Indications for Use | The Insertion Tool is used to facilitate the introduction of a guidewire during general intravascular procedures. | | |
| Comparison of Technological Characteristics | The Insertion Tool incorporates substantially equivalent device materials, device configuration, packaging, fundamental technology, manufacturing processes, sterilization process and intended use as those featured in the Boston Scientific (previously known as SCIMED Life Systems, Inc.) predicate devices. | | |

1

Insertion Tool

Comparison to Predicate Devices.
CharacteristicProposed compared to Predicate
Mechanism of ActionSame Mechanism of Action
ComponentsSame components, configuration, design and function.
MaterialsSame device materials with exception of the hub colorant.
PackagingSame packaging materials with the exception of the change to the protective sheath material. Same packaging configuration.
Sterilization
Method/SALSame method and level of sterility assurance.
Device CompatibilitySame compatibility.
Device DimensionsMinor changes to dimensions.
BiocompatibilitySame biocompatibility.

Comparison to Predicate Devices:

Performance Data

Design Verification and Design Validation Testing was performed to support a determination of substantial equivalence. The results of these tests provide reasonable assurance that the proposed modified device has been designed and tested to assure conformance to the requirements for its intended use. No new safety or performance issues were raised during the device testing.

Therefore, these devices may be considered substantially equivalent to the predicate device.

The following Design Verification bench tests were completed:

ID Guidewire Compatibility (Hub to Shaft ID)

Hub Tensile Strength Test

The following Design Validation tests were completed: Guidewire Insertion 0.018" Straight Tip Guidewire Insertion Guidewire Insertion 0.014" J-Tip Guidewire Insertion Y-Adaptor Compatibility

Conclusion

Based on the indications for use, technological characteristics, safety and performance testing, the Insertion Tool has been shown to be appropriate for its intended use and is considered to be substantially equivalent to the AVENUE™ Coronary Guidewire as submitted in K922410 and the Encore™ 26 Advantage Kit as submitted in K123214.

2

Image /page/2/Picture/0 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized eagle with three stripes representing the department's mission of promoting health, well-being, and human services. The eagle is encircled by the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement.

DEPARTMENT OF HEALTH & HUMAN SERVICES

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

April 16, 2014

Boston Scientific Corporation c/o Lisa Mee Senior Regulatory Affairs Specialist One Scimed Place Maple Grove, MN 55311

Re: K140673

Trade/Device Name: Insertion Tool Regulation Number: 21 CFR 870.1330 Regulation Name: Insertion Tool Regulatory Class: Class II Product Code: DQX Dated: March 14, 2014 Received: March 18, 2014

Dear Ms. Mee:

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

3

Page 2 - Ms. Lisa Mee

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.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 Industry and Consumer Education 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,

Bram D. Zuckerman -S

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): _K140673

Device Name: Insertion Tool

Indications for Use:

The Insertion Tool is used to facilitate the introduction of a guidewire during general intravascular procedures.

Prescription Use × (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)

Bram D. Zuckerman -2014.04.16 21:10:06 -04'00'

Attachment 2