K Number
K140761
Device Name
KAHN UTERINE CANNULA, JARCHO UTERINE CANNULA, NEAL FALLOPIAN CANNULA
Date Cleared
2014-04-21

(26 days)

Product Code
Regulation Number
884.1300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Kahn Uterine Trigger Cannula, Jarcho Self-Retaining Uterine Cannula, and Neal Fallopian Cannula are indicated to test the patency (lack of obstruction) of the fallopian tubes by pressurizing the uterus and filling them with carbon dioxide gas.
Device Description
The V. Mueller® Uterine Cannula devices are constructed with a stopcock, finger ring control, an elongate shaft and a distal end with a rubber acorn.
More Information

V. Mueller Preamendment Uterine Cannulas

Not Found

No
The device description and performance studies focus on mechanical function and biocompatibility, with no mention of AI/ML or related concepts.

No
The device is used to test the patency (lack of obstruction) of fallopian tubes, which is a diagnostic function, not a therapeutic one. It assesses a condition rather than treating, curing, or preventing it.

Yes

Explanation: The device is used to "test the patency (lack of obstruction) of the fallopian tubes," which is a diagnostic purpose to determine a medical condition (obstruction).

No

The device description clearly states it is constructed with physical components like a stopcock, finger ring control, elongate shaft, and a distal end with a rubber acorn, indicating it is a hardware device.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The description clearly states that this device is used to pressurize the uterus and fill the fallopian tubes with carbon dioxide gas to test for patency. This is a procedure performed directly on the patient's body, not on a sample taken from the body.

Therefore, based on the provided information, this device is a surgical or procedural instrument used for a diagnostic procedure performed in vivo (within the living body), not an in vitro diagnostic test.

N/A

Intended Use / Indications for Use

The proposed devices are intended for use in obstetrical/gynecologic procedures wherein the device is connected to an insufflator on the proximal end. The distal end is inserted through the vagina into the cervix and the uterus and fallopian tubes are insufflated with Carbon Dioxide gas to check for patency.
The Kahn Uterine Trigger Cannula, Jarcho Self-Retaining Uterine Cannula, and Neal Fallopian Cannula are indicated to test the patency (lack of obstruction) of the fallopian tubes by pressurizing the uterus and fallopian tubes and filling them with carbon dioxide gas.

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

HES

Device Description

The V. Mueller® Uterine Cannula devices are constructed with a stopcock, finger ring control, an elongate shaft and a distal end with a rubber acorn.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

vagina, cervix, uterus, fallopian tubes

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-clinical tests were conducted. The performance test summary showed "PASS" for Biocompatibility (ISO 10993-1:2009 / AC 2010) and Functionality (Plating Thickness Analysis). No clinical tests were conducted.

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.

V. Mueller Preamendment Uterine Cannulas

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

§ 884.1300 Uterotubal carbon dioxide insufflator and accessories.

(a)
Identification. A uterotubal carbon dioxide insufflator and accessories is a device used to test the patency (lack of obstruction) of the fallopian tubes by pressurizing the uterus and fallopian tubes and filling them with carbon dioxide gas.(b)
Classification. Class II (performance standards).

0

Special 510(k) Premarket Notification: Uterine Cannulas

Image /page/0/Picture/2 description: The image contains the logo for CareFusion. The logo consists of a circular graphic on the left and the word "CareFusion" on the right. The circular graphic appears to be an abstract design, while the text is in a bold, sans-serif font.

APR 2 1 2014

510(k) SUMMARY

A summary of 510(k) safety and effectiveness information in accordance with 21 CFR 807.92.

SUBMITTER INFORMATION
NameCareFusion 2200 Inc
Address75 N. Fairway Dr.
Vernon Hills, IL 60061
Phone number(847) 362-8094
Fax number(312) 949-0272
Establishment
Registration Number1423507
Name of contact personJane Weber
Date prepared18-APR-2014
DEVICE INFORMATION
Trade or proprietary
nameV. Mueller Uterine Cannula
Common or usual nameUterine Cannula
Classification nameUterotubal carbon dioxide insufflator and accessories
Classification panel85 Obstetrics/Gynecology
RegulationClass II per 21CFR 884.1300, Product code HES
Product Code(s)GL2360, GL2375, GL2400
Legally marketed
device(s) to which
equivalence is claimedV. Mueller Preamendment Uterine Cannulas
Reason for 510(k)
submissionMaterial modification
Device descriptionThe V. Mueller® Uterine Cannula devices are constructed with a stopcock,
finger ring control, an elongate shaft and a distal end with a rubber acorn.
Intended use of the
deviceThe proposed devices are intended for use in obstetrical/gynecologic
procedures wherein the device is connected to an insufflator on the proximal
end. The distal end is inserted through the vagina into the cervix and the
uterus and fallopian tubes are insufflated with Carbon Dioxide gas to check for
patency.
Indications for useThe Kahn Uterine Trigger Cannula, Jarcho Self-Retaining Uterine Cannula,
and Neal Fallopian Cannula are indicated to test the patency (lack of
obstruction) of the fallopian tubes by pressurizing the uterus and fallopian
tubes and filling them with carbon dioxide gas.
CharacteristicPredicate Device
Preamendment Uterine CannulasNew Device
Type of DeviceReusableReusable
Intended for direct patient
contact?YesYes
Intended for extended
use? (more than 24 hrs)NoNo
Cleaning MethodManual and UltrasonicManual and Ultrasonic
Sterilization MethodProduct is sold non-sterile and
sterilized by the end user via the
following steam sterilization options:
• Gravity Displacement
• PrevacuumProduct is sold non-sterile and
sterilized by the end user via the
following steam sterilization options:
• Gravity Displacement
• Prevacuum
MaterialsStainless Steel
Black Silicone
Rubber
Flexible Tip Cannula: FEP (GL2360
only)
Stop cock component
• Brass
• NickelStainless Steel
Black Silicone
Rubber
Flexible Tip Cannula: FEP(GL2360
only)
Stop cock component
• Brass
• Nickel
• Chrome
PERFORMANCE DATA

1

Special 510(k) Premarket Notification: Uterine Cannulas

Image /page/1/Picture/2 description: The image shows the word "CareFusion" in a sans-serif font. To the left of the word is a circular logo with a stylized design. The logo appears to have three concentric shapes within the circle.

SUMMARY OF THE TECHNOLOGICAL CHARACTERISTICS OF THE DEVICE COMPARED TO THE PREDICATE DEVICE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUMMARY OF NON-CLINICAL TESTS CONDUCTED FOR DETERMINATION OF SUBSTANTIAL EQUIVALENCE

Performance Test Summary-New Device

CharacteristicStandard/Test/FDA GuidanceResults Summary
BiocompatibilityISO 10993-1:2009 / AC 2010PASS
FunctionalityPlating Thickness AnalysisPASS

SUMMARY OF CLINICAL TESTS CONDUCTED FOR DETERMINATION OF SUBSTANTIAL EQUIVALENCE AND/OR OF CLINICAL INFORMATION

N/A - No clinical tests were conducted for this submission.

CONCLUSIONS DRAWN FROM NON-CLINICAL AND CLINICAL DATA

The results of the non-clinical tests demonstrate the Uterine Cannulas meet all performance requirements, and are substantially equivalent to the predicate devices.

...

2

Image /page/2/Picture/0 description: The image shows the logo for the Department of Health & Human Services USA. The logo features a stylized eagle with three curved lines representing its wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is 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 20993-0002

April 21, 2014

CareFusion 2200, Inc. Jane Weber Regulatory Affairs Manager 75 N. Fairway Drive Vernon Hills, IL 60061

Re: K140761

Trade/Device Name: V. Mueller Uterine Cannula (Kalın Uterine Trigger Cannula, Jarcho Self-Retaining Uterine Cannula, and Neal Fallopian Cannula) Regulation Number: 21 CFR§ 884.1300 Regulation Name: Uterotubal carbon dioxide insufflator and accessories Regulatory Class: II Product Code: HES Dated: March 25, 2014 Received: March 26, 2014

Dear Jane Weber,

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.

3

Page 2 - Jane Weber

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 (OS) 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,

Herbert.

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

4

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page.

510(k) Number (if known) K140761

Device Name

V. Mueller Uterine Cannula (Kahn Uterine Trigger Cannula, Jarcho Cannula, and Neal Fallopian Cannula)

Indications for Use (Describe)

The Kahn Uterine Trigger Cannula, Jarcho Self-Retaining Uterine Cannula, and Neal Fallopian Cannula are indicated to test the patency (lack of obstruction) of the fallopian tubes by pressurizing the uterus and filling them with carbon dioxide gas.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON A SEPARATE PAGE IF NEEDED.

:・・・・ FOR FDA USE ONLY - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 : ਿਸ਼ਵੀਅਨ ਅਤੇ ਸਾਰੇ ਦੇ ਸਿੰਘ ਕੀ ਤੇ : - - - - - - - - -

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

Herbert P. Lerner 2014.04.21 14:5

FORM FDA 3881 (1/14)