K Number
K152251
Device Name
Endobronchial Tube
Date Cleared
2016-06-10

(305 days)

Product Code
Regulation Number
868.5740
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Endobronchial Tube is used to isolate the left or right lung of a patient for surgery, one lung ventilation or one lung anesthesia.
Device Description
The Endobronchial Tube is made of Polyvinylchloride and is available in sizes 26fr to 41fr. They are designated as double lumen tube with 2 cuffs and separate 15mm connectors for isolating and ventilating one lung during surgical procedures. The tubes contain an x-ray opaque line that runs through the tube making them detectable by x-ray. Environments of use: Hospital-OR and ICU
More Information

Not Found

No
The summary describes a physical medical device (Endobronchial Tube) and its performance testing, with no mention of AI or ML capabilities.

No
This device is a surgical tool used to isolate and ventilate a lung during medical procedures, rather than providing therapy for a medical condition.

No

The device is an Endobronchial Tube used for isolating and ventilating one lung during surgical procedures, which is a therapeutic rather than a diagnostic function.

No

The device description clearly states it is made of Polyvinylchloride and is a physical tube with cuffs and connectors, indicating it is a hardware device. The performance studies also focus on physical properties and biocompatibility.

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

Here's why:

  • Intended Use: The intended use is to isolate the left or right lung for surgery, ventilation, or anesthesia. This is a therapeutic or procedural use, not a diagnostic one.
  • Device Description: The description details a physical tube used for ventilation and isolation within the body. It does not describe a device used to examine specimens derived from the human body to provide information for diagnostic purposes.
  • Lack of Diagnostic Function: There is no mention of the device being used to analyze biological samples (blood, urine, tissue, etc.) or to provide diagnostic information about a patient's condition.
  • Performance Studies: The performance studies focus on the physical and functional characteristics of the tube (biocompatibility, cuff performance, air flow, etc.), which are relevant to its use as a medical device for ventilation and isolation, not for in vitro diagnostics.

In vitro diagnostics are devices used to perform tests on samples taken from the human body to detect diseases, conditions, or infections. This Endobronchial Tube is a medical device used directly on the patient for a procedural purpose.

N/A

Intended Use / Indications for Use

The Endobronchial Tube is used to isolate the left or right lung of a patient for surgery, one lung ventilation or one lung anesthesia.

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

CBI

Device Description

The Endobronchial Tube is made of Polyvinylchloride and is available in sizes 26fr to 41fr. They are designated as double lumen tube with 2 cuffs and separate 15mm connectors for isolating and ventilating one lung during surgical procedures. The tubes contain an x-ray opaque line that runs through the tube making them detectable by x-ray. Environments of use: Hospital-OR and ICU

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lung

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Hospital-OR and ICU

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 testing was performed and included standards such as ISO 5361 and ISO 10993-1. The Endobronchial Tube have been found to fall within the required limits of the testing. The test results can be found in both the Biocompatibility (Section16) and the Performance Testing_Bench (Section19) of this submission.
Biocompatibility testing included:

  • in vitro cytotoxicity: Test result showed no potential toxicity to L-929 cells.
  • Skin sensitization Test using Guinea Pig Maximization test: Test result showed no significant evidence of causing skin sensitization in guinea pig.
  • Oral Mucosa Irritation test: Test result showed no significant evidence of causing oral irritation in the hamster.
    Performance Testing (Bench tests):
  • cuff diameter: Pass
  • cuffed tube collapse test: Pass
  • Cuff herniation test: Pass
  • Seal testing: Pass
  • Sealing of cuff inflating system: Pass
  • Sealing of connector assembly: Pass
  • inflating tube: Pass
  • Kink resistance test: Pass
  • Gauging of One Way Valve: Pass
  • Liquid leakage of One Way Valve: Pass
  • Air leakage of One Way Valve: Pass
  • Separation force of One Way Valve: Pass
  • Stress cracking: Pass
  • Security of construction of suction catheter: Pass
  • Shaft resistant to negative pressure of suction catheter: Pass
  • 15mm connector: Pass
  • Burst Testing: Pass
  • Bond Strength: Pass
  • Air flow resistance: Pass
  • Radiopaque test: Pass
  • Endotoxin test: Pass
    Clinical and animal testing were not performed.

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.

K092886

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

Not Found

§ 868.5740 Tracheal/bronchial differential ventilation tube.

(a)
Identification. A tracheal/bronchial differential ventilation tube is a device used to isolate the left or the right lung of a patient for anesthesia or pulmonary function testing.(b)
Classification. Class II (performance standards).

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle-like symbol composed of three overlapping profiles facing right. The profiles are rendered in black and create a sense of depth. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the symbol.

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

June 10, 2016

Henan Tuoren Medical Device Co., Ltd C/O Long Yang COO Shenzhen Hlongmed Biotech Company R15-08, East Building, Yihai Plaza, Chuangye Road, Nanshan District, Shenzhen, Guangdong, 518054 China

Re: K152251 Trade/Device Name: Endobronchial Tube Models: Left: Fr26, Fr28, Fr31, Fr32, Fr33, Fr35, Fr37, Fr39, Fr41; Right: Fr26, Fr28, Fr31, Fr32, Fr33, Fr35, Fr37, Fr39, Fr41 Regulation Number: 21 CFR 868.5740 Regulation Name: Tracheal/Bronchial Differential Ventilation Tube Regulatory Class: Class II Product Code: CBI Dated: May 6, 2016 Received: May 12, 2016

Dear Long Yang:

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

1

Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated 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 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. 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 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.

Tejashri Purohit-Sheth, M.D.

Tejashri Purohit-Sheth, M.D. Clinical Deputy Director DAGRID/ODE/CDRH FOR

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K152251

Device Name

Endobronchial Tube

Models: Left: Fr26, Fr31, Fr32, Fr33, Fr35, Fr37, Fr39, Fr41; Right: Fr26, Fr28, Fr33, Fr33, Fr33, Fr37, Fr39, Fr41

Indications for Use (Describe)

The Endobronchial Tube is used to isolate the left or right lung of a patient for surgery, one lung ventilation or one lung anesthesia.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

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"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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TUOREN Henan Tuoren Medical Device Co., Ltd

510(k) Summary

(as required by 807.92(c))

The assigned 510(K) number is: K152251

Date of Summary: June 9, 2016

1. Submitter information

Manufacturer Name: Henan Tuoren Medical Device Co., Ltd

Address: Weiyuan Industrial Zone, Menggang ,Changyuan Country, Henan, China

Establishment Registration Number: 3006984712

Contact Person and Title: Meizi Zhang/Manager of Registration Department

Tel: 0086-13633736073

Fax: 0086-373-8605321

Email: 13633736073@163.com

2. Contact person

2.1 Primary Contact Person

Long Yang (COO) Shenzhen Hlongmed Biotech Company R1508, East Building, Yihai Plaza, Chuangye Road, Nanshan District,Shenzhen, P.R. China Tel: 0086-755-86664986 Fax: 0086-755-86664933 E-mail: yanglong@hlongmed.com

2.2 Secondary Contact Person

Meizi Zhang(Manager of Registration Department) Henan Tuoren Medical Device Co., Ltd Tel: 0086-13633736073

3. Device Classification

Device SponsorHenan Tuoren Medical Device Co., Ltd
------------------------------------------------------

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Trade/Device NameEndobronchial Tube
ModelLeft: Fr26, Fr28, Fr31, Fr32, Fr33, Fr35, Fr37, Fr39, Fr41
Right: Fr26, Fr28, Fr31, Fr32, Fr33, Fr35, Fr37, Fr39, Fr41
Common NameEndobronchial Double Lumen Tube
Classification NameTube, Tracheal/Bronchial, Differential Ventilation (W/Wo Connector)
Regulatory ClassClass II
Classification regulation21CFR 868.5740
Review PanelAnesthesiology
Regulation Medical SpecialtyAnesthesiology
Regulation NameTracheal/bronchial differential ventilation tube
Product CodeCBI

OREN Henan Tuoren Medical Device Co., Ltd

4. Intended Use/ Indications for Use

The Endobronchial Tube is used to isolate the left or right lung of a patient for surgery, one lung ventilation or one lung anesthesia.

5. Predicate Device

Well LEAD Endobronchial Tubes(K092886)

6. Device Description

The Endobronchial Tube is made of Polyvinylchloride and is available in sizes 26fr to 41fr. They are designated as double lumen tube with 2 cuffs and separate 15mm connectors for isolating and ventilating one lung during surgical procedures. The tubes contain an x-ray opaque line that runs through the tube making them detectable by x-ray. Environments of use: Hospital-OR and ICU

7. Substantial Equivalence

Henan Tuoren Medical Device Co., Ltd claims the proposed devices to be substantially equivalent to the devices previously cleared by FDA in K092886. Henan Tuoren Medical

5

TUOREN Henan Tuoren Medical Device Co., Ltd

Device Co.. Ltd claims this equivalence because the proposed devices have an equivalent intended use, manufacturing materials, operating principles and physical operational specifications as compared to the predicate devices. The similarities and differences between the proposed and predicate devices have been identified and explained in the comparison matrix, the comparison matrix can be referred to the below table. The differences between subject device and the predicate device is just the size and packaging, these differences do not effect substantial equivalence, the analysis and justification is: For the size differences, all models of proposed devices comply to the same standard ISO 5361 compared to predicate devices. For the packaging differences, the multi-functional joint of proposed device comply to the same standard ISO 5356-1 compared to predicate devices, and the suction catheters of proposed devices comply to the same standard ISO 8836 compared to predicate devices..

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ItemElement Of ComparisonProposed DevicePredicate DeviceS/D*
1Classification NameTube, Tracheal/Bronchial, Differential Ventilation
(W/Wo Connector)Tube, Tracheal/Bronchial, Differential Ventilation
(W/Wo Connector)S
2Regulatory ClassClass IIClass IIS
3Classification regulation21CFR 868.574021CFR 868.5740S
4Classification PanelAnesthesiologyAnesthesiologyS
5Product CodeCBICBIS
6Regulation NameTracheal/bronchial differential ventilation tubeTracheal/bronchial differential ventilation tubeS
7Indications
for
Use/Intended UseEndobronchial Tubes is used to isolate the left or the
right lung of a patient for surgery,one lung ventilation
or one lung anesthesia.The Well Lead Endobronchial Tubes is used to
isolate the left or the right lung of a patient for
surgery,one lung ventilation or one lung anesthesia.S
8Directions for UsePrescription UsePrescription UseS
9Patient PopulationPatients undergoing surgical procedure requiring
isolation of one lungPatients undergoing surgical procedure requiring
isolation of one lungS
10Patient contact MaterialTube-PVC and Cuff-PVCTube-PVC and Cuff-PVCS
11Size(Fr)26 to 41 French28 to 41 FrenchD, does not affect the
product performance
12Design FeaturesDouble lumen shaft, 2 cuffs, Stylet, Carlens adapterDouble lumen shaft, 2 cuffs, Stylet, Carlens adapterS
13Composition
of
Endobronchial Tubesmain tube, cuff, connector, inflating tube, valve, pilot
balloonmain tube, cuff, connector, inflating tube, valve,
pilot balloonS
14Angle of bevel70°70°S
15Radius of curvature140mm140mmS
ItemElement Of ComparisonProposed DevicePredicate DeviceS/D*
16Radiopaque lineYesYesS
17Connection to ventilation
source15mm connector15mm connectorS
18Shelf-life5 years5 yearsS
19Single Use
Single patient, disposableYesYesS
20Method of sterilizationEthylene Oxide Sterilized per ISO 11135Ethylene Oxide Sterilized per ISO 11135S
21The Sterility Assurance
LevelSAL 10-6SAL 10-6S
22EO and ECH residualThe ethylene oxide residual is conform to ISO
10993:7 for Limited Exposure Devices of 4mg/day
for EO and 9/mg/day for ECH.The ethylene oxide residual is conform to ISO
10993:7 for Limited Exposure Devices of 4mg/day
for EO and 9/mg/day for ECH.S
23Biocompatibility1.Cytotoxicity testing per 10993-5
  1. Sensitization testing per ISO 10993-10
    3.Irritation Test per ISO 10993-10
    All the test passed. | 1. Cytotoxicity testing per 10993-5
  2. Sensitization testing per ISO 10993-10
  3. Irritation Test per ISO 10993-10
    All the test passed. | S |
    | 24 | Applied Standards | ISO 5361
    ISO 10993-1
    ISO 10993-5
    ISO 10993-10
    ISO 11135
    ISO 10993-7 | ISO 5361
    ISO 10993-1
    ISO 10993-5
    ISO 10993-10
    ISO 11135
    ISO 10993-7 | S |
    | 25 | Packaging | Sterile, packed with a multi-functional joint and three
    Suction Catheters | Sterile, packed with switch connector and two
    suction catheters | D, does not affect the product performance |
    | 26 | Environments of use | Hospital-OR and ICU | Hospital-OR and ICU | S |

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TUORen Henan Tuoren Medical Device Co., Ltd

8. Product Performance Testing

All testing that is required by the required standards has been performed. Non-clinical testing was performed and included standards such as ISO 5361 and ISO 10993-1. The Endobronchial Tube have been found to fall within the required limits of the testing. The test results can be found in both the Biocompatibility (Section16) and the Performance Testing_Bench (Section19) of this submission. Therefore we have concluded that the Endobronchial Tube are substantially equivalent.

A brief summary of tests relied upon to demonstrate substantial equivalence to the predicate can be found in the table below:

Type of TestReferenced StandardTest result
in vitro cytotoxicityISO10993-5:2009Under the conditions of using ISO10993-5: 2009
test method MTT method MEM extract, the test
article Endobronchial Tube extract showed no
potential toxicity to L-929 cells.
Under the conditions of using ISO10993-5: 2009
test method MTT method MEM with 10% FBS
extract, the test article Endobronchial Tube extract
showed no potential toxicity to L-929 cells.
Skin sensitization
Test using Guinea
Pig Maximization
testISO10993-10:2010Under the conditions of using ISO10993-10: 2010
test methods guinea pig maximization test 0.9%
sodium chloride injection extract, the test article
Endobronchial Tube extract showed no significant
evidence of causing skin sensitization in the guinea
pig;
Under the conditions of using ISO10993-10:2010
test methods guinea pig maximization test sesame
oil extract, the test article Endobronchial Tube
extract showed no significant evidence of causing
skin sensitization in the guinea pig;

1) Biocompatibility testing

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Type of TestReferenced StandardTest result
Oral Mucosa
Irritation testISO10993-10:2010Under the conditions of using ISO10993-10:2010
test methods 0.9% sodium chloride extract, the test
result showed that the test article Endobronchial
Tube extract show no significant evidence of
causing oral irritation in the hamster.

Under the conditions of using ISO10993-10:2010
test methods sesame oil extract, the test result
showed that the test article Endobronchial Tube
extract show no significant evidence of causing
oral irritation in the hamster. |

TUOREN Henan Tuoren Medical Device Co., Ltd

2) Performance Testing

Type of Bench TestReference standardsAcceptable CriteriaPass/fail
cuff diameterISO 5361: 2012The maximum cuff diameter shall be within ± 0.5mm of the nominal value when tested according to ISO 5361 Annex BPass
cuffed tube collapse testISO 5361: 2012the steel ball shall pass freely through the tube when tested according to ISO 5361 Annex CPass
Cuff herniation testISO 5361: 2012no part of the inflated cuff shall reach beyond the nearest edge of the bevel when tested according to ISO 5361 Annex DPass
Seal testingISO 5361: 2012The leakage limit is ≤2.0ml/h at cuff pressures not to exceed 2,7 kPa (27 cmH2O) when tested according to ISO 5361 Annex GPass
/Sealing of cuff inflating system:
No air leakage happens under the condition of continuous 3kPa positive pressure imposition for 10 secondsPass
/Sealing of connector assembly:
No air leakage happens on any joints under the condition of continuous 6kPa gas pressure imposition to lumen of main tube(shaft) for 60 seconds.Pass
inflating tubeISO 5361: 2012The inflating tube shall have an outside diameter of not more than 3.0mmPass
ISO 5361: 2012The angle between the inflating tube and the Endobronchial tube at the point of separation shall not exceed 45°.Pass
Kink resistance testISO 5361: 2012the steel ball shall pass freely through the lumen of the tube when tested according to ISO 5361 Annex HPass
Gauging of One Way ValveISO 594/1 1986The plane of the maximum diameter at the opening of the female conical fitting of One Way Valve lie between the two limit planes of the gauge.Pass
Liquid leakage of One Way ValveISO 594/1 1986no leakage sufficient to form a falling drop of waterPass
Air leakage of One Way ValveISO 594/1 1986Continued formation of air bubbles not be evidentPass
Separation force of One Way ValveISO 594/1 1986The conical fitting under test remain attached to the test fixturePass
Stress crackingISO 594/1 1986There shall be no evidence of stress cracking of the conical fitting
Security of construction of suction catheterISO 8836-2007the force required to detach any component permanently attached to the shaft shall be not less than that specified in standardPass
Shaft resistant to negative pressure of suction catheterISO 8836-2007a vacuum source at 40kPa below ambient pressure for 15s at a temperature of 23°C ±2°C with the patient end occluded, the shaft shall not collapsePass
15mm connectorISO5356-1: 2004Comply with the ISO5356-1: 2004Pass
Burst Testing/Cuff burst: The volume of injected gas when cuff bursting happens is larger than 40ml during inflation of endobronchial tube
bursting between cuff and main tube:
There should be no fracture on junctions while inflated 30kpa gas.Pass
Bond Strength/The joints of endobronchial tube should be firm bonding.When an axial force of 50±5N is applied at 50±5mm/min, the testing portion(between connector andPass
Henan Tuoren Medical Device Co., Ltd
Air flow resistance/Pressure increment should no more than 0.2Kpa/h when testing the endobronchial tube under the specified flow rate(3, 6, 9L/min)Pass
Radiopaque test/When exposing the Endobronchial tube with the low dose rays, the X-ray machine should have film development.Pass
Endotoxin testUSP36_NF310.25EU/ml, 20EU/DevicePass

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TUORen Henan Tuoren Medical Device Co., Ltd

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TU●Ren Henan Tuoren Medical Device Co., Ltd

9. Clinical Testing and animal testing

Clinical and animal testing were not performed for Endobronchial Tube as part of the premarket Notification requirements for this 510(k) submission and the subject of this premarket submission, Endobronchial Tube, did not require clinical and animal studies to support substantial equivalence.

10. Substantial Equivalence Conclusion

The information provided in the 510(k) submission is sufficient to demonstrate the substantial equivalence of subject device to the predicate device.