K Number
K161413
Device Name
Low Profile Balloon Feeding Device
Date Cleared
2017-02-09

(262 days)

Product Code
Regulation Number
876.5980
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Low Profile Balloon Feeding Device is indicated for use in patients who require long term feeding, are unable to tolerate oral feeding, who are at low risk for aspiration, require gastric decompression and/or medication delivered directly into the stomach through a secured (initial placement) or formed (replacement) stoma. The Low Profile Balloon Feeding Device is intended for all age groups.
Device Description
The Low Profile Balloon Feeding Device is used to provide nutrition, medication, and decompression access into the stomach through a secured (initial placement) or formed (replacement) stoma. The Low Profile Balloon Feeding Device consists of an external bolster, feeding catheter, and internal retention balloon, similar to the predicate devices. The feeding catheter is inserted into the stomach through a stoma and is held in place with an internal retention balloon. The device can have an MR Conditional balloon fill-valve or will be MR Safe when assembled with the Invisi-Valve. The devices are provided in a number of sizes to accommodate different stoma diameters and lengths and can have either a blunt or tapered tip balloon. The catheter tubes range in diameter from 10Fr to 24Fr, which is the same as the primary predicate. The stoma lengths are available in a wider range of options, from 0.5cm to 10.0 cm.
More Information

No
The summary describes a mechanical feeding device and its physical characteristics and performance testing, with no mention of AI or ML.

No
The device provides access for nutrition and medication but does not directly treat a disease or condition itself.

No

The device is described as a "Low Profile Balloon Feeding Device" used to provide nutrition, medication, and decompression access into the stomach. Its intended use focuses on feeding and medication delivery, not on identifying, monitoring, or treating a disease or condition.

No

The device description clearly outlines physical components such as an external bolster, feeding catheter, and internal retention balloon, which are hardware elements. The performance studies also focus on the physical properties and integrity of these components.

Based on the provided text, 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 Low Profile Balloon Feeding Device is a medical device used to deliver nutrition, medication, and provide decompression directly into the stomach through a stoma. It is a physical device inserted into the body, not a test performed on a sample outside the body.
  • Intended Use: The intended use clearly describes a method of feeding and medication delivery, not a diagnostic test.

Therefore, this device falls under the category of a medical device, specifically a feeding tube, rather than an in vitro diagnostic.

N/A

Intended Use / Indications for Use

The Low Profile Balloon Feeding Device is indicated for use in patients who require long term feeding, are unable to tolerate oral feeding, who are at low risk for aspiration, require gastric decompression and/or medication delivered directly into the stomach through a secured (initial placement) or formed (replacement) stoma. The Low Profile Balloon Feeding Device is intended for all age groups.

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

KNT

Device Description

The Low Profile Balloon Feeding Device is used to provide nutrition, medication, and decompression access into the stomach through a secured (initial placement) or formed (replacement) stoma.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

stomach

Indicated Patient Age Range

all age groups

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)

AMT conducted various performance tests on the components contained within the Low Profile Balloon Feeding Device. Testing found that all components and materials met or exceeded design specifications established by AMT. Bench tests have been carried out on samples of the Low Profile Balloon Feeding Device. The tests carried out included: Stoma Pullout Minimum Overmold Bond Strength Fill Valve Blow Out Fill Valve Pullout Fill Valve Cycle Test Balloon Assembly Bond Peel/Tear Strength Balloon Burst Assembled Balloon Size Interlock Pullout Leak Test Balloon Concentricity Ratio Tubing Tensile Testing Flow Rate Balloon Volume Maintenance Balloon Integrity Balloon Integrity in Simulated Gastric Fluid Testing

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.

K122653

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.

K043114, K945618

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

§ 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.

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Image /page/0/Picture/1 description: The image shows the logo for the Department of Health & Human Services (HHS). The logo features a stylized caduceus, which is a symbol often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the caduceus.

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

February 9, 2017

Applied Medical Technology, Inc. Michelle Scott Regulatory/QA Specialist 8006 Katherine Boulevard Brecksville, OH 44141

Re: K161413

Trade/Device Name: Low Profile Balloon Feeding Device Regulation Number: 21 CFR§ 876.5980 Regulation Name: Gastrointestinal Tube and Accessories Regulatory Class: II Product Code: KNT Dated: January 9, 2017 Received: January 10, 2017

Dear Michelle Scott:

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

1

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 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.

Benjamin R. Fisher -S

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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Indications for Use

510(k) Number (if known) K161413

Device Name Low Profile Balloon Feeding Device

Indications for Use (Describe)

The Low Profile Balloon Feeding Device is indicated for use in patients who require long term feeding, are unable to tolerate oral feeding, who are at low risk for aspiration, require gastric decompression and/or medication delivered directly into the stomach through a secured (initial placement) or formed (replacement) stoma. The Low Profile Balloon Feeding Device is intended for all age groups.

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)

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SECTION - 5

510(k) Summary

Low Profile Balloon Feeding Device


Date Prepared:February 8, 2017
Submitter:Applied Medical Technology, Inc.
8006 Katherine Boulevard
Brecksville, OH 44141
Phone: 440-717-4000
Fax: 440-717-4200
Contact Person: Michelle Scott - Regulatory/QA Specialist
Email: michelle.scott@appliedmedical.net
Device
Information:Trade/Device Name: Low Profile Balloon Feeding Device
Common Name: Gastrointestinal Feeding Tubes
Classification Name: Tubes, Gastrointestinal (And Accessories) (21 CFR 876.5980)
Product Code: KNT
Regulatory Class: II
Review Panel: Gastroenterology and Urology
Predicate
Device:Primary Predicate: Kimberly-Clark MIC-KEY SF Low Profile Gastrostomy (K122653)
Reference Device: Kimberly-Clark MIC-KEY Low Profile Gastrostomy Tube (K043114)
Reference Device: Low Profile Balloon Feeding Device (K945618)
Intended Use:The Low Profile Balloon Feeding Device is indicated for use in patients who
require long term feeding, are unable to tolerate oral feeding, who are at low risk
for aspiration, require gastric decompression and/or medication delivered
directly into the stomach through a secured (initial placement) or formed
(replacement) stoma. The Low Profile Balloon Feeding Device is intended for
all age groups.
Device
Description:The Low Profile Balloon Feeding Device is used to provide nutrition,
medication, and decompression access into the stomach through a secured
(initial placement) or formed (replacement) stoma.
Technological
Characteristics:The Low Profile Balloon Feeding Device consists of an external bolster, feeding
catheter, and internal retention balloon, similar to the predicate devices. The
feeding catheter is inserted into the stomach through a stoma and is held in place
with an internal retention balloon. The device can have an MR Conditional
balloon fill-valve or will be MR Safe when assembled with the Invisi-Valve.
The devices are provided in a number of sizes to accommodate different stoma
diameters and lengths and can have either a blunt or tapered tip balloon. The
catheter tubes range in diameter from 10Fr to 24Fr, which is the same as the
primary predicate. The stoma lengths are available in a wider range of options,
from 0.5cm to 10.0 cm.
Biocompatibility
Testing:The Low Profile Balloon Feeding Device has been tested for biocompatibility
based on the applicable sections of the following standards:
ISO 10993-1: 2009 Biological Evaluation of Medical Devices - Part 1:
Evaluation and testing within a risk management process ISO 10993-3: 2003 Biological Evaluation of Medical Devices - Part 3:
Tests for genotoxicity, carcinogenicity, and reproductive toxicity. ISO 10993-5: 2009 Biological Evaluation of Medical Devices - Part 5:
Tests for in vitro cytotoxicity. ISO 10993-6: 2007 Biological Evaluation of Medical Devices - Part 6:
Test for local effects after implantation. ISO 10993-7: 2008 Biological Evaluation of Medical Devices - Part 7:
Ethylene Oxide Sterilization Residuals. ISO 10993-10: 2010 Biological Evaluation of Medical Devices - Part
10: Tests for irritation and skin sensitization. ISO 10993-11:2006 Biological Evaluation of Medical Devices – Part
11: Tests for systemic toxicity ISO 10993-12:2007 Biological Evaluation of Medical Devices – Part
12: Sample preparation and reference materials An independent risk assessment was completed on the patient contacting
materials and it was determined that the Low Profile Balloon Feeding Device
met the acceptance criteria for permanent contact (greater than 30 days) with
mucosal membrane and breached/compromised surfaces.
Performance
Testing:AMT conducted various performance tests on the components contained within
the Low Profile Balloon Feeding Device. Testing found that all components and
materials met or exceeded design specifications established by AMT.
Bench tests have been carried out on samples of the Low Profile Balloon
Feeding Device. The tests carried out included:
Stoma Pullout Minimum Overmold Bond Strength Fill Valve Blow Out Fill Valve Pullout Fill Valve Cycle Test Balloon Assembly Bond Peel/Tear Strength Balloon Burst Assembled Balloon Size Interlock Pullout Leak Test
Balloon Concentricity Ratio Tubing Tensile Testing Flow Rate Balloon Volume Maintenance Balloon Integrity Balloon Integrity in Simulated Gastric Fluid Testing
Conclusion:The Low Profile Balloon Feeding Device is substantially equivalent to the predicate device cleared under K122653 in intended use, design, biocompatibility, performance, and principles of operation.

Applied Medical Technology, Inc. – 510(k) Submission Low Profile Balloon Feeding Device Section 5 – Page 5.1

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Applied Medical Technology, Inc. – 510(k) Submission Low Profile Balloon Feeding Device Section 5 – Page 5.2

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