K Number
K162129
Date Cleared
2016-08-31

(30 days)

Product Code
Regulation Number
878.4780
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The RENASYS-G Gauze Dressing Kits with Soft Port are intended to be used in conjunction with Smith & Nephew NPWT systems. Smith & Nephew NPWT systems are indicated for patients who would benefit from a suction device (negative pressure wound therapy) as it may promote wound healing via the removal of fluids, including irrigation and body fluids, wound exudates and infectious materials.

Appropriate wound types include:
Chronic
Acute
Traumatic
Sub-acute and dehisced wounds
Ulcers (such as pressure or diabetic)
Partial-thickness burns
Flaps and Grafts

Device Description

The RENASYS Gauze Wound Dressing Kit with Soft Port consists of the following components:

  • . Antimicrobial gauze wound filler
  • Soft Port assembly
  • Non-adherent wound contact layer ●
  • RENASYS Transparent film ●
  • . Saline bullet
  • . No Sting Skin Prep
  • . Wound ruler

The RENASYS-G Gauze kits are offered in four sizes: small, medium, large and extralarge. The components of the kit are individually packaged and sterilized and kitted in a non-sterile kit package. The kit is single use.

The Soft Port assembly attaches to an exudate canister to deliver negative pressure wound therapy to the wound. The qauze kits are designed specifically for use with the RENASYS negative pressure wound therapy devices and canisters.

AI/ML Overview

This document is a 510(k) summary for the RENASYS-G Gauze Dressing Kits with Soft Port. It describes the device, compares it to a predicate device, and outlines the non-clinical tests performed to demonstrate substantial equivalence.

Here's a breakdown of the requested information based on the provided text:

1. A table of acceptance criteria and the reported device performance

The document does not explicitly state quantitative acceptance criteria for the device's performance in terms of wound healing efficacy or similar outcomes. Instead, the study focuses on verifying the substantial equivalence of the modified device to its predicate. The "acceptance criteria" are implied by the successful completion of the verification tests, ensuring the modifications do not compromise the device's performance or safety.

Acceptance Criteria (Implied)Reported Device Performance
Maintenance of package seal integrity during transitTransit testing was conducted to assure the sterile barrier of the RENASYS Transparent Film remains intact in the flat configuration.
Individually packaged and sterilized components meet criteria for 24-month shelf lifeStability testing and simulated wound model testing on aged product has been conducted to assure acceptance criteria are met.
Device complies with applicable standards (e.g., ISO 10993 for biocompatibility)All components comply with ISO 10993. The device complies with listed standards (EN ISO 13485:2003, EN 1041:2008 +A1, ISO 15223-1:2012, EN ISO 14971:2012, EN ISO 10993-1:2009, EN 62366:2008).
Indications for Use are substantially equivalentSubstantially equivalent (to predicate device).
Materials are substantially equivalentSubstantially equivalent (to predicate device).
Soft Port Assembly is substantially equivalentSubstantially equivalent (to predicate device).
Sterilization method is identicalIdentical (to predicate device).

2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective)

The document does not explicitly state the sample sizes for the "transit testing" or "stability testing" or provide details on the data provenance (country of origin, retrospective/prospective). These are non-clinical (bench) tests, not typically subject to the same patient data collection requirements.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g., radiologist with 10 years of experience)

This information is not applicable. The tests performed are non-clinical bench tests (transit testing, stability testing), which do not involve expert interpretation or ground truth establishment in the way clinical studies with expert reviewers would.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set

This information is not applicable as there are no expert adjudications in these non-clinical bench tests.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

There was no MRMC comparative effectiveness study. This document describes the substantial equivalence of a medical device (wound dressing kit), not an AI-powered diagnostic tool.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

This information is not applicable. The device is a physical wound dressing kit, not an algorithm or AI system.

7. The type of ground truth used (expert concensus, pathology, outcomes data, etc)

For the non-clinical tests described:

  • Transit testing: The "ground truth" for package seal integrity would be based on validated physical testing methods and established criteria for package integrity.
  • Stability testing: The "ground truth" for shelf life and performance specifications would be based on validated laboratory testing methods to assess material degradation, sterilization maintenance, and functional performance over time.

8. The sample size for the training set

This information is not applicable. The tests performed are non-clinical bench tests for device modifications, not a machine learning model requiring a training set.

9. How the ground truth for the training set was established

This information is not applicable as there is no training set for an algorithm in this context.

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

August 31, 2016

Smith & Nephew, Inc. Ms. Laura Revnolds Director, Regulatory Affairs 970 Lake Carillon Drive, Suite 300 St. Petersburg, FL 33716

Re: K162129

Trade/Device Name: RENASYS-G Gauze Dressing Kits with Soft Port Regulation Number: 21 CFR 878.4780 Regulation Name: Powered suction pump Regulatory Class: Class II Product Code: OMP Dated: July 29, 2016 Received: August 1, 2016

Dear Ms. Reynolds:

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 device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

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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/Resourcesfor You/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,

David Krause -S

Binita S. Ashar, M.D., M.B.A., F.A.C.S. for Director Division of Surgical 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) K162129

Device Name RENASYS-G Gauze Dressing Kits with Soft Port

Indications for Use (Describe)

The RENASYS-G Gauze Dressing Kits with Soft Port are intended to be used in conjunction with Smith & Nephew NPWT systems. Smith & Nephew NPWT systems are indicated for patients who would benefit from a suction device (negative pressure wound therapy) as it may promote wound healing via the removal of fluids, including irrigation and body fluids, wound exudates and infectious materials.

Appropriate wound types include:

Chronic
Acute
Traumatic
Sub-acute and dehisced wounds
Ulcers (such as pressure ordiabetic)
Partial-thickness burns
Flaps and Grafts

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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Image /page/3/Picture/0 description: The image shows the Smith & Nephew logo. The logo consists of an orange flower-like symbol on the left, followed by the text "We are" in gray. To the right of that, the text "smith&nephew" is written in orange.

Wound Management

Smith & Nephew, Inc. 970 Lake Carillon Drive Suite 300 St. Petersburg, FL 33716

Customer Care Center: 1 800 876-1261 www.smith-nephew.com

510(k) SUMMARY

General Information

Submitter Name/ Address:Smith & Nephew, Inc.970 Lake Carillon DriveSuite 300St Petersburg, FL 33716
Establishment registration Number:3006760724
Contact Person:Laura ReynoldsDirector Regulatory Affairs
Phone Number:(727) 686-8736
Date Prepared:August 30, 2016

Device Description

Trade Name:RENASYS™-G GauzeDressing Kit with Soft Port
Common or Usual Name:Negative Pressure Wound TherapyPowered suction pump
Device Classification:Powered suction pump; 21 CFR 878.4780Class II
Product Code:OMP

Predicate Device Information

510(k)#DeviceClearance Date
K142979RENASYS EZ MAX NegativePressure Wound Therapy System andRENASYS Foam and Gauze NPWTWound Dressing Kits with Soft PortApr 29, 2015

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Device Description

RENASYS Gauze NPWT Wound Dressing Kit with Soft Port

The RENASYS Gauze Wound Dressing Kit with Soft Port consists of the following components:

  • . Antimicrobial gauze wound filler
  • Soft Port assembly
  • Non-adherent wound contact layer ●
  • RENASYS Transparent film ●
  • . Saline bullet
  • . No Sting Skin Prep
  • . Wound ruler

The RENASYS-G Gauze kits are offered in four sizes: small, medium, large and extralarge. The components of the kit are individually packaged and sterilized and kitted in a non-sterile kit package. The kit is single use.

The Soft Port assembly attaches to an exudate canister to deliver negative pressure wound therapy to the wound. The qauze kits are designed specifically for use with the RENASYS negative pressure wound therapy devices and canisters.

Indications for Use

The RENASYS-G Gauze Wound Dressing Kit with Soft Port is intended to be used in conjunction with Smith & Nephew NPWT systems. Smith & Nephew NPWT systems are indicated for patients who would benefit from a suction device (negative pressure wound therapy) as it may promote wound healing via the removal of fluids, including irrigation and body fluids, wound exudates and infectious materials. Appropriate wound types include: chronic, acute, traumatic, sub-acute and dehisced wounds, ulcers (such as pressure or diabetic), partial-thickness burns, flaps and grafts.

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Comparison between Subject and Predicate Devices

RENASYS-G Gauze Dressing Kit with Soft Port

Subject Device:Predicate Device:
510(k)# K142979
Trade Name:RENASYS-G GauzeDressing Kit with Soft PortRENASYS EZ MAX NPWTand RENASYS Foam andGauze Dressing Kits withSoft Port
Indications for Use:Substantially equivalentSubstantially equivalent
Materials:Substantially equivalentSubstantially equivalent
Soft Port Assembly:Substantially equivalentSubstantially equivalent
Single-use orReusable:Single-useSingle-use
Method ofSterilization:IdenticalIdentical
Biocompatibility:All components comply withISO 10993All components comply withISO 10993
Packaging:Individually packaged andsterilized components arekitted into Tyvek pouch.RENASYS Transparent Filmlies flat in slightly largerouter Tyvek pouch.Individually packaged andsterilized components arekitted into Tyvek pouch.RENASYS Transparent Filmis folded prior to placing inpouch.
Kit Shelf-life24 months9 months
Kit configurationIdenticalRENASYS G - GauzeDressing Kits with Soft Port,Small, Medium, Large, X-large
Product Codes:
Renasys-G GauzeDressing Kit withSoft Port-Small6602093366800933
RENASYS-GGauze Dressing Kitwith Soft Port-Medium6602093466800934
RENASYS-GGauze Dressing Kit
Subject Device:Predicate Device:
Trade Name:RENASYS-G GauzeDressing Kit with Soft Port510(k)# K142979RENASYS EZ MAX NPWTand RENASYS Foam andGauze Dressing Kits withSoft Port
with Soft Port-Large6602093566800935
RENASYS-GGauze Dressing Kitwith Soft Port-ExtraLarge6602093666800936

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Table of Modifications

ModificationReason For ChangeVerification TestingPerformed
The sterile RENASYSTransparent Film iscurrently folded prior tobeing placed in the outerpackaging of the kit. Themodification is to placethe transparent film flat,not folded, into the outerpackaging of the kit.This changenecessitates increasingthe size of the outerDuring routine transittesting, Smith & Nephewidentified breaches in theseal of the primarypackaging of theTransparent Filmspecifically in area of thepouch where it is folded.Transit testing wasconducted to assure thesterile barrier of theRENASYS TransparentFilm remains intact inthe flat configuration
Product codesreferenced in thepredicate 510(k)(K142979) have beenchangedThere have been nochanges to the kit contents,the product code changeswere due to internalbusiness decision.NA
Extend shelf life from 9months to 24 monthsShelf life extensionStability testing andsimulated wound modeltesting on aged producthas been conducted toassure acceptancecriteria are met.

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Non-Clinical Tests (Bench)

RENASYS-G Gauze Dressing Kit with Soft Port

Testing has been conducted to verify the modifications to the RENASYS-G Gauze Dressing Kits with Soft Port meet design specifications and demonstrate substantial equivalence to the predicate device.

  • Verification that the change of the configuration of the Renasys Transparent Film in the outer pouch maintains package seal integrity during transit.
  • Verification that individually packaged and sterilized components within the kit . meet criteria for 24 month shelf life, including meeting performance specifications.

Standards

The device complies with the following standards:

EN ISO 13485:2003 Quality Management Systems - Medical Devices - System requirements for regulatory purposes

EN 1041:2008 +A1 Information Supplied by Manufacturers with Medical Devices

ISO 15223-1:2012 Medical Devices – Symbols to be used with medical device labels, labeling and information to be supplied.

EN ISO 14971:2012 Medical Devices — Application of Risk Management to Medical Devices

EN ISO 10993-1:2009 Biological evaluation of medical devices-Evaluation and testing with a risk management process

EN 62366:2008: Medical devices - Application of usability engineering to medical devices

Conclusion

In establishing substantial equivalence to the currently marketed predicate device, Smith & Nephew, Inc. evaluated the indications for use, materials, technology and product specifications of the device. Verification testing has been successfully completed to demonstrate that the subject device RENASYS-G Gauze Dressing kits with Soft Port are substantially equivalent to the predicate device for the intended use.

§ 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.