K Number
K170105
Device Name
Jac-Cell Medic testers
Manufacturer
Date Cleared
2017-02-28

(47 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The ATI-014A insulation and continuity testing system is a non-destructive, non-patient contacting, voltage insulation tester designed to test the insulation of electrosurgical instruments. The ATI-021 has the same indications for use for insulation testing, but does not include continuity testing.
Device Description
The tester is a non-sterile multiple use handheld device operated by 9V battery. An embedded software (firmware) is used to program a microcontroller hardware platform, that interface the user's actions with visual and audible output signals. The tester is used pre-operating room by nurses in hospitals, for the purpose of verifying the insulation (for ATI-021 and ATI-014A) and continuity (for ATI-014A) of electrosurgical instruments. The tester is tested for functionality prior to each use.
More Information

Not Found

No
The description mentions embedded software and a microcontroller, but there is no mention of AI, ML, or related concepts like training or test sets. The performance studies focus on equivalence to a predicate device based on testing principles and output signals, not on learning or adaptive capabilities.

No
The device is a tester used to verify the insulation and continuity of electrosurgical instruments, not to treat a patient.

No

The device is designed to test the insulation and continuity of electrosurgical instruments, not to diagnose a medical condition in a patient.

No

The device description explicitly states it is a "handheld device operated by 9V battery" with "microcontroller hardware platform," indicating it is a physical hardware device with embedded software (firmware), not a software-only device.

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

Here's why:

  • Intended Use: The device is designed to test the insulation and continuity of electrosurgical instruments. This is a quality control or functional test of a medical device, not a test performed on a biological sample (like blood, urine, or tissue) to diagnose a disease or condition.
  • Device Description: The description clearly states it's a "non-patient contacting, voltage insulation tester." IVD devices are used to analyze samples taken from a patient.
  • Lack of Biological Sample Analysis: There is no mention of the device interacting with or analyzing any biological samples.

IVD devices are specifically designed to perform tests in vitro (outside the body) on biological specimens to provide information for the diagnosis, monitoring, or treatment of diseases or conditions. This device's function falls outside of that scope.

N/A

Intended Use / Indications for Use

The ATI-014A insulation and continuity testing system is a non-destructive, non-patient contacting, voltage insulation tester designed to test the insulation of electrosurgical instruments. The ATI-021 has the same indications for use for insulation testing, but does not include continuity testing.

Product codes

GEI

Device Description

The tester is a non-sterile multiple use handheld device operated by 9V battery. An embedded software (firmware) is used to program a microcontroller hardware platform, that interface the user's actions with visual and audible output signals.

The tester is used pre-operating room by nurses in hospitals, for the purpose of verifying the insulation (for ATI-021 and ATI-014A) and continuity (for ATI-014A) of electrosurgical instruments.

The tester is tested for functionality prior to each use, and is made out of the following components:

ComponentATI-021ATI-014A
Foot pedalyesyes
End connector boxnoyes
Cable Male-Female (2)yesno
Adaptor Male-Malenoyes
Adaptor Male- Alligator (1)yesno
Adaptor Male- Alligator (2)noyes
Test plateyesno
Brush test electrodeyesyes
Hook test electrodenoyes
Caring plastic case with foamyesyes

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

Pre-operation nurses in Hospitals

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

Non clinical tests: Bench testing confirms same performance to predicate device(s). The bench tests of subject tester (ATI-014A) confirm it is substantially equivalent with the predicate one (ATI-014), from the point of view of testing principles (using the high voltage), input commands, output voltage level used for test, output signals and electrical resistance measurement for cables (i.e., both functions of insulation and electrical continuity testing). The bench tests of subject tester (ATI-021) confirm that he is substantially equivalent with the predicate one (ATI-014), from the point of view of testing principles (using the high voltage), input commands, output voltage level used for test and output signals for the function of insulation testing.

Clinical tests: Not applicable.

Conclusions: Jac-Cell Medic testers perform as designed, in accordance with requirements. It is as safe and effective as the predicate device(s).

Key Metrics

Not Found

Predicate Device(s)

K020334

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4400 Electrosurgical cutting and coagulation device and accessories.

(a)
Identification. An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.(b)
Classification. Class II.

0

Image /page/0/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, stacked on top of each other.

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

February 28, 2017

JAC-CELL MEDIC % Mr. Jay Mansour Mansour Consulting LLC 845 Aronson Lake Court Roswell, Georgia 30075

Re: K170105

Trade/Device Name: Jac-Cell Medic testers Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: Class II Product Code: GEI Dated: December 22, 2016 Received: January 12, 2017

Dear Mr. Mansour:

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 of medical device

1

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.

Jennifer R. Stevenson -S

For Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K170105

Device Name JAC-CELL MEDIC TESTERS

Indications for Use (Describe)

The ATI-014A insulation and continuity testing system is a non-destructive, non-patient contacting, voltage insulation tester designed to test the insulation of electrosurgical instruments.

The ATI-021 has the same indications for use for insulation testing, but does not include continuity testing.

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.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

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

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"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."

3

K170105

510k Summary

As required by 21 CFR 807.92 (c)

1- Date summary prepared: February 27, 2017

Owner/Submitter/Sponsor/Applicant information: 2-

JAC-CELL MEDIC 5764 Pare Street Tmr Mont - Royal Quebec, CANADA H4P 2M2

  • 3- Device information:
    Common/usual/classification name: Insulation tester & Insulation and continuity tester

Device name: Jac-Cell Medic testers

FDA 3 letter codeGEI
FDA regulation number: 21 CFR878.4400
Regulation medical specialtyGeneral & Plastic Surgery
Review panelGeneral & Plastic Surgery
Class2
  • 4- Substantial equivalency is claimed against the following predicate device(s):
510k numberTrade or Proprietary or Model NameManufacturer
K020334Insulation and continuity tester (ATI-014)Jac-Cell Medic

5- Description of the device:

Device model nameModel number
1Insulation tester1ATI-021
2Insulation and continuity tester2ATI-014A

The tester is a non-sterile multiple use handheld device operated by 9V battery. An embedded software (firmware) is used to program a microcontroller hardware platform, that interface the user's actions with visual and audible output signals.

The tester is used pre-operating room by nurses in hospitals, for the purpose of verifying the insulation (for ATI-021 and ATI-014A) and continuity (for ATI-014A) of electrosurgical instruments.

The tester is tested for functionality prior to each use, and is made out of the following components:

4

K170105

ComponentATI-021ATI-014A
Foot pedalyesyes
End connector boxnoyes
Cable Male-Female (2)yesno
Adaptor Male-Malenoyes
Adaptor Male- Alligator (1)yesno
Adaptor Male- Alligator (2)noyes
Test plateyesno
Brush test electrodeyesyes
Hook test electrodenoyes
Caring plastic case with foamyesyes

6-Intended use + indications for use

The ATI-014A insulation and continuity testing system is a non-destructive, non-patient contacting, voltage insulation tester designed to test the insulation of electrosurgical instruments. The ATI-021 has the same indications for use for insulation testing, but does not include continuity testing.

  • 7-Basis for a determination of substantial equivalency:
    • (a) Indications for use: The indication for use of ATI-014A and predicate ATI-014 are identical. The indication for use of ATI-021 is covered by indications for use of predicate device ATI-014.
    • (b) Technological characteristics: The technological characteristics are the same as the predicate device(s), as tabulated below:
DevicePredicate DeviceATI-014AATI-021
Category/ParameterSpecific Element of comparisonATI-014
Indications for UseIdenticalInsulation/Continuity
TestingInsulation/Continuity
TestingInsulation Testing
Target populationIdenticalPre-operation nurses
in HospitalsPre-operation nurses
in HospitalsPre-operation nurses in
Hospitals
DesignationIdenticalTester and
AccessoriesTester and
AccessoriesTester and Accessories
Material/Flammability
ratingEnclosureABS Plastic/UL94-
HBABS Plastic/UL94-
V0 (flame retardant)ABS Plastic / UL94-HB
BiocompatibilityNot Required, Non-
Patient ContactNot Required, Non-
Patient ContactNot Required, Non-Patient
Contact
Energy UsedBattery PoweredYesYesYes
Rechargeable BatteryNoNoNo
Level9V9V9V
Average current consumption30mA20mA20mA
Battery life (continous test)30 hrs.41 hrs.41 hrs.
ProtectionShortcircuitShortcircuitShortcircuit
Battery level discharge warningat 7Vat 7Vat 6.75V
Energy Delivered1.5nF Capacitor dischargenot available5.88 mJoules5.88 mJoules
PerformanceVoltage Insulation
and Electrical
Continuity TesterVoltage Insulation
and Electrical
Continuity TesterVoltage Insulation Tester
Insulation testing sectionK170105
Working principle: High Voltage (HV)
electrical discharge in area were insulation
is brokenYesYesYes
High Level (for surface insulation testing)
HV Output2800 V2800 V2800 V
Tolerance+/-2.5%+/-2.5%+/-2.5%
Low Level (for inside cable insulation
testing) HV Output1500V1500Vnot applicable
Tolerance+/-2.5%+/-2.5%not applicable
Electrical continuity section
Working principle: Electrical resistance
measuringYesYesnot applicable
Continuity testing level10 Ohms10 Ohmsnot applicable
Tolerance+/-20%+/-10%not applicable
Shortcircuit testing level150 Kohms150 Kohmsnot applicable
Tolerance+/-20%+/-10%not applicable
Compatibility with
Environment and other
devicesNon-RoHSRoHSRoHS
UsagePre-operating RoomPre-operating RoomPre-operating Room
Standard metBasic safety and
Essential performanceIEC60601-1:1988ES60601-
1:2005/(R02012 and
A1:2012ES60601-1:2005/(R02012
and A1:2012
EMC/EMI ConformityEN60601-1-2:2001IEC60601-1-2:2007
FCC Part 15-
Subpart BIEC60601-1-2:2007
FCC Part 15-Subpart B
ICES-003ICES-003
Risk AnalysisISO 14971:2007ISO 14971:2007
Sterilitynot applicablenot applicablenot applicable
Technical InformationManufacturing TechnologyDiscrete
ComponentsSurface MountSurface Mount
Microcontroller embeded systemn/aYesYes
Hand Held deviceYesYesYes
Enclosure Model1593-YGY1553TT Bat1553D Batt
Dimensions5.5"x2.6"x1"6.5"x3.2"x1.4"6"x3.5"x1.2"
Weight0.55 Lbs0.57 Lbs0.51 Lbs
Tilt StandYesYesYes
Output Visual Signals
"Pass" for insulation testingGreen Light/LedGreen Light/LedGreen Light/Led
"Fault" for insulation testingRed Light/LedRed Light/LedRed Light/Led
"Good" for electrical resistance testingGreen Light/LedGreen Light/Lednot applicable
"Fault" for electrical resistance testingRed Light/LedRed Light/Lednot applicable
"Battery Level" warningRed Light/LedOrange Light/LedOrange Light/Led
Output Audible Signals
On "Fault" detectionYesYesYes

5

Tab 6 | Page 3 of 4

6

K170105

  • (c) Non clinical tests- brief discussion:
    Bench testing confirms same performance to predicate device(s).

The bench tests of subject tester (ATI-014A) confirm it is substantially equivalent with the predicate one (ATI-014), from the point of view of testing principles (using the high voltage), input commands, output voltage level used for test, output signals and electrical resistance measurement for cables (i.e., both functions of insulation and electrical continuity testing).

The bench tests of subject tester (ATI-021) confirm that he is substantially equivalent with the predicate one (ATI-014), from the point of view of testing principles (using the high voltage), input commands, output voltage level used for test and output signals for the function of insulation testing.

  • (d) Clinical tests- brief discussion:
    Not applicable.

  • (e) Non clinical and clinical tests- conclusions drawn demonstrating that the device is as safe and as effective, and performs as well as or better than the predicate device(s):
    Jac-Cell Medic testers perform as designed, in accordance with requirements. It is as safe and effective as the predicate device(s).