K Number
K192034
Device Name
HDX 100% Silicone 2-way Foley Catheter, 14Fr/10cc, HDX 100% Silicone 2-way Foley Catheter, 16Fr/5cc, HDX 100% Silicone 2-way Foley Catheter, 18Fr/10cc
Manufacturer
Date Cleared
2020-04-21

(266 days)

Product Code
Regulation Number
876.5130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Urological catheter is intended for drainary tract. Catheterization is accomplished by inserting the catheter through the urethra and into the bladder. Intended population is adults and pediatrics.
Device Description
The Subject Device is a single-use, 2-way Foley catheter that is constructed of medical grade silicone. It incorporates two (2) lumens, one for inflation/deflation of the other for drainage of the urinary tract. The balloon, at the distal end of the catheter, is inflated to the labeled fill volume and remains inflated via the incorporated two-way valve in the connector at the proximal end of the inflation lumen. The connector engages with slip/taper luer connection that is standard on syringes. With the balloon inflated, the catheter maintains position in the urinary tract for the duration of the clinical application. Prior to removal, the balloon is deflated via the 2-way valve connection. The drainage inlet is located distal to the catheter's balloon. The urinary bag is a standard non-interconnectable connector. The Subject Device is packaged inside a perforated plastic sleeve that is inserted into a sterile barrier pouch. Ten (10) units are packaged into a carton, which is the saleable unit. The Subject Device is terminally sterilized via Ethylene Oxide (EO). The Subject Device will be initially offered in 14. 16. 18Fr sizes. The entire length of the Subject Device is disposable. The Subject Device is not sold as a set, there are no accessories or components included.
More Information

Not Found

No
The device description details a standard mechanical urological catheter with no mention of software, algorithms, or any features indicative of AI/ML.

No
Explanation: This device is a catheter used for drainage, not for treating a disease or condition. Its purpose is to facilitate the flow of urine, which is a supportive function rather than a therapeutic one.

No

The device description clearly states its purpose is for drainage of the urinary tract, and it functions as a Foley catheter to maintain position in the urinary tract for the duration of clinical application. There is no mention of it being used to diagnose a medical condition or ailment.

No

The device description clearly details a physical, single-use Foley catheter made of silicone with lumens, a balloon, and connectors, indicating it is a hardware medical device, not software-only.

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

Here's why:

  • Intended Use: The intended use is for draining the urinary tract by inserting a catheter into the bladder. This is a therapeutic or diagnostic procedure performed directly on the patient's body, not an examination of specimens derived from the human body.
  • Device Description: The device is a physical catheter designed for insertion and drainage. It does not involve the analysis of biological samples (like urine, blood, etc.) outside of the body.
  • Lack of IVD Characteristics: The description does not mention any components or functions related to:
    • Reagents or kits for testing.
    • Analyzing biological specimens.
    • Providing information about a patient's health status based on in vitro analysis.

The device is clearly a medical device used for a clinical procedure, but it falls under the category of devices used in vivo (within the body) rather than in vitro (in glass/outside the body).

N/A

Intended Use / Indications for Use

Urological catheter is intended for drainary tract. Catheterization is accomplished by inserting the catheter through the urethra and into the bladder. Intended population is adults and pediatrics.

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

EZL

Device Description

The Subject Device is a single-use, 2-way Foley catheter that is constructed of medical grade silicone. It incorporates two (2) lumens, one for inflation/deflation of the other for drainage of the urinary tract. The balloon, at the distal end of the catheter, is inflated to the labeled fill volume and remains inflated via the incorporated two-way valve in the connector at the proximal end of the inflation lumen. The connector engages with slip/taper luer connection that is standard on syringes. With the balloon inflated, the catheter maintains position in the urinary tract for the duration of the clinical application. Prior to removal, the balloon is deflated via the 2-way valve connection. The drainage inlet is located distal to the catheter's balloon. The urinary bag is a standard non-interconnectable connector. The Subject Device is packaged inside a perforated plastic sleeve that is inserted into a sterile barrier pouch. Ten (10) units are packaged into a carton, which is the saleable unit. The Subject Device is terminally sterilized via Ethylene Oxide (EO). The Subject Device will be initially offered in 14. 16. 18Fr sizes. The entire length of the Subject Device is disposable. The Subject Device is not sold as a set, there are no accessories or components included.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

urinary tract, urethra, bladder

Indicated Patient Age Range

adults and pediatrics

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)

The test program was performed in accordance to FDA guidance and recognized performance states, which includes the following:

  • Biocompatibility
  • Sterilization
  • Packaging Integrity (i.e., Sterile Barrier)
  • Transportation
  • Performance/Functionality
    Successful results were achieved with all evaluations 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.

K984084

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

§ 876.5130 Urological catheter and accessories.

(a)
Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract. This generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coudé catheters, balloon retention type catheters, straight catheters, upper urinary tract catheters, double lumen female urethrographic catheters, disposable ureteral catheters, male urethrographic catheters, and urological catheter accessories including ureteral catheter stylets, ureteral catheter adapters, ureteral catheter holders, ureteral catheter stylets, ureteral catheterization trays, and the gastro-urological irrigation tray (for urological use).(b)
Classification. (1) Class II (performance standards).(2) Class I for the ureteral stylet (guidewire), stylet for gastrourological catheter, ureteral catheter adapter, ureteral catheter connector, and ureteral catheter holder. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health and Human Services seal on the left and the FDA acronym along with the full name of the agency on the right. The FDA part of the logo is in blue, with the acronym in a solid blue square and the agency's name in a lighter shade of blue.

April 21, 2020

Pathway, LLC Aaron Rogers Director of Regulatory and Quality 8779 Cottonwood Avenue, Suite 105 Santee, CA 92071

Re: K192034 Trade/Device Name: HDX 100% Silicone 2-way Foley Catheter, 14Fr/10cc HDX 100% Silicone 2-way Foley Catheter, 16Fr/5cc HDX 100% Silicone 2-way Foley Catheter, 18Fr/10cc Regulation Number: 21 CFR 876.5130 Regulation Name: Urological catheter and accessories Regulatory Class: II Product Code: EZL Dated: March 19, 2020 Received: March 23, 2020

Dear Aaron Rogers:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

(21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safetyreporting-combination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-devices/medical-device-safety/medical-devicereporting-mdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Purva Pandya Acting Assistant Director DHT3B: Division of Reproductive, Gynecology and Urology Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K192034

Device Name

HYDROPHILIX 100% Silicone 2-Way Foley Catheter, 14Fr/10cc HYDROPHILIX 100% Silicone 2-Way Foley Catheter, 16Fr/5cc HYDROPHILIX 100% Silicone 2-Way Foley Catheter, 18Fr/10cc

Indications for Use (Describe)

Urological catheter is intended for drainary tract. Catheterization is accomplished by inserting the catheter through the urethra and into the bladder. Intended population is adults and pediatrics.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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K192034 page 1 of 3

Image /page/3/Picture/1 description: The image contains the logo for Hydrophilix. On the left is a blue hexagon shape with a circular design in the middle. To the right of the shape is the company name, HYDROPHILIX, in blue font.

Image /page/3/Picture/2 description: The image shows the word "pathway" in lowercase letters, with a stylized logo to the right of the word. The logo consists of two curved shapes, one above the other, forming a diamond-like shape. The text and logo are in a gray color. The image appears to be a logo or branding element.

510(K) SUMMARY - K192034

Submitter Information

Company Name:Hydrophilix, Inc.
Company Address:12100 Wilshire Blvd
Suite 800
Los Angeles, CA 90025
Contact Person:Aaron Rogers
Pathway, LLC.
Director of Regulatory & Quality
(619) 415-0103
arogers@pathwaynpi.com
Date:April 21, 2020
Device Identification
Device Trade Name:HYDROPHILIX 100% Silicone 2-Way Foley
Catheter, 14Fr/10cc
HYDROPHILIX 100% Silicone 2-Way Foley
Catheter, 16Fr/5cc
HYDROPHILIX 100% Silicone 2-Way Foley
Catheter, 18Fr/10cc
Common Name:Foley Catheter
Classification Name:Urological catheter and accessories
Classification Number:876.5130
Regulatory Class:Class II
Product Code(s):EZL
Product Code Name:Catheter, Retention Type, Balloon
Advisory Panel:Gastroenterology/Urology

Identification of Predicate Device

Predicate Device
Device NameRegulation No.Product Code510(K) NumberClearance Date
Bardex Lubi-Sil Foley Catheter876.5130 - Urological catheter and accessoriesEZLK984084February 1, 1999

Device Description

The Subject Device is a single-use, 2-way Foley catheter that is constructed of medical grade silicone. It incorporates two (2) lumens, one for inflation/deflation of the other for drainage of the urinary tract.

4

The balloon, at the distal end of the catheter, is inflated to the labeled fill volume and remains inflated via the incorporated two-way valve in the connector at the proximal end of the inflation lumen. The connector engages with slip/taper luer connection that is standard on syringes. With the balloon inflated, the catheter maintains position in the urinary tract for the duration of the clinical application. Prior to removal, the balloon is deflated via the 2-way valve connection.

The drainage inlet is located distal to the catheter's balloon. The urinary bag is a standard non-interconnectable connector.

The Subiect Device is packaged inside a perforated plastic sleeve that is inserted into a sterile barrier pouch. Ten (10) units are packaged into a carton, which is the saleable unit. The Subject Device is terminally sterilized via Ethylene Oxide (EO).

The Subject Device will be initially offered in 14. 16. 18Fr sizes. The entire length of the Subject Device is disposable. The Subject Device is not sold as a set, there are no accessories or components included.

Indications for Use

Urological catheter intended for drainage of the urinary tract. Catheterization is accomplished by inserting the catheter through the urethra and into the bladder. Intended population is adults and pediatrics.

Comparison Table - Subject and Predicate Devices
Comparison
FeatureSubject DevicePredicate Device
Indications for UseUrological catheter intended for drainage of
the urinary tract. Catheterization is
accomplished through the urinary tract.
Intended population is adults and pediatrics.Used in the drainage and/or collection
and/or measurement of urine. Generally,
drainage is accomplished by inserting the
catheter through the urethra and into the
bladder. However, drainage is sometimes
accomplished by suprapubic or other
placement of the catheter, such as a
nephrostomy tract.
Type2-way with inflation and drainage lumens2-way with inflation and drainage lumens
Size/Balloon Size14Fr/10cc8, 10Fr/3cc Balloon
16Fr/5cc12-24Fr, even sizes/5cc Balloon
18Fr/10cc16-24Fr, even sizes/30cc Balloon
MaterialSilicone, Medical GradeSilicone, High Grade
Performance
StandardASTM F623ASTM F623
Single-Use?YesYes
Prescription Use?YesYes
Sterile?YesYes

Comparison of Technological Characteristics with Predicate Device

Summary of Evaluations Performed

The test program was performed in accordance to FDA guidance and recognized performance states, which includes the following:

  • Biocompatibility
  • Sterilization
  • Packaging Integrity (i.e., Sterile Barrier) ●

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K192034 page 3 of 3

  • Transportation .
  • Performance/Functionality .

Successful results were achieved with all evaluations conducted.

Conclusion

The Subject Device has demonstrated it is substantially equivalent to the commercially available predicate.