K Number
K974568
Device Name
CHASE ANASTOMOSIS VISUALIZATION DEVICE
Date Cleared
1998-01-06

(32 days)

Product Code
Regulation Number
880.5475
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Chase Anastomosis Visualization Device is indicated for use during procedures wherein clearing of a wound or surgical site, for enhanced visibility, must be maintained by non-contact means.
Device Description
The Chase Anastomosis Visualization Device consists of a malleable wand, a 0.2 micron filter, and a sterile fluid inlet line. The overall length of the wand is approximately 10.125 inches in length. The stainless steel wire is completely embedded within the wall along its length for the purpose of maintaining a user chosen shape. The distal tip is designed to provide a fan-shaped irreigation mist pattern. The remaining proximal length of the wand is the regulated gas inlet which consists of a 0.2 micron medical grade in-line bacterial filter made of a hydrophobic membrane and a 1/4 inch tubing connecter. A 1/4 inch PVC tube which connects the in-line filter to the regulated gas source. A fluid inlet line extends from a point near the proximal end of the malleable section of the wand and terminates in a female luer-lock adaptor for conneciton to a standard fluid administration set which provides for flow control and on-off capacity
More Information

Not Found

Not Found

No
The device description focuses on mechanical components and fluid delivery, with no mention of AI/ML, image processing, or data analysis.

No
The device is described as a visualization tool to clear a surgical site for enhanced visibility, not to treat a disease or condition.

No.
The device description indicates it is used for clearing a surgical site for enhanced visibility by non-contact means, producing an irrigation mist. Its purpose is to facilitate visualization during a procedure, not to diagnose a condition.

No

The device description clearly outlines physical components such as a malleable wand, filter, and tubing, indicating it is a hardware 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 "clearing of a wound or surgical site, for enhanced visibility, must be maintained by non-contact means." This describes a device used during a surgical procedure to improve visualization of the surgical field.
  • Device Description: The description details a device that delivers a fluid mist to a surgical site. This is a physical intervention on the patient's body, not a test performed on a sample taken from the body.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) in vitro (outside the body) to provide information about a patient's health status, diagnose conditions, or monitor treatment. This device does none of those things.

The device is clearly intended for direct use on a patient during surgery to improve the surgeon's view, which is not the function of an IVD.

N/A

Intended Use / Indications for Use

The Chase Anastomosis Visualization Device is indicated for use during procedures wherein clearing of a wound or surgical site, for enhanced visibility, must be maintained by non-contact means.

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

FMQ

Device Description

The Chase Anastomosis Visualization Device consists of a malleable wand, a 0.2 micron filter, and a sterile fluid inlet line. The overall length of the wand is approximately 10.125 inches in length. The stainless steel wire is completely embedded within the wall along its length for the purpose of maintaining a user chosen shape. The distal tip is designed to provide a fan-shaped irreigation mist pattern. The remaining proximal length of the wand is the regulated gas inlet which consists of a 0.2 micron medical grade in-line bacterial filter made of a hydrophobic membrane and a 1/4 inch tubing connecter. A 1/4 inch PVC tube which connects the in-line filter to the regulated gas source. A fluid inlet line extends from a point near the proximal end of the malleable section of the wand and terminates in a female luer-lock adaptor for conneciton to a standard fluid administration set which provides for flow control and on-off capacity

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

wound or surgical site

Indicated Patient Age Range

Not Found

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)

Substantial Equivalence: This device is substantially equivalent to the RMI Surgical Site Visualization Wand.
All material are identical to the predicate device. Materials: Validated 100% Ethylene Oxide sterilization cycle (Overkill Method) Sterilization: SAL - 10*
All functional characteristics of the Chase Medical Anastomosis Visualization Device are nondifferentiable as compared with the predicate.
Leak Test Requirements: No leaks at 10 psi air on Chase device
Tubing Bond Strength: Exceeds 10 lb. tensile strength
Package Integrity: Tyvek/Polymylar passed burst test per ASTM F1140-88
Shipping & Distribution Testing: Per National Safe Transit Ass. vibration and drop tests
Accelerated Aging: Two year shelf life

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.

Not Found

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

§ 880.5475 Jet lavage.

(a)
Identification. A jet lavage is a device used to clean a wound by a pulsatile jet of sterile fluid. The device consists of the pulsing head, tubing to connect to a container of sterile fluid, and a means of propelling the fluid through the tubing, such as an electric roller pump.(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 880.9.

0

K974568

SUMMARY OF SAFETY AND EFFECTIVENESS

JAN - 6 1900

CHASE ANASTOMOSIS VISUALIZATION DEVICE

General Information I.

A. Generic Name:Anastomosis Visualization Device
B. Trade Name of Device:CHASE Anastomosis Visualization Device
C. Applicant's Name and Address:CHASE MEDICAL INC. , Richardson, TX
D. Pre-market Notification Number:Not assigned
  • Indication for Use: II.
    The Chase Anastomosis Visualization Device is indicated for use during procedures wherein clearing of a wound or surgical site, for enhanced visibility, must be maintained by non-contact means.

  • III. Device Description
    The Chase Anastomosis Visualization Device consists of a malleable wand, a 0.2 micron filter, and a sterile fluid inlet line. The overall length of the wand is approximately 10.125 inches in length. The stainless steel wire is completely embedded within the wall along its length for the purpose of maintaining a user chosen shape. The distal tip is designed to provide a fan-shaped irreigation mist pattern. The remaining proximal length of the wand is the regulated gas inlet which consists of a 0.2 micron medical grade in-line bacterial filter made of a hydrophobic membrane and a 1/4 inch tubing connecter. A 1/4 inch PVC tube which connects the in-line filter to the regulated gas source. A fluid inlet line extends from a point near the proximal end of the malleable section of the wand and terminates in a female luer-lock adaptor for conneciton to a standard fluid administration set which provides for flow control and on-off capacity

  • IV. Device Classification: Class II device

  • V. Safety and Effectiveness:

Substantial Equivalence: This device is substantially equivalent to the RMI Surgical Site Visualization Wand.

  • VI. Other Safety and Effectiveness Data:
    All material are identical to the predicate device. Materials: Validated 100% Ethylene Oxide sterilization cycle (Overkill Method) Sterilization: SAL - 10*

1

SUMMARY OF SAFETY AND EFFECTIVENESS

Functional Testing

All functional characteristics of the Chase Medical Anastomosis Visualization Device are nondifferentiable as compared with the predicate.

Leak Test Requirements:No leaks at 10 psi air on Chase device
Tubing Bond Strength:Exceeds 10 lb. tensile strength
Package Integrity:Tyvek/Polymylar passed burst test per ASTM
F1140-88
Shipping & Distribution Testing:Per National Safe Transit Ass. vibration and
drop tests
Accelerated Aging:Two year shelf life

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle or bird-like symbol with three curved lines representing its wings or body. The symbol is enclosed within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged around the upper portion of the circle. The logo is black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Bert Davis ·President Chase Medical, Incorporated 1876 Firman Drive 75081 Richardson, Texas

JAN - 6 1998

Re : K974568 Chase Anastomosis Visualization Device Trade Name: Requlatory Class: II Product Code: FMQ Dated: November 24, 1997 Received: December 5, 1997

Dear Mr. Davis:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the device, subject to the general controls provisions The general controls provisions of the Act of the Act. include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Requlations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with ----the current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic (QS) inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory In addition, FDA may publish further announcements action. concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531

3

Page 2 - Mr. Davis

through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or requlations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling requlation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

Tim Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

K974568

CHASE MEDICAL INC.

ANASTOMOSIS VISUALIZATION DEVICE

Indications For Use: ***

The Chase Anastomosis Visualization Device is indicated for use during procedures wherein clearing of a wound or surgical site, for enhanced visibility, must be maintained by non-contact means.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

OR Over-The-Counter Use_ Prescription Use

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Optional Format 1-2-96)