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510(k) Data Aggregation

    K Number
    K173147
    Date Cleared
    2018-06-20

    (264 days)

    Product Code
    Regulation Number
    868.1400
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K133806

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The SuperNO2VA Et™ Device is a nasal mask that creates a seal when positioned over a patient's nose to direct anesthesia gas, air, and / or oxygen to the upper airway during the continuum of anesthesia care.

    It has a means for sampling expired gases from the patient's exhaled breath from the oral / nasal areas.

    The SuperNO2VA Et™ Device is intended for short-term (30 kg.). It is a single patient use, disposable.

    The SuperNO2VA Et™ Device is contraindicated for use in long-term ventilation conditions and treatment of sleep apnea.

    To be used under clinical supervision with adequate alarms and safety systems for monitoring and treatment of ventilatory failure.

    Device Description

    The SuperNO2VA Et™ Device is a nasal mask with a sampling port for the nasal portion and a sampling "hood" for over the mouth.

    The subject device is similar to an anesthesia or oxygen mask with gas sampling port. Instead of covering the full face the SuperNO2VA Et™ Device design is to allow the clinician to have access to the oral cavity during a procedure but still be able to provide air, oxygen or anesthesia gases to the patient while also sampling expired gases from the nasal or oral areas.

    The design incorporates the standard 15 mm male circuit connector, luer fitting for the gas sampling line and a slip-fit port for pressure monitoring or oxygen if the mask is used with a manual resuscitator or hyperinflation bag.

    The mask is not considered a long-term use device as it would only be used from pre- to postoperative care. This would be similar to the standard anesthesia mask.

    It is not for use in long-term ventilation conditions or the treatment of sleep apnea.

    AI/ML Overview

    Here's a breakdown of the acceptance criteria and study information for the SuperNO2VA Et™ Device, based on the provided text:

    1. Table of Acceptance Criteria and Reported Device Performance

    The document primarily focuses on demonstrating substantial equivalence to predicate devices rather than explicitly stating pre-defined acceptance criteria for each tested parameter. However, we can infer some criteria from the comparative testing and performance values presented. The "Proposed SuperNO2VA EtTM Device" column shows the reported performance.

    FeatureAcceptance Criteria (Inferred from Predicate/Equivalence)Reported Device Performance (SuperNO2VA Et™ Device)
    Mechanical Performance
    Internal Volume (Nasal mask only)Comparable to K163277 (Medium – 53 ml, Large – 87 ml)Medium – 53 ml, Large - 87 ml
    Pressure to maintain a sealComparable to K163277 (Up to 30 cmH2O)Up to 30 cmH2O
    Resistance to flowComparable to K163277 (0.46 cmH2O @ 50 lpm, 1.8 cmH2O @ 100 lpm) & Medline (30 lpm – 0.13 cmH2O, 60 lpm – 0.25 cmH2O, 90 lpm – 0.51 cmH2O)0.46 cmH2O @ 50 lpm, 1.8 cmH2O @ 100 lpm
    Leak rate under pressureComparable to K163277 (0.8 Lpm @ 20 cmH2O)0.8 Lpm @ 20 cmH2O
    Dead space (Nasal mask only)Comparable to K163277 (Medium – 53 ml, Large – 87 ml)Medium – 53 ml, Large – 87 ml
    Pressure / Leakage (General)Maintain pressure > 20 cmH2O with 10 lbs. force, Leakage 20 cmH2O with 10 lbs. force, Leakage
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