EMT QUIK-COVER FLEXIBLE ENDOSCOPE BARRIER SHEATH, SERIES 1-7

K061324 · Rtc Inc.-Memcath Technologies, LLC · FED · Jun 20, 2006 · Gastroenterology, Urology

Device Facts

Record IDK061324
Device NameEMT QUIK-COVER FLEXIBLE ENDOSCOPE BARRIER SHEATH, SERIES 1-7
ApplicantRtc Inc.-Memcath Technologies, LLC
Product CodeFED · Gastroenterology, Urology
Decision DateJun 20, 2006
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 876.1500
Device ClassClass 2

Indications for Use

The EndoMedical Technologies Quik-Cover™ Flexible Endoscope Barrier Sheath provides a sterile, disposable protective covering for flexible endoscopes during endoscopic examination of bladder, urethra, lower gastrointestinal tract, and upper gastrointestinal structures including the esophagus.

Device Story

Sterile, single-use polymeric sheath; covers patient-contact surfaces of flexible endoscopes. Features distal optical window; preloaded on deployment tube. Some models include Y-connector and side ports for air, water, suction, and biopsy instrument passage. Used during endoscopic procedures to eliminate need for high-level endoscope disinfection between patients. Applied by sliding over endoscope; no vacuum or pressure source required. Protects patient from cross-contamination; benefits clinical workflow by reducing endoscope reprocessing requirements.

Clinical Evidence

Bench testing only. Performance validated through nonclinical testing including optical quality of the sheath window, mechanical testing of the sheath, and finished device barrier testing.

Technological Characteristics

Contiguous polymeric sheath; distal optical window; proximal connector; optional Y-connector/side ports for fluid/instrument passage. Single-use; sterile. Mechanical deployment via sliding mechanism; no energy source required.

Indications for Use

Indicated for use as a sterile, disposable protective covering for flexible endoscopes during endoscopic examination of the bladder, urethra, lower gastrointestinal tract, and upper gastrointestinal structures (including the esophagus).

Regulatory Classification

Identification

An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.

Special Controls

*Classification* —(1)*Class II (special controls).* The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.

In combination with the general controls of the FD&C Act, the integrated operating table-electromechanical surgical system is subject to the following special controls: 1. (1) Premarket clinical performance testing, or a combination of premarket clinical performance testing and postmarket surveillance (in accordance with special control (2)), must include the following: 1. (i) Objective performance measures (e.g., rate and number of conversions to other surgical modalities, rate of device related adverse events (including tissue injury, hematoma, and increased blood loss), and their severity, cause, and outcomes) must be reported with relevant descriptive comparator performance measures. 2. (ii) The data must demonstrate the performance of the device for providing accurate and precise control of attached surgical instruments in range of clinical conditions relevant to the device's intended use. 3. (iii) The test dataset must include data collected from a patient population representative of the intended patient population under anticipated conditions of use. 2. (2) Data obtained from postmarket surveillance must demonstrate, in consideration of the premarket data obtained in accordance with special control (1), that the device performs in accordance with special control (1), unless FDA determines, based on the totality of the premarket data, that data from postmarket surveillance is not required to demonstrate that the device performs as intended. Such postmarket surveillance must be conducted per a protocol determined appropriate by FDA to demonstrate that the device performs as intended (in consideration of the premarket data obtained in accordance with special control (1)), and must include initiation, enrollment, and reporting requirements to ensure timely periodic updates to FDA on post-market surveillance progress and outcomes. 3. (3) Animal performance testing must evaluate the extent of port site trauma due to repositioning of table during surgical procedures when utilizing robotic minimally invasive and laparoscopic approaches 4. (4) The device manufacturer must develop, and update as necessary, a device-specific use training program that ensures proper device setup/use/shutdown, accurate control of instruments to perform the intended surgical procedures, troubleshooting and handling during unexpected events or emergencies, and safe practices to mitigate use error. 5. (5) The device manufacturer may only distribute the device to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program. (6) Human factors assessment must demonstrate that the user can correctly use the device system across all intended use environments with the provided instructions and training materials, including patient access during normal operating conditions and emergency situations, and effects arising from the integrated nature of the operating table and robotic surgical arms. (7) Labeling must include: (i) A detailed summary of clinical performance testing conducted with the device, including study population, results, adverse events, and comparisons to any comparator groups identified; (ii) A statement in the labeling that the safety and effectiveness for the representative specific procedures was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of the patient's underlying disease or condition, unless FDA determines that it can be removed or modified based on clinical performance data submitted to FDA; (iii) Identification of compatible devices; (iv) The list of surgical procedures for which the device has been determined to be safe with clinical justification; (v) Reprocessing instructions for reusable components; (vi) A shelf life for any sterile components; (vii) A description of the device-specific use training program; (viii) A statement that the device is only for distribution to facilities that implement and maintain the device-specific use training program and ensure that users of the device have completed the device-specific use training program; and (ix) A summary of any completed postmarket surveillance data collected as required by special control (2), including updated labeling to accurately reflect outcomes observed in postmarket surveillance. (8) Non-clinical performance testing must demonstrate that the device performs as intended under anticipated conditions of use and must include: (i) Device motion accuracy and repeatability; (ii) System testing; (iii) Instrument reliability; (iv) Crosstalk; (v) Table motion control; (vi) Thermal effects on tissue; (vii) User-device interface performance; (viii) Workspace access testing; and (ix) Performance testing with compatible devices. (9) Software verification, validation, and hazard analysis must be performed. (10) Electromagnetic compatibility and electrical, thermal, and mechanical safety testing must be performed. (11) Performance data must demonstrate the sterility of all patient-contacting device components. (12) Performance data must support the shelf life of the device components provided sterile by demonstrating continued sterility and package integrity over the labeled shelf life. (13) Performance data must validate the reprocessing instructions for the reusable components of the device. (14) Performance data must demonstrate that all patient-contacting components of the device are biocompatible. (15) Performance data must demonstrate that all patient-contacting components of the device are non-pyrogenic. (16) The device manufacturer must submit a report to the FDA annually on the anniversary of initial marketing authorization for the device, until such time as FDA may terminate such reporting, which comprises the following information: (i) Cumulative summary, by year, of complaints and adverse events since date of initial marketing authorization; and (ii) Identification and rationale for changes made to the device, labeling, or device specific use training program, which did not require submission of a premarket notification during the reporting period.

Predicate Devices

Submission Summary (Full Text)

{0}------------------------------------------------ Document Date: 5/05/06 #### 510(k) Summary 5. | Date Prepared | May 5, 2006 | |-------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | New Device | EndoMedical Technologies Quik-Cover™ Flexible Endoscope Barrier Sheath | | Predicate Devices | K000767 Memcath Urology Introducer Sheath | | | K042531 UPDATED SLIP Urology Introducer Sheath, Percutaneous Systems, Inc. | | | K990354 Vision-Sciences EndoSheaths for use with Flexible ENT Scopes | | | K021344 Vision-Sciences Flexible Fiberoptic Bronchoscope and EndoSheath System | | | K040215 Vision-Sciences Flexible Cystoscope with EndoSheath System | | | K031786 Vision-Sciences Trans-Nasal Esophagoscope with EndoSheath System | | | K963344 SS-F32 EndoSheath for use with the Vision-Sciences Model S-F100 Sigmoidoscope | | Contact | Marc Jaker, Vice President<br>RTC, Inc. - Memcath Technologies, LLC<br>1777 Oakdale Ave<br>West St. Paul, MN 55118<br>Phone: 651-450-7400 Fax: 651-450-7555<br>Email: mjaker@rtcincmn.com | ### Intended Use The EndoMedical Technologies Quik-Cover™ Flexible Endoscope Barrier Sheath provides a sterile, disposable protective covering for flexible endoscopes during endoscopic examination of bladder, urethra, lower gastrointestinal tract, and upper gastrointestinal structures including the esophagus. ## Device Description The EndoMedical Technologies Quik-Cover Flexible Endoscope Barrier Sheath (EndoMedical Technologies Quilt-Cover™) is a sterile, single-use device that covers the entire patient contact surface of flexible endoscopes and eliminates the need for high-level disinfection of the endoscope following each procedure. The device is composed of a contiguous polymeric sheath, with an optical window at the distal end which is preloaded on a deployment tube. Some models of the EndoMedival Technologies Quik-Cover™ include a Y-connector and side port channel(s) that are intended to allow passage of air, water, suction and biopsy instruments. Page 10 of 31 Comment: Removed references to ENT and broncho {1}------------------------------------------------ # Substantial Equivalence Comparison The intended use of the EndoMedical Technologics Quik-Cover™ is similar to the predicate devices in that the sheaths are sterile, disposable protective accessories used to cover endoscopes, cathelers or instruments to help prevent the transmission of pathogens. The EndoMedical Technologies Quik-Cover™ device configuration is similar to the predicate devices in that all devices are comprised of a membrane sheath, a proximal connector and, with respect to the that an are novel a ventify a distal polymeric window. Some models of the EndoMedical Technologies Quik-Cover™ and predicate devices also include a side working channel. The EndoMedical Technologics Quik-Cover™ application method is similar to the predicate devices ir that the shealth slides on and off with no vacuum/ pressure source required. The EndoMedical Technologies Quik-Cover™ sheath material is identical to the sheath material for the Memcath Urology Introducer Sheath (K000767) and the SLIP Urology Introducer Sheath (K042531) predicate devices. Safety and performance characteristics related to minor design differences have been addressed through the following nonclinical tests: - Optical qualities of sheath window . - Sheath mechanical tests . - . Finished device barrier testing Nonclinical performance testing demonstrated that the EndoMedical Technologies Quik-Cover reliably achieves the desired affect and is safe for its intended use. No new questions of safety or effectiveness for endoscope barrier sheaths were raised during the testing. The EndoMedical Technologies Quilt-Cover Flexible Endoscope Barrier Sheath is, therefore, substantially equivalent to currently marketed devices. Koc1324 PG. 2 of 2 Page 11 of 31 {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 with three lines representing its body and wings. The eagle is facing right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the eagle. Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 JUN 20 2006 Mr. Marc Jaker Vice President RTC, Inc .- Memcath Technologies LLC 1777 Oakdale Ave. WEST ST. PAUL MN 55118 Re: K061324 Trade/Device Name: EndoMedical Technologies Quik-Cover™ Flexible Endoscope Barrier Sheath Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: FED Dated: May 8, 2006 Received: May 18, 2006 Dear Mr. Jaker: 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. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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. {3}------------------------------------------------ Page 2 - 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); 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. This letter will allow you to begin marketing your device as described in your Section 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 regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter: | 21 CFR 876.xxx | (Gastroenterology/Renal/Urology) | 240-276-0115 | |----------------|----------------------------------|--------------| | 21 CFR 884.xxx | (Obstetrics/Gynecology) | 240-276-0115 | | 21 CFR 894.xxx | (Radiology) | 240-276-0120 | | Other | | 240-276-0100 | Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html. Sincerely vours. Nancy C. Hogdon Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {4}------------------------------------------------ #### Indications for Use Statement 4. 510(k) Number (if known): K061324 Device Name: EndoMedical Technologies Quik-Cover™ Flexible Endoscope Barrier Sheath Indications for Use: The EndoMedical Technologies Quik-Cover™ flexible endoscope barrier sheath provides a sterile, disposable protective covering for endoscopes used during examination of structures such as the bladder, urethra, lower gastrointestinal tract, and upper gastrointestinal structures including the esophagus. Over-The-Counter Use Prescription Use XX AND/OR (21 CFR 80I Subpart C) (Part 21 CFR 801 Subpart D) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Nancyc Brogdon --- (Division Sign-Off) Division of Reproductive, Abdominal, Radiological Devices 510(k) Number K061324 10 of 33
Innolitics

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