BI-FUNNEL GASTROSTOMY FEEDING TUBE, TRI-FUNNEL GASTROSTOMY FEEDING TUBE

K142075 · Xeridiem (Formerly Mri) · PIF · Jan 8, 2015 · Gastroenterology, Urology

Device Facts

• Record ID: K142075
• Device Name: BI-FUNNEL GASTROSTOMY FEEDING TUBE, TRI-FUNNEL GASTROSTOMY FEEDING TUBE
• Applicant: Xeridiem (Formerly Mri)
• Product Code: PIF · Gastroenterology, Urology
• Decision Date: Jan 8, 2015
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.5980
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Gastrostomy Feeding Tube (G-Tube) is intended to provide enteral feeding, medication administration and gastric decompression.

Device Story

Gastrostomy feeding tube (G-Tube) available in Bi-Funnel and Tri-Funnel versions; used for enteral feeding, medication delivery, and gastric decompression. Device consists of silicone shaft, adjustable external bolster, and internal balloon. Inserted through established gastrointestinal stoma tract; balloon inflated with sterile/distilled water via inflation valve to secure position against stomach wall. Bi-Funnel allows delivery of feeding or medication; Tri-Funnel allows simultaneous delivery via separate ports. Features male ENFit connectors to prevent misconnection with non-enteral systems (e.g., IV). Used in clinical settings; operated by healthcare professionals. Benefits patient by providing reliable access for nutrition and decompression while reducing risk of accidental misconnection.

Clinical Evidence

Bench testing only. No clinical data. Performance testing included ASTM F2528 (flow rate, balloon burst/maintenance/concentricity/integrity), ENFit performance (stress cracking, axial load, disconnection, overriding), tensile testing, leak testing, simulated use (human factors), shelf life, sterilization, packaging, and biocompatibility.

Technological Characteristics

Silicone shaft, bolster, and balloon; ABS connectors/caps; LLDPE tether. Radiopaque marker (Barium Sulfate). Balloon inflation via luer slip/lock. ENFit connector system. Sizes 12-24 FR; 5/20 mL balloon volumes. Sterile (ETO).

Indications for Use

Indicated for placement in adult populations that require enteral feeding, medication administration or gastric decompression through an established gastrointestinal stoma tract.

Regulatory Classification

Identification

A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use).

Special Controls

*Classification.* (1) Class II (special controls). The barium enema retention catheter and tip with or without a bag that is a gastrointestinal tube and accessory or a gastronomy tube holder accessory 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 (general controls) for the dissolvable nasogastric feed tube guide for the nasogastric tube. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 876.9.

Predicate Devices

• Flow-Thru (Compat®) Balloon Replacement Gastrostomy Tubes (K885339)

Submission Summary (Full Text)

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

January 8, 2015

Xeridiem (formerly Mri) Jesus Valencia RA Specialist 4700 S. Overland Drive Tucson, AZ 85714

Re: K142075

> Trade/Device Name: Bi-Funnel Gastrostomy Feeding Tube and Tri-Funnel Gastrostomy Feeding Tube Regulation Number: 21 CFR§ 876.5980 Regulation Name: Gastrointestinal tube and accessories Regulatory Class: II Product Code: PIF Dated: December 11, 2014 Received: December 12, 2014

Dear Jesus Valencia,

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.

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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 (reporting of medical device-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 [phone] or [phone] 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 [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Herbert P. Lerner -S

for Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Indications for Use

| Form Approved: OMB No. | 0910-0120 |
|------------------------|------------------|
| Expiration Date: | January 31, 2017 |

See PRA Statement below.

| 510(k) Number (if known) | K142075 |
|--------------------------|---------|
|--------------------------|---------|

Device Name

Bi-Funnel Gastrostomy Feeding Tube and Tri-Funnel Gastrostomy Feeding Tube

Indications for Use (Describe)

The G-Tube is indicated for placement in adult populations that require enteral feeding, medication or gastric decompression through an established gastrointestinal stoma tract.

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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# 510(k) Summary

As required by 21 CFR 807.92, this "510(k) Summary" provides a basis for the substantial equivalence determination of the device listed below.

### General Information

| Date Prepared: | January 6th, 2015 |
|-----------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Submitter: | Xeridiem<br>4700 S. Overland Dr.<br>Tucson, AZ 85714<br>Contact: Jesus Valencia, RA Specialist<br>[phone] ext. 135<br>[e-mail] |
| 510(k) Correspondent: | Same as above |

#### Device Information

| Trade Name: | Bi-Funnel Gastrostomy Feeding Tube and<br>Tri-Funnel Gastrostomy Feeding Tube |
|-----------------------|-------------------------------------------------------------------------------|
| Common Name: | Balloon Gastrostomy Feeding Tube |
| Classification Name: | Gastrointestinal Tubes and Accessories<br>[21 CFR 876.5980, Product Code PIF] |
| Classification Panel: | Gastroenterology/Urology |
| Class: | Class II |

#### Predicate Device Information

| Trade Name: | Flow-Thru (Compat®) Balloon Replacement Gastrostomy Tubes |
|-----------------------|----------------------------------------------------------------------------------|
| Common Name: | Balloon Gastrostomy Feeding Tube |
| Classification Name: | Tubes, gastrointestinal (and accessories)<br>[21 CFR 876.5980, Product Code KNT] |
| Classification Panel: | Gastroenterology/Urology |
| Class: | Class II |
| 510(k) Number: | K885339 |

#### Device Description

The Gastrostomy Feeding Tube (G-Tube) consists of two product versions (models): a Bi-Funnel G-Tube and a Tri-Funnel G-Tube. Each G-Tube version is offered in varying shaft French (FR) sizes and balloon sizes. Both versions are offered in the same functional length. The overall difference between the Bi-Funnel and Tri-Funnel G-Tube is that the Tri-Funnel G-Tube allows for simultaneous delivery of feeding solutions and medications while the Bi-Funnel G-Tube allows for delivery of either feeding solutions or medications at a time. The table below summarizes the device offerings for the Bi-Funnel and Tri-Funnel G-Tubes:

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| Model P/N: | Device Description | French Size<br>Offerings (FR) | Balloon Recommended<br>Fill Volume (mL) | Functional<br>Length (cm) |
|------------|-------------------------------------------|-------------------------------|-----------------------------------------|---------------------------|
| 70-0047 | Bi-Funnel<br>Gastrostomy<br>Feeding Tube | 12 | 5 | 10 |
| | | 14 | | |
| | | 16 | | |
| | | 18 | 20 | |
| | | 20 | | |
| | | 22 | | |
| | | 24 | | |
| 70-0048 | Tri-Funnel<br>Gastrostomy<br>Feeding Tube | 12 | 5 | 10 |
| | | 14 | | |
| | | 16 | | |
| | | 18 | 20 | |
| | | 20 | | |
| | | 22 | | |
| | | 24 | | |

Table 5.1 – Proposed Device Offerings

Both Bi-Funnel and Tri-Funnel G-Tubes consist of a silicone funnel, shaft, adjustable external balloon. The funnel for the Bi-Funnel G-Tube has two ports: one port houses the balloon inflation valve which allows for balloon inflation and deflation, and the other port houses the male ENFit* connector (also known as PG Lock* connector) which allows for delivery of feeding solutions and medication. The Tri-Funnel G-Tube has three ports: one port houses the balloon inflation valve, the center port houses the male ENFit connector which allows for delivery of feeding solutions, and the last (side) port houses another male ENFit connector which allows for delivery of medications. Attached to the ENFit connectors are a tether and a cap. The cap is intended to cover the ENFit connector when the device is not in use and the tether is intended to secure the connector when the device is in use. The same ENFit connector, tether and cap components are used for both Bi-Funnel and Tri-Funnel G-Tubes. The remaining components (shaft, adjustable bolster and balloon) are commonly shared for the Bi-Funnel and Tri-Funnel G-tubes and identical in both versions.

- . *Note: The term "PG Lock" was the qeneric name used to describe the enteral connectors attached to the proposed device before these had an industry trade name. After commencing the design and development project for the proposed device, the Global Enteral Device Supplier Association (GEDSA) settled on an industry trade name for the enteral connectors and termed these connectors "ENFit". Within the body of this submission and within the supporting documentation, both "PG Lock" and "ENFit" connectors are used interchangeably; however, both terms refer to the same enteral connectors.
In use, the distal end of the G-Tube is inserted through a gastrointestinal stoma tract and into the stomach. Once the device is inside the stomach, a male luer slip or luer lock syringe is connected to the balloon inflation valve and the balloon is inflated with sterile or distilled water to the recommended fill volume printed on the balloon inflation port. Then, the G-Tube is withdrawn until the balloon stops against the inner stomach wall and lastly the external bolster adjusted flush against the abdomen by sliding down the shaft of the G-Tube. The shaft is printed with the rated shaft French size and graduation marks as a reference for identifying the diameter and length of the stoma tract. Once secured in place, the G-Tube will serve as a channel for administering nutrients and medication into the stomach and for gastric decompression. Enteral administration sets and syringes incorporating female ENFit connectors will be connected to the male ENFit connectors on the G-Tubes for delivering feeding solutions, medications, and for tube flushing. The male ENFit connection system was designed with the purpose of preventing unwanted misconnections with non-enteral connectors (i.e., luers delivering !.V. fluids). When device replacement is deemed necessary, the balloon is deflated and the G-Tube is pulled out of the stoma tract. The G-Tube is then replaced as previously described above. A more detailed device description with drawings is included in Section 11 of this 510(k).

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# Intended Use

The Gastrostomy Feeding Tube (G-Tube) is intended to provide enteral feeding, medication administration and gastric decompression.

## Indications for Use

The G-Tube is indicated for placement in adult populations that require enteral feeding, medication administration or gastric decompression through an established gastrointestinal stoma tract.

# Technological Characteristics

The device comparison table below provides a general summary of the technological characteristics of the Gastrostomy Feeding Tube (proposed) device compared to the predicate device.

| | Gastrostomy Feeding Tube | Flow-Thru (Compat®) Balloon Replacement Gastrostomy Tubes |
|-------------------------|------------------------------------------------|---------------------------------------------------------------------|
| | (Proposed device) | (Predicate Device) - K885339 |
| FDA Class | Same as K885339 | Class II |
| FDA Product Code | PIF | KNT |
| FDA Regulation | Same as K885339 | 876.5980 - Tubes, gastrointestinal (and accessories) |
| 510k # | N/A | K885339 |
| Indications for Use | The G-Tube is indicated for placement in adult | The Compat® Replacement Gastrostomy Tube is used as a |
| | populations that require enteral feeding, | replacement for surgically, laparoscopically or endoscopically |
| | medication administration or gastric | placed gastrostomy tubes when an established, well-healed and |
| | decompression through an established | mature tract (i.e. stoma tract) between the stomach and external |
| | gastrointestinal stoma tract. | body surface exists. The device delivers enteral formula and |
| | | medications directly into the stomach and is intended for single |
| | | patient use. |
| User Population | Same as K885339 | Adult |
| Operating principle | Same as K885339 | Device tip enters though the stoma tract and into the stomach, |
| | | then the device is secured in place by inflating the balloon and |
| | | adjusting the external bolster. Once secured in place, the device |
| | | serves as a channel for administering nutrients and medication into |
| | | the stomach and for gastric decompression |
| Single Patient Use | Same as K885339 | Yes |
| Sterile | Same as K885339 | Yes (ETO) |
| Shaft | Same as K885339 | Silicone 70D |
| External Bolster | Same as K885339 | Silicone 40D |
| Balloon | Same as K885339 | Silicone 24D |
| Funnel | Same material as K885339 with slight | Silicone 60D |
| | difference in profiles | |
| Radiopaque Marker | Same as K885339 | Barium Sulfate |
| Connectors | ABS (Connectors/Caps) & LLDPE (Tether) | Polyvinyl Chloride Connectors & Polycarbonate Barbed Adaptor |
| Balloon Inflation Valve | Same material types as K885339 with slight | Thermoplastic inflation valve |
| | difference in profiles | |
| Product Offerings | 12 - 24 French Sizes (Shaft) | 14 - 24 French Sizes (Shaft) |
| | 0 - 10 cm (Functional Length) | 0 - 10 cm (Functional Length) |
| | 5 & 20 mL (Balloon Recommended Fill Volume) | 5 & 15 mL (Balloon Recommended Fill Volume) |
| Packaging | Same as K885339 | Poly/Tyvek Chevron Pouch (1 unit and two labeling inserts inside |
| | | pouch) |
| Kit Components | Same as K885339 | None |

| | | Table 5.2 - Device Comparison Table | |
|--|--|-------------------------------------|--|
| | | | |

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# Performance Characteristics

Nonclinical bench testing was conducted for supporting substantial equivalence between the proposed and predicate devices. The bench tests addressed device performance characteristics such as:

- ASTM F2528 testing ●
- O Flow rate
- Balloon burst volume O
- Balloon volume maintenance O
- Balloon concentricity O
- O Balloon size over shaft size
- Balloon integrity in water O
- Balloon integrity in simulated gastric fluid O
- ENFit performance testing
- Falling drop test O
- O Stress cracking
- Resistance to axial load O
- Resistance to separation from unscrewing O
- Resistance to overriding O
- O Disconnection by unscrewing
- Tensile testing
- Leak testing

●

- Simulated use (human factors)
- Shelf life testing
- Sterilization
- Packaging validation
- Biocompatibility
- Enteral Connector Misconnection Assessment
- . Enteral Connector Risk Management Report
- Human Factors Validation Study
- ENFit Misconnection data with FMEA

A more detailed description of the performance testing is included in Section 18 of this 510(k). In conclusion, the proposed device performed equivalent to or better than the predicate device.

#### Device Comparison

As outlined in Table 5.2, the proposed device is substantially equivalent to the legally marketed predicate device. Specifically, the proposed device have has the same intended use, in as far as that both are used for administration of enteral nutrition and gastric decompression, and similar indications, technological characteristics, and principles of operation as the previously cleared predicate device. A substantial equivalence device comparison table comparing the similarities and differences between the proposed device and its predicate is provided in Table 5.2 above. The proposed device differs from the predicate device in certain funnel and connector design features which are required to reduce the likelihood of enteral misconnections and the profile of the funnel and connector ports. The minor differences identified in the technological characteristics do not raise new questions of safety or efficacy. Performance (bench) testing demonstrates that the proposed device is as safe and effective as its predicate device.

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# Substantial Equivalence - Comparison to Predicate Device

In order to support substantial equivalence of the proposed device to its predicate, the following are provided among the information and summary tables included in this 510(k) submission: 1.) device description, 2.) indications for use, 3.) device comparison tables, 4.) material information, 5.) nonclinical (bench) test results, and 6.) product labeling. In particular, nonclinical test results demonstrate that there were no differences that are critical to the intended use of the proposed device or that affect the safety and effectiveness of the proposed device when used as labeled.

The proposed and predicate devices have the same intended use, in as far as that both are used for administration of enteral nutrition and gastric decompression, and similar indications, technological characteristics and principles of operation. The minor differences in technological characteristics have been identified and do not present any new issues of safety or effectiveness. Thus, the Gastrostomy Feeding Tube is substantially equivalent to the Flow-Thru (Compat®) Balloon Replacement Gastrostomy Tubes (K885339).

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