Maxxi Rip Sensor

K171304 · Neurovirtual USA, Inc. · MNR · Jun 24, 2019 · Anesthesiology

Device Facts

• Record ID: K171304
• Device Name: Maxxi Rip Sensor
• Applicant: Neurovirtual USA, Inc.
• Product Code: MNR · Anesthesiology
• Decision Date: Jun 24, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 868.2375
• Device Class: Class 2
• Attributes: Pediatric

Indications for Use

Maxxi Rip Sensor is intended for measuring of respiratory effort signals. They function as accessories for sleep/ polysomnography (PSG) systems. The device is offered in different sizes to be used on adult patients. The intended environments are hospitals, institutions, sleep centers or sleep clinics.

Device Story

Maxxi Rip Sensor captures respiratory effort signals for PSG systems; utilizes elastic belt worn around thorax or abdomen; belt tension changes during respiration converted to electrical signal via interface box; output transmitted to PSG recorder for clinician analysis; used in hospitals, institutions, sleep centers, or clinics; assists in sleep study diagnostics; device validated for use with Neurovirtual BWMini PSG.

Clinical Evidence

Bench testing only. Evidence includes signal integrity testing (signal-to-noise ratio, bandwidth, linearity), electrical safety (IEC 60601-1), and electromagnetic compatibility (IEC 60601-1-2). Performance verification protocols confirmed signal output quality, physical dimensions, and connectivity against established acceptance criteria.

Technological Characteristics

Respiratory inductive plethysmography (RIP) technology. Components: disposable RIP belts (polyester/Dorlastan, ABS buckles, Nylon/Velcro), reusable interface box (ABS plastic), and cables (PVC). Frequency response: 0-1Hz. Connectivity: Monopolar DIN 42-802 touch-proof connector. Power: Passive (not grid-connected). Standards: IEC 60601-1, IEC 60601-1-2. Dimensions: 50.80 x 36.50 x 18.90 mm.

Indications for Use

Indicated for measuring respiratory effort signals in adult patients (>2 years of age) as an accessory to sleep/polysomnography (PSG) systems in clinical environments.

Regulatory Classification

Identification

A breathing (ventilatory) frequency monitor is a device intended to measure or monitor a patient's respiratory rate. The device may provide an audible or visible alarm when the respiratory rate, averaged over time, is outside operator settable alarm limits. This device does not include the apnea monitor classified in § 868.2377.

Predicate Devices

• Nox RIP Belts (K151361)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

June 24, 2019

Neurovirtual USA, INC. Eduardo Faria CEO 2315 NW 107th Ave Suite# 1M27 Doral, Florida 33172

Re: K171304

Trade/Device Name: Maxxi Rip Sensor Regulation Number: 21 CFR 868.2375 Regulation Name: Breathing Frequency Monitor Regulatory Class: Class II Product Code: MNR Dated: May 17, 2019 Received: May 22, 2019

Dear Eduardo Faria:

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 Actinclude 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

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requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device 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-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) 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-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device (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 ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

for James J. Lee. Ph.D. Assistant Director DHT1C: Division of ENT. Sleep Disordered Breathing, Respiratory and Anesthesia Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental 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) K171304

Device Name Maxxi Rip Sensor

Indications for Use (Describe)

Maxxi RIP Sensor is intended for measuring of respiratory effort signals. They function as accessories for sleep/ polysomnography (PSG) systems.

The device is offered in different sizes to be used on adult patients.

The intended environments are hospitals, institutions, sleep centers or sleep clinics.

| Type of Use (Select one or both, as applicable) | |
|-----------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------|
| <div> <span> <span style="text-decoration: line-through;">X</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> </div> | <div> <span> <span style="">☐</span> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |

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Image /page/3/Picture/0 description: The image shows the logo for Neurovirtual. The logo consists of a stylized waveform graphic in shades of orange, followed by the word "NEUROVIRTUAL" in dark blue. A thin, light orange line extends from the waveform graphic over the word "NEUROVIRTUAL".

Neurovirtual USA Inc. 3303 W Commercial Blvd Suite #100 Fort Lauderdale. FL 33309 - USA Phone: [phone] – Fax [phone]

#### Section 5 510(k) SUMMARY

- A) Submitter's Name: Neurovirtual USA. Inc.
Owner / Operator Registration Number: 9091724 Manufacture Registration Number: 3006136239

- B) Address: 3303 W Commercial Blvd #100 Fort Lauderdale, FL 33309 USA
- C) Phone and Fax Numbers Phone: [phone] Fax: [phone]
- D) Contact Person: Eduardo J. Faria
- E) Preparation Date: June 21, 2019
- F) Classification Name:

Common / Usual Name: Ventilatory effort recorder Proprietary Name: Maxxi Rip Sensor Product Code: MNR Class: Class II Regulation: 21 CFR 868.2375

## G) Device Description

Maxxi Rip Sensor is a device intended to capture respiratory effort from a patient and output the signal to a PSG device for sleep studies. This signal is captured using an elastic belt fastened around the thorax or abdomen that will exhibit a change in tension as the thorax or abdomen expands or contracts. This change in tension is measured and converted to a signal output by the interface and processed by a PSG device.

The product is composed of 3 major parts, the interface box, the cable and the belt.

Cables are used to connect between the respiratory effort sensor (RIP belts) and the applicable sleep recorder/polysomnography (PSG) system.

The device is offered in different sizes to be used on adult patients.

The Maxxi Rip was validated with Neurovirtual BWMini PSG device recorder only, therefore we don't quarantee compatibility with other devices.

## H) Substantial Equivalence:

The Maxxi Rip Sensor is equivalent with the following products:

| 510(k) Number | Model | Company |
|---------------|---------------|-----------------|
| K151361 | Nox RIP Belts | Nox Medical ehf |

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Image /page/4/Picture/0 description: The image shows the logo for Neurovirtual. The logo features a stylized waveform graphic in shades of orange and yellow on the left. To the right of the graphic is the word "NEUROVIRTUAL" in a bold, sans-serif font, with the "O" in "NEURO" replaced by a solid orange circle.

Neurovirtual USA Inc. 3303 W Commercial Blvd Suite #100 Fort Lauderdale, FL 33309 - USA Phone: [phone] – Fax [phone]

# 1. Indications for Use:

| Indications for Use Comparison | |
|----------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------|
| Neurovirtual | Nox Medical ehf |
| Maxxi Rip Sensor | Nox RIP Belts |
| Maxxi RIP Sensor is intended for measuring of<br>respiratory effort signals. They function as<br>accessories for sleep/polysomnography (PSG)<br>systems. | Nox RIP Belts are intended for measuring of<br>respiratory effort signals. They function as<br>accessories for sleep/polysomnography (PSG)<br>systems. |
| The device is offered in different sizes to be used<br>on adult patients. | The intended environments are hospitals,<br>institutions, sleep centers, sleep clinics, or other<br>test environments, including the patient´s home. |
| The intended environments are hospitals,<br>institutions, sleep centers or sleep clinics. | |

# 2. Technological Characteristics Comparison:

The predicate devices used to establish substantial equivalence for the Maxxi Rip Sensor is outlined below. This section of this submission will provide a comparison of design, materials, and technical specifications of the Maxxi Rip Sensor to each of the predicate devices stratified by functional modality.

| Specifications Comparison | | | |
|--------------------------------------------------|-------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------|------------|
| Device Brand and<br>Common Name | Neurovirtual<br>Maxxi Rip Sensor | Nox Medical ehf<br>Nox RIP Belts | Comments |
| 510(k) Number | K171304 | K151361 | NA |
| Classification | MNR | MNR | Identical |
| Regulation # | 21 CFR 868.2375 | 21 CFR 868.2375 | Identical |
| Classification Name | Ventilatory effort recorder | Ventilatory effort recorder | Identical |
| Patient Population | Indicated for use on patients<br>greater than 2 years of age | Indicated for use on patients greater<br>than 2 years of age | Identical |
| Prescription Use | YES | YES | Identical |
| Mechanism of<br>action/Principle of<br>operation | respiratory inductance<br>plethysmograph | respiratory inductance<br>plethysmograph | Identical |
| Intended Environment<br>Use | hospitals, institutions, sleep<br>centers or sleep clinics | hospitals, institutions, sleep centers,<br>sleep clinics, or other test<br>environments, including the<br>patient´s home | Equivalent |
| Type of modules | RIP Belt and Interface | Rip Belt and Interface | Identical |
| Frequency Response | 0-1Hz | Not declared | Equivalent |
| Disposable | RIP Belts: Disposable<br>Interface and Cable: Reusable<br>Adjustable Belt: Reusable | RIP Belts: Disposable<br>Interface and Cable: Reusable | Equivalent |
| Shelf life | 10 years | Not declared | Equivalent |
| Dimensions | 50.80 x 36.50 x 18.90 mm | Not declared | Equivalent |
| Different belt sizes | YES from X-Small to X-Large | YES from X-Small to X-Large | Identical |
| RIP Belt Material | Polyester/Dorlastan<br>ABS Buckles<br>Nylon - Velcro | Polyester/Dorlastan | Equivalent |
| Cables Material | PVC - plastic injection | - PVC - wire jacket | Equivalent |

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Image /page/5/Picture/0 description: The image shows the logo for Neurovirtual. The logo consists of a stylized waveform graphic in shades of orange, followed by the word "NEUROVIRTUAL" in blue. The "O" in Neurovirtual is replaced with a solid orange circle. The waveform graphic is positioned to the left of the text, with a horizontal line extending from the waveform to the beginning of the word "NEUROVIRTUAL".

Neurovirtual USA Inc. 3303 W Commercial Blvd Suite #100 Fort Lauderdale. FL 33309 - USA Phone: [phone] – Fax [phone]

| | TPE - device end strain relief<br>TPU - wire jacket<br>Ni plated stainless steel – snaps | ABS/PC - belts end<br>TPE - device end strain relief<br>Gold plated stainless steel - snaps | |
|-----------------------------------------|-------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------|------------|
| Interface Enclosure<br>Material | Plastic ABS enclosure<br>Electronic components<br>Printed Circuit board | ABS plastic | Equivalent |
| Connection to Patient | Around the abdomen or thorax | Around the abdomen or thorax | Identical |
| Type of Equipment to<br>Be Connected to | Sleep recorder | Sleep recorder | Identical |
| Connector Type | Monopolar DIN 42-802<br>touch proof | Nox proprietary RIP snaps | Equivalent |
| Signals Measured | Respiratory Effort (Abdomen and<br>Thorax) | Respiratory Effort (Abdomen and<br>Thorax) | Identical |
| Respiratory Effort<br>Technology | RIP (Respiratory Inductive<br>Plethysmography)<br>technology | RIP (Respiratory Inductive<br>Plethysmography)<br>technology | Identical |
| Power Source | Not intended to be connected to<br>the power grid | Not intended to be connected to the<br>power grid | Identical |
| Isolation | No component included in the<br>RIP Belts that<br>are relied on as means of<br>protection | No component included in the RIP<br>Belts that<br>are relied on as means of protection | Identical |
| Applicable Standards | IEC 60601-1<br>IEC 60601-1-2 | IEC 60601-1<br>IEC 60601-1-2 | Identical |
| Packing | Plastic bag | Plastic bag | Identical |

Discussion: As showed above the comparison shows that Maxxi Rip Sensor was developed to be substantial equivalent to the predicate, despite the small differences in the intended environment use and material the subject device does meet the performance criteria when compared with the predicate demonstrating substantially equivalence.

## I) Performance Testing Summary:

## 1. Safety and Effectiveness Testing

The Maxxi Rip was submitted to standard IEC 60601-1 test which resulted in full compliance as reported in the test reports.

#### 2. EMC Testing

The Maxxi Rip was submitted to electromagnetic compatibility test, standard IEC 60601-1-2 which resulted in full compliance as reported in the test reports.

#### 3. Risk Analysis

The Maxxi Rip was developed according to the ISO14971 for appropriate actions related to risks found during the development to reach appropriate performance, safety and substantially equivalence with the predicate.

## 4. Signal Quality and Comparison Testing:

Siqnal integrity tests were conducted for the Maxxi Rip Sensor with focus on signal to noise ratio, signal range, bandwidth and linearity and the test results compared to the signal integrity test conducted for the predicate NOX-RIP.

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Neurovirtual USA Inc. 3303 W Commercial Blvd Suite #100 Fort Lauderdale, FL 33309 - USA Phone: [phone] – Fax [phone]

# 5. Performance Testing:

The performance test is executed for certain % amount of the products manufactured. This phase is necessary to identify possible flaws with the product and manufacturing process mistakes.

| Performance Test<br>protocol | Description | Acceptance Criteria |
|--------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Belt Signal Verification | Verify the signal output stretching and<br>releasing the inductive belt in order to get<br>a sine wave form in the output. | The signal must have a clean sine wave form<br>following the belts stimulation. Devices with<br>showing the signal output with interreferences will<br>be rejected. |
| Belt Dimensions | Verify if the dimensions of the belts in rest<br>are within the acceptable range in<br>accordance with the product<br>specifications. | Smaller adjustment: 900mm<br>Larger adjustment: 1200mm<br>Allowance: +-10% |
| Belt Connectivity | Using a multimeter in continuity scale,<br>check if the internal belt wiring has<br>connectivity. | Not allowed false contact, or no connectivity. |
| Belt Visual Conditions | Verify the visual aspects of the product.<br>Any scratches, ruptures, wrong labels,<br>oxidation, packing flaws, and connector<br>conditions will be rejected. | All damage types are not allowed, products with<br>scratches, wire ruptures, wrong labeling, oxidation,<br>packing flaws or connector issues will be rejected<br>and not put to sales. |
| Cable Dimensions | Verify if the cable length is within the<br>acceptable range. | Cable A: 250mm<br>Cable B: 2000mm<br>Allowance: +-5% |
| Cable Connectivity | Using a multimeter in continuity scale,<br>check if the cable has connectivity. | Not allowed false contact, or no connectivity. |
| Cable Visual Conditions | Verify the visual aspects of the product.<br>Any scratches, ruptures, wrong labels,<br>oxidation, packing flaws, and connector<br>conditions will be rejected. | All damage types are not allowed, products with<br>scratches, wire ruptures, wrong labeling, oxidation,<br>packing flaws or connector issues will be rejected<br>and not put to sales. |
| Interface functional<br>test | Verify if the signal output from the pre-<br>approved belt is working properly. | The signal must have a clean sine wave form<br>following the belts stimulation. Devices with<br>showing the signal output with interreferences will<br>be rejected. |
| Interface<br>Visual Conditions | Verify the visual aspects of the product.<br>Any scratches, ruptures, wrong labels,<br>oxidation, packing flaws, and connector<br>conditions will be rejected. | All damage types are not allowed, products with<br>scratches, wire ruptures, wrong labeling, oxidation,<br>packing flaws or connector issues will be rejected<br>and not put to sales. |

Conclusion: Based on the performance test applied to this Maxxi Rip Sensor and the predicate comparison, we conclude that the quality and performance for the specified Indications for use for this product was reached as well the substantially equivalency to the predicate.