Kangaroo Gastrostomy Feeding Tube with ENFit Y-Port

K180622 · Covidien · KNT · Oct 23, 2018 · Gastroenterology, Urology

Device Facts

• Record ID: K180622
• Device Name: Kangaroo Gastrostomy Feeding Tube with ENFit Y-Port
• Applicant: Covidien
• Product Code: KNT · Gastroenterology, Urology
• Decision Date: Oct 23, 2018
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.5980
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric

Intended Use

The Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port is indicated for use in an established gastrostomy tract as a replacement tube for the administration of nutrition, fluids, and medications to the stomach of a patient, 2 years and older, that are physically unable to manage nutritional intake through normal mastication and deglutition.

Device Story

Kangaroo™ Gastrostomy Feeding Tube is a silicone replacement tube for enteral feeding. Device features a balloon retention system at the tip and an external skin disc for secure placement. An ENFit Y-Port enteral adapter is integrated into the funnel end to facilitate connection to feeding sets. Device is used in clinical or home settings to deliver nutrition, fluids, and medications directly to the stomach. Healthcare providers or caregivers insert the tube into an established gastrostomy tract. The device simplifies enteral access for patients unable to swallow or chew. It is supplied with water-soluble jelly to assist insertion. The design ensures compatibility with standard enteral connectors, reducing risk of misconnection and improving patient safety during long-term nutritional support.

Clinical Evidence

No clinical data was relied upon for this determination. Evidence is based on bench testing, including positive pressure liquid leak, axial load separation, unscrewing resistance, stress cracking, tensile strength, balloon burst volume, flow rate, simulated gastric fluid exposure, biocompatibility, and 5-year shelf-life testing.

Technological Characteristics

Silicone gastrostomy tube with balloon retention and external skin disc. Features ENFit Y-Port enteral adapter. Complies with EN 1615:2000, ASTM F 2528-06, and ISO 80369-3 standards. Dimensions vary by French size (12Fr to 28Fr). Non-powered, mechanical device.

Indications for Use

Indicated for patients 2 years and older with established gastrostomy tracts who are physically unable to manage nutritional intake via normal mastication and deglutition, requiring administration of nutrition, fluids, and medications to the stomach.

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

• AQUARIUS™ Gastrostomy Replacement Tube (K143378)

Reference Devices

• Low Profile Balloon Feeding Device (K161413)
• MRI'S All Silicone Gastrostomy Tube (K951489)
• Dobbhoff Single Pass PEG Kit (K913784)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains 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.

October 23, 2018

Covidien Alexis Erazo Principal Regulatory Affairs Specialist 15 Hampshire Street Mansfield. Massachusetts 02048

Re: K180622

Trade/Device Name: Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port Regulation Number: 21 CFR 876.5980 Regulation Name: Gastrointestinal tube and accessories Regulatory Class: Class II Product Code: KNT, PIF Dated: September 11, 2018 Received: September 12, 2018

Dear Alexis Erazo:

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 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

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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); 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/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; 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 http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely.

# Daniel G. Walter Jr -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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# Indications for Use

510(k) Number (if known) K180622

Device Name

Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port

Indications for Use (Describe)

The Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port is indicated for use in an established gastrostomy tract as a replacement tube for the administration of nutrition, fluids, and medications to the stomach of a patient, 2 years and older, that are physically unable to manage nutritional intake through normal mastication and deglutition.

| Type of Use (Select one or both, as applicable): | |
|----------------------------------------------------------------------------------|----------------------------------------------------------------------|
| <input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D) | <input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) |

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### 510(k) Summary Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port, K180622

#### Preparation date:

October 17, 2018

#### Manufacturer's Name:

Covidien 15 Hampshire Street Mansfield, MA 02048

# Corresponding Official:

Alexis Erazo, Principal Requlatory Affairs Specialist Phone: [phone] [e-mail]

#### Name of Medical Device:

| Trade Name: | Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port |
|----------------------|------------------------------------------------------|
| Common Name: | Tubes, gastrointestinal |
| Classification Name: | Gastrointestinal tube and accessories |
| Regulation Number: | 21 CFR 876.5980 |
| Product Code: | KNT, PIF |
| Class: | II |

#### ldentification of Predicate Device:

| 510(k) Number: | K143378 |
|---------------------|----------------------------------------|
| Device Description: | AQUARIUS™ Gastrostomy Replacement Tube |
| Submitter: | Degania Silicone Ltd |

#### ldentification of Reference Devices:

| 510(k) Number: | K161413 |
|---------------------|------------------------------------|
| Device Description: | Low Profile Balloon Feeding Device |
| Submitter: | Applied Medical Technology, INC. |

| 510(k) Number: | K951489 |
|---------------------|-------------------------------------|
| Device Description: | MRI'S All Silicone Gastrostomy Tube |
| Submitter: | Manufacturing & Research, Inc. |

| 510(k) Number: | K913784 |
|---------------------|----------------------------------|
| Device Description: | Dobbhoff Single Pass PEG Kit |
| Submitter: | Biosearch Medical Products, Inc. |

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# Device Description:

The Kangaroo™ Gastrostomy Feeding Tube is a silicone qastrostomy tube with a balloon retention device located at the tip of the tube. An external skin disc is provided on the outer lumen of the device and is used in conjunction with the balloon to provide a secure retention system for the Kanqaroo™ Gastrostomy Feeding Tube. The ENFit Y-Port Enteral Adapter is secured within the funnel end of the Gastrostomy Tube Lumen. The Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port is packaged with a packet of water-soluble jelly used to ease the insertion of the device.

# Intended Use/Indications for Use:

The Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port is indicated for use in an established gastrostomy tract as a replacement tube for the administration of nutrition, fluids, and medications to the stomach of a patient, 2 years and older, that are physically unable to manage nutritional intake through normal mastication and deqlutition.

# Product Comparison Summary:

The proposed Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port has the same intended use and same general fundamental technological characteristics and as compared to the predicate AQUARIUS™ Gastrostomy Replacement Tube (K143378). Comparison verification testing demonstrates that the Kanqaroo™ Gastrostomy Feeding Tube with ENFit Y-Port does not raise new questions of safety and efficacy that it is as safe and effective as the predicate. Furthermore, the comparison verification testing demonstrates that the performance of the proposed device is substantially equivalent as that of the legally marketed K143378 AQUARIUS™ Gastrostomy Replacement Tube.

# Non-Clinical Performance Data:

Laboratory testing was completed to support substantial equivalence between the proposed device and the predicate device. The proposed device was evaluated to show compliance to the standards requirements (listed below) as well as performance characteristics related to the modification of the device.

- . EN 1615:2000, Enteral feeding catheters and enteral giving sets for single use and their connectors - Design and testing
- . ASTM F 2528-06 Standard Test Methods for Enteral Feeding Devices with a Retention Balloon
- . ISO 80369- 3 Small-bore connectors for liquids and gases in healthcare applications – Part 3: Connectors for enteral applications

The following testing was conducted to demonstrate that the device continues to meet the requirements of the product specifications and supports the determination of substantial equivalence.

- . Positive pressure liquid leak
- Leak Test for G-tube 12Fr & 28 Fr

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- Resistance to separation from axial load
- Resistance to separation from unscrewing
- . Resistance to overriding
- . Disconnection by unscrewing
- . Stress Cracking
- . Tensile strength
- . Tensile strength of the connections of G-tube 12Fr & 28 Fr
- Dimension verification
- . Balloon burst volume for G-tube 12Fr & 28 Fr
- . Flow rate
- . Simulated Gastric fluids for G-tube 12Fr, 16Fr, 18Fr, & 24Fr
- Biocompatibility evaluation ●
- . Shelf-life (5 years)

# Clinical Data:

Clinical evaluations were not relied upon for evidence of safety of effectiveness, or for a determination of substantial equivalence.

### Conclusion:

The proposed Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port has the same intended use and same qeneral fundamental technological characteristics as compared to the predicate AQUARIUS™ Gastrostomy Replacement Tube (K143378). Comparison verification testing provided demonstrates that the Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port does not raise new questions of safety and efficacy, and that it is as safe and effective as the predicate. Furthermore, the comparison verification testing demonstrates that the performance of the proposed device is substantially equivalent as that of the legally marketed K143378 AQUARIUS™ Gastrostomy Replacement Tube. In addition, the Kangaroo™ Gastrostomy Feeding Tube with ENFit Y-Port has the similar indications for use as the legally marketed Low Profile Balloon Feeding Device by Applied Medical Technologies (K161413). Furthermore, the device design and materials are identical to those of reference devices MRI'S All Silicone Gastrostomy Tube (K951489) and Dobbhoff Single Pass PEG Kit (K913784).