TELEFLEX INCORPORATED

Exhibit 10.21

TELEFLEX INCORPORATED

155 South Limerick Road
Limerick, Pennsylvania 19468

As of November 20, 2009

Re:		Amendment No. 1 (this “Amendment”) to the Note Purchase Agreement dated as of October 1, 2007

TO THE NOTEHOLDERS
REFERENCED BELOW

Ladies and Gentlemen:

     Reference is made to the Note Purchase Agreement dated as of October 1, 2007 (as in effect on the date hereof, the “Existing Note Agreement”, and as amended hereby, the “Note Agreement”) among Teleflex Incorporated, a Delaware corporation (the “Company”), and each of the institutions named on the signature pages thereof (the “Purchasers”), pursuant to which the Purchasers purchased (i) U.S.$130,000,000 in aggregate principal amount of the Company’s 7.62% Series A Senior Notes due October 1, 2012, (ii) U.S.$40,000,000 in aggregate principal amount of the Company’s 7.94% Series B Senior Notes due October 1, 2014, and (iii) U.S.$30,000,000 in aggregate principal amount of the Company’s Floating Rate Series C Senior Notes due October 1, 2012, (collectively, the “Existing Notes”). Each current holder of an Existing Note is herein referred to as a “Noteholder”, and such holders collectively are referred to as the “Noteholders”.

     The Company has requested that the Noteholders agree to amend certain provisions of the Existing Note Agreement as more fully described herein, and the Noteholders are willing to do so, on the terms and conditions set forth herein, and accordingly, the Company and the Noteholders hereby agree as follows:

     Section 1. Definitions. All capitalized terms used herein but not defined herein shall have the respective meanings ascribed thereto in Schedule B to the Existing Note Agreement.

     Section 2. Amendments. Effective as provided in Section 4 hereof, the Existing Note Agreement shall be amended as follows:

     (a) The definition of “Consolidated Leverage Ratio” set forth in Schedule B to the Existing Note Agreement shall be amended and restated in its entirety to read as follows:

     “Consolidated Leverage Ratio” means, as at any date, the ratio of (a) Consolidated Total Indebtedness on such date (subject to the proviso set forth in the definition of “Indebtedness” and excluding Indebtedness in respect of any Receivables Securitization Program permitted pursuant to Section 10.1(g) and 10.2(e)) to (b) Consolidated EBITDA for the period of four consecutive fiscal quarters ending on or most recently ended prior to such date.

     (b) The definition of “Consolidated Total Assets” set forth in Schedule B to the Existing Note Agreement shall be amended and restated in its entirety to read as follows:

     “Consolidated Total Assets” means, at any time, the aggregate amount of all assets of the Company and its Subsidiaries at such time, as determined on a consolidated basis in accordance with GAAP, excluding the book value at such time of an amount of undivided percentage interests in accounts receivable sold by special purpose Subsidiaries under Receivables Securitization Programs permitted pursuant to Section 10.1(g) and 10.2(e) that is equal to the amount of Indebtedness of such Subsidiaries in respect of such programs at such time.

     Section 3. Representations and Warranties. The Company represents and warrants to each Noteholder on the date hereof that (a) the representations and warranties of the Company set forth in the Note Agreement and of the Company and each of the Subsidiary Guarantors in each of the other Financing Documents to which it is a party, are true and correct in all material respects on and as of the date hereof (or, if any such representation or warranty is expressly stated to have been made as of a specific date, as of such specific date), (b) this Amendment has been duly authorized, executed and delivered by the Company and this Amendment, the Note Agreement and the Notes each constitute the legal, valid and binding obligation, contract and agreement of the Company enforceable against the Company in accordance with its terms, except as enforcement may be limited by bankruptcy, insolvency, reorganization, moratorium or similar laws or equitable principles relating to or limiting creditors’ rights generally, (c) the execution, delivery and performance by the Company of this Amendment (i) does not require the consent or approval of any governmental or regulatory body or agency, and (ii) will not (A) violate (1) any provision of law, statute, rule or regulation or the certificate of incorporation, bylaws or other constitutive document of the Company, (2) any order of any court or any rule, regulation or order of any other agency or government binding upon the Company, or (3) any provision of any material indenture, agreement or other instrument to which the Company is a party or by which its properties or assets are or may be bound, including, without limitation, the Bank Credit Agreement, or (B) result in a breach or constitute (alone or with due notice or lapse of time or both) a default under any indenture, agreement or other instrument referred to in clause (ii)(A)(3) of this Section 3(c), (d) immediately prior to, and immediately after giving effect to this Amendment, no Default or Event of Default has occurred and is continuing under the Note Agreement and (e) neither the Company nor any of its Affiliates has paid or agreed to pay any fees or other consideration to any creditor in connection with the obtaining of the amendments described in Section 4(c) below.

     Section 4. Conditions to Effectiveness. The amendments set forth in Section 2 hereof shall become effective, as of the date hereof, upon the satisfaction of the following

conditions precedent:

     (a) the execution and delivery hereof by the Company and the Required Holders;

     (b) the payment by the Company of all reasonable fees and expenses of the Noteholders relating to this Amendment, including, but not limited to, the reasonable fees and disbursements of Bingham McCutchen LLP, special counsel to the Noteholders;

     (c) the delivery to the Noteholders of executed amendments to the Note Purchase Agreement dated as of July 8, 2004 to which the Company is a party and the Bank Credit Agreement, in each case corresponding to the amendments provided for herein, in form and substance satisfactory to the Required Holders; and

     (d) the representations and warranties set forth in Section 3 above shall be true and correct.

     Section 5. Miscellaneous.

     5.1 Ratification; Agreement Unchanged. The Existing Note Agreement and the Existing Notes are in all respects ratified and confirmed, and the terms, covenants and agreements thereof shall remain unchanged and in full force and effect except as amended hereby.

     5.2 References to Note Agreement and Notes. From and after the effective date of this Amendment, all references to “this Agreement” in the Existing Note Agreement and in the Existing Notes shall be deemed to be references to the Note Agreement.

     5.3 Execution in Counterparts. This Amendment may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument. Delivery of an executed counterpart of a signature page to this Amendment by facsimile transmission or electronic mail shall be effective as delivery of a manually executed counterpart of this Amendment.

     5.4 Governing Law. This Amendment shall be construed and enforced in accordance with, and the rights of the parties shall be governed by, the law of the State of New York excluding choice-of-law principles of the law of such State that would permit or require the application of the laws of a jurisdiction other than such State.

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     IN WITNESS WHEREOF, the parties hereto have caused this Amendment No. 1 to be duly executed and delivered as of the day and year first written above.