Seattle-based Mirador Biomedical is trying to sell hospitals a little digital device for about $35 apiece, in hopes of preventing a rare and disastrous thing from happening to patients. Now the company has gathered some data that it hopes will prove it’s worth the money.
Mirador’s device is a digital pressure sensor that’s supposed to help medical professionals tell whether they are about to insert a thick central line catheter into an artery instead of a vein (a classic hospital screw-up that can lead to an emergency hemorrhage, stroke, or death). Researchers working with Mirador wanted to know if the device could help prevent these errors from happening, and see whether the tool can save the healthcare system more money than it costs.
Researchers at four different academic centers, including the University of Washington and Yale University, saw encouraging results. Staff sought to insert catheters into central veins of 298 patients, using catheters equipped with Mirador’s pressure sensor, and ultrasound imaging to help guide the needle to the right spot in almost every case. Using ultrasound guidance, the staff still messed up five times out of those 298 cases (a 1.7 percent error rate) in which the syringe hit an artery instead of a vein. The Mirador device caught all five of those instances, and saved the patients from an emergency, because staff knew to stop before inserting the full catheter and guidewire, according to results published this week in the peer-reviewed journal Anesthesia and Analgesia.
“The device was easily used by trainees, and users expressed a positive level of satisfaction,” researchers said in the journal.
A cost-benefit analysis of the new findings shows that catching those errors and eliminating dangerous bleeding episodes should save hospitals $116 on average for each central line insertion performed, even after paying $35 for the disposable Mirador tool. Researchers arrived at the $116 per patient figure by adding up the tens of thousands of dollars spent on treating the complications of improperly inserted catheters, and by factoring in the hospital’s cost of defending from malpractice lawsuits.
“It’s important for Mirador because our device is new. People always ask whether it’s effective. This demonstrates it is,” says co-founder and CEO Karl Schmidt.
Mirador is hoping this latest bit of evidence will provide a lift for its business. Schmidt, Justin Hulvershorn, and Doug Swartz co-founded the company in 2009, and have raised a little more than $2.5 million in a pair of financings. Its backers include WRF Capital, Summit Capital. The company won FDA clearance to start selling the first couple iterations of its Compass Vascular Access product in October 2010.
Since then, the business has been what you could call steady-but-not-spectacular. The company has seen revenue grow in 11 consecutive quarters, Schmidt says, but he wouldn’t provide absolute sales numbers. Mirador has developed line extensions of its product for six different clinical settings, and cast a broadening net by selling its device to “hundreds” of hospitals in the U.S., European Union, Middle East, and South Korea, Schmidt says. The company has seven employees. It’s not yet profitable, but “we’re getting there,” Schmidt says. He didn’t provide a timetable for when Mirador expects to reach that milestone.
No other company has a pressure sensor quite like Mirador’s, but ultrasound companies have flooded hospitals with marketing messages about how their cool imaging tools can be used to prevent improper catheter insertions. The problem with ultrasound, Schmidt says, is that it takes some training for people to get good at, and sometimes catheters need to get inserted under bones like the clavicle, and ultrasound images can’t see through the bone. A digital pressure sensor, by comparison, doesn’t require a pair of skilled hands, and it provides a definitive answer on whether a syringe is poking a vein or artery.
Still, a company like Mirador has plenty of obstacles in front of it. Many hospitals have spent years in denial, believing that improper catheter insertions are somebody else’s problem. When the events happen rarely, memories of the situation can fade, Schmidt says.
Mirador, in its early days, has found that it has to find in-house “champions” at hospitals who believe that they need to root out this problem—technically known as “inadvertent arterial cannulation.” Not only does Mirador need an internal champion at the hospital, it needs someone with real clout who can make a convincing case on its behalf to a hospital purchasing committee. “We call them champions with juice,” Schmidt says.
Mirador is clearly hoping that a few more champions with juice will read the new paper, and start advocating for more prevention of these bloody errors. Schmidt says he’s encouraged that hospitals are starting to appear more motivated to change their ways, sometimes setting up specialized teams in which nurses handle central vein catheter insertions on a regular basis, rather than have physicians do them once in a while. It’s also possible that hospitals are starting to feel the pressure of the Affordable Care Act, which is supposed to make them care less about simply doing procedures, and more about giving the patient a better result. Already, Schmidt says, you can see hospitals getting more motivated to combat hospital-acquired infections, rather than pooh-poohing them, or denying they exist.
“We’re in the beginning stages. People are beginning to realize that arterial cannulations are a big deal, and they should be doing more to prevent them. Especially when one of these examples is fresh in their mind,” Schmidt says.