Appearance
The Market
Market Size and Growth
Global market: $1.3-3.2B (varies by methodology and scope definition)
Growth: 5-8% CAGR through 2030
Market definition: Extended dwell midline catheters for 1-4 week IV therapy
Drivers:
- Aging population needing more IV therapy
- Shift from inpatient to outpatient infusion
- Chemotherapy access demand growing
- Difficult IV access cases increasing (obesity, chronic disease)
Who Buys
Four personas control the purchasing decision. Each cares about different things.
Vascular Access Director (VAD)
Decision authority: Device selection
What they care about: Staff competency, patient outcomes, training burden, workflow efficiency
How to find them: LinkedIn (title search), AVA conference, INS conference, hospital vascular access team meetings
What resonates:
"BD's PowerGlide Pro has a 77% injury rate per MAUDE event (n=26). The failure pattern is mechanical -- guidewire interaction with catheter at the bevel. Stiletto eliminates that mechanism entirely."
Value Analysis Committee (VAC)
Decision authority: Purchasing approval
What they care about: Cost-effectiveness, risk mitigation, evidence-based decisions
How to find them: Ask the VAD for a referral, GPO exception process managers, clinical quality committees
What resonates:
"One retained fragment retrieval costs $15-30K. Stiletto's design makes that complication impossible."
Chief Nursing Officer (CNO)
Decision authority: Strategic alignment
What they care about: Staff satisfaction, patient safety culture, nursing retention, workflow efficiency
How to find them: LinkedIn Sales Navigator, AONE (American Organization of Nurse Leaders)
What resonates:
"When nurses trust their devices, they work with more confidence. Stiletto's 2-step insertion eliminates the guidewire complications that erode that trust."
Risk Manager
Decision authority: Liability assessment
What they care about: Documented adverse event patterns, claims history, litigation risk, due diligence
How to find them: Hospital admin referral, ASHRM (American Society for Healthcare Risk Management)
What resonates:
"BD's PowerGlide shows a consistent mechanical failure pattern across multiple facilities in MAUDE data. That's discoverable in litigation. A design that eliminates the failure mechanism changes the due diligence calculus."
Top 30 Markets by CMS Procedure Volume
Real data from CMS Medicare 2022 public files. These are the highest-volume markets for vascular access procedures.
Note on CMS Data
This data comes from publicly available CMS Medicare Part B utilization files -- it is not stored in our ClickHouse database. Medicare represents ~30% of total procedures. Actual market volume is 3-4x larger. These numbers are directionally accurate for market sizing and prioritization.
| Rank | City | State | Providers | Procedures | Major Hospital Systems |
|---|---|---|---|---|---|
| 1 | Houston | TX | 187 | 6,315 | MD Anderson, Memorial Hermann, Houston Methodist |
| 2 | Baltimore | MD | 138 | 5,639 | Johns Hopkins, University of Maryland, MedStar |
| 3 | New York | NY | 183 | 5,167 | NYU Langone, Mount Sinai, Memorial Sloan Kettering |
| 4 | Dallas | TX | 136 | 4,595 | UT Southwestern, Baylor Scott & White, Parkland |
| 5 | Philadelphia | PA | 110 | 4,474 | Penn Medicine, Jefferson, Temple |
| 6 | Saint Louis | MO | 129 | 4,271 | Barnes-Jewish, SSM Health, BJC |
| 7 | Chicago | IL | 127 | 4,244 | Northwestern, Rush, University of Chicago |
| 8 | Indianapolis | IN | 129 | 4,233 | IU Health, Community Health, Ascension St. Vincent |
| 9 | Boston | MA | 138 | 4,055 | Mass General, Brigham, Dana-Farber |
| 10 | Los Angeles | CA | 125 | 4,023 | UCLA, Cedars-Sinai, City of Hope |
Total procedures in top 10 markets: 46,978 annually (Medicare only -- actual volume 3-4x higher)
Technology Trends
1. Guidewire Elimination
The market is moving away from guidewire-based insertion. Documented failure modes (kinking, knotting, fracturing), training complexity, and insertion time are driving the shift.
Stiletto position: First-mover with SlipStream Technology.
2. Power Injection Capability
Power injectable is table stakes for CT contrast compatibility. Every serious midline must support it.
Stiletto position: Full power injection capability without the guidewire.
3. Tip Location Systems
Real-time tip positioning during insertion (BD Sherlock 3CG, NaviCam, Arrow VPS). Becoming standard practice.
Stiletto position: Compatible with standard tip location methods.
4. Antimicrobial Coatings
Chlorhexidine/silver sulfadiazine and minocycline/rifampin coatings reduce catheter-related bloodstream infections.
Stiletto position: Monitor for future iterations.
Where the Market Is Heading
Short-term (1-2 years):
- Safety-conscious institutions evaluating alternatives to PowerGlide
- Data-driven purchasing decisions gaining ground over GPO inertia
- Nursing staff having more influence on device selection
Medium-term (3-5 years):
- Guidewire-free designs becoming the standard expectation
- Connected devices with real-time monitoring
- AI-assisted placement guidance
Implication for Stiletto: The window to establish market position is now, before BD redesigns or new entrants arrive. First-mover advantage in guidewire-free midlines compounds over time as safety data accumulates.
Competitive Position
BD dominates complexity-tolerant buyers. ICU Medical and Teleflex compete on coatings (antimicrobial, anti-thrombotic) but keep the guidewire. AngioDynamics differentiates on material science. Stiletto targets safety-conscious institutions willing to simplify. The quadrant to own is "Simple & Safe" -- fewer steps, fewer failure modes, lower training burden.
Data: CMS Medicare 2022 procedure volumes (public files). Market sizing from industry reports. Technology trends from FDA 510(k) filings and industry conferences.