BARD Intra-abdominal

Pressure Monitoring Device

Advancing the Delivery of Health Care.

CONFIDENTIAL-Internal use only

Training Objectives

Overview the BMD Theme Selling process

for IAP Monitoring

Understand the competitive landscape for

IAP measurement

CONFIDENTIAL-Internal use only

Unmet Clinical Need

Need for early detection of IAH and intervention before ACS
develops
Need for accurate and reproducible bladder pressure
measurements, which are valuable in assessing whether
IAH is contributing to organ dysfunction
Need for more efficient and reliable monitoring techniques
that minimize the risk of infection for patient & provider

CONFIDENTIAL-Internal use only

Prevalence of IAH

Are you aware of the high prevalence of IAH/ACS in the surgical & medical ICU
settings?

Studies show total prevalence of IAP>12 mmHg is >50%3

Abdominal Pressure

Total Prevalence

MICU Prevalence

SICU Prevalence

IAP > 12 mmHg

58.8%

54.4%

65%

IAP > 15 mmHg

28.9%

29.8%

27.5%

IAP > 20 mmHg

8.2%

10.5%

5.0%

Numerous conditions are indications for IAP monitoring4a

CONFIDENTIAL-Internal use only

Introducing BMDs New IAP Monitoring Device

CONFIDENTIAL-Internal use only

Introducing BMDs New IAP Monitoring Device

CONFIDENTIAL-Internal use only

Proper Positioning
The Bard Intra-abdominal Pressure Monitoring Device is:

Safe

Designed to follow CDC Category I recommendations for prevention of CAUTIs by

maintaining a closed urinary drainage system 1

Includes a StatLock Foley stabilization device for proper securement of indwelling

catheter to prevent movement and urethral traction

Addresses clinician concerns regarding potential exposure

Consistent

Convenient

Ensures measurement reproducibility by minimizing inter- and intra-observer variation

Contains materials necessary for intravesical IAP monitoring in a simple, convenient

kit

CONFIDENTIAL-Internal use only

The IAP Sales Process Flowchart

CONFIDENTIAL-Internal use only

BMD SALES PROCESS

THEME SELLING

IMPLEMENTATION
FINAL APPROVAL
EVALUATION
COMMITTEE PROCESS
SELL (THEME, DEMONSTRATE, COMMITMENT)
APPOINTMENT
TARGET

CONFIDENTIAL-Internal use only

Targeting
Maximize Existing Critical Care Call Points
Use IAP as a "lead in" or "add on" at your Large Trauma/University
hospitals

In SWIFT accounts use the closed system benefit when comparing

against the competition for IAP measurement
In Bardex IC accounts you can focus on SWIFT benefits of securement
In Acute Care accounts focus on importance of securing the Foley,
maintaining a closed system and initiate IC discussion

Find competitive accounts and convert them to a Closed system

CONFIDENTIAL-Internal use only

Primary Focus = Trauma & Burn Centers

Who uses competitive IAP measurement devices?
Trauma8

Burns9

# Hospitals
333
438
489

Trauma Surgeons, TBICU

Directors and RNs will be
primary call points

Level
1
2
3

125 specialized Burn Centers

1,187 beds overall
45,000 burn
hospitalizations/yr
50% to 125 specialized
burn centers
50% to other hospitals

Burn Unit Directors and Nurse

Managers will be primary call
points

CONFIDENTIAL-Internal use only

4 Steps to Demo
Customer Needs

DEMONSTRATE: Value Proposition

Confirm Value Prop

Clarify Objections
Product Capabilities

Stakeholder

Value Proposition
Designed to follow CDC Category I recommendations for prevention of
CAUTIs by maintaining a closed urinary drainage system 1

Critical Care Nurse & ICP

Includes a StatLock Foley stabilization device for proper securement of

indwelling catheter to prevent movement and urethral traction
Needle-less system
Convenience & ease of use
Designed to follow CDC Category I recommendations for prevention of
CAUTIs by maintaining a closed urinary drainage system 1

Physicians

Includes a StatLock Foley stabilization device for proper securement of

indwelling catheter to prevent movement and urethral traction
Measurement consistency
Needle-less system
Nursing Convenience / Increased Compliance
One reorder code

Materials Management

Continued cost avoidance

Standardization of vendors

CONFIDENTIAL-Internal use only

4 Steps to Demo
Customer Needs

DEMONSTRATE: Product Capabilities

Confirm Value Prop

Clarify Objections
Product Capabilities

Feature

Benefit
Maintains a closed, sterile urinary
drainage system

Valve Port

Allows for urine cultures while IAP

kit is patient-mounted
Creates a reliable seal

Drain Tube Clamp

Maintains drain tube integrity

Stabilizes catheter to prevent
pistoning and accidental
dislodgement

StatLock Foley
Stabilization Device

Saves nursing time by avoiding

hunting for components and
opening other kits for parts

Convenient,
all-inclusive kit

CONFIDENTIAL-Internal use only

Rationale
Helps meet CDC Category I
recommendations for closed system1
Maintains system functionality

Ensures measurement consistency

Reduces likelihood of urethral

irritation and enhances patient
comfort
Avoids unnecessary delays in
obtaining measurement
May aid in improving nursing
compliance

Why Use Bards IAP Monitoring Device?

Literature suggests IAP monitoring may improve patient outcome2.
Our devices provides a better way that addresses the concerns of:

Increasing the risk of UTIs from opening

the system to measure IAP:

Nursing Time:

Our kit requires less set up steps

Our kit standardizes materials & methods to
ensure measurement consistency

inconsistent measurements:

Urethral irritation from traction on the

Foley catheter:

Poor in-service and training for a

complex device:

Our kit does not require breaking the system

Our kit provides better securement

(StatLock Foley vs. Tape)
Our kit comes with the service and support
from BMD TMs vs. distributor reps

CONFIDENTIAL-Internal use only

Competition

CONFIDENTIAL-Internal use only

The Majority of Users Use Readily Available

Components to Measure IAP

Manual
Palpation
15%

Source: AACN Attitude and Usage Survey, fielded by BMD May 2005.
N= 60 Base : Respondents who are current users of the procedure

CONFIDENTIAL-Internal use only

IAP Monitoring Competition

There are a limited number of solutions for IAP
monitoring:
Not available
in the US

Fluid
FluidColumn
Column
Manometers
Manometers

Modified
Modified
NG
NGTubes
Tubes

Ad-hoc
Ad-hocKits
Kits

Specialized
SpecializedKits
Kits
(Wolfe
(WolfeTory)
Tory)

CONFIDENTIAL-Internal use only

Home-made Kits
Assembled kits that utilize tubing, stopcocks, syringe, saline and
transducer to infuse saline into the bladder and measure Intraabdominal Pressure
Home-made assembly:
Transducer
2 stopcocks
1 60 ml syringe
1 tubing with saline bag spike / Luer connector
1 tubing with Luer both ends
1 needle / Angiocath
Clamp for Foley
Assembled in proper sterile fashion
Source: Abdominal-Compartment-Syndrome.org - Teaching Materials, Dr. Tim Wolfe Slide Show 6A
http://www.abdominal-compartment-syndrome.org/teaching/slideshow081505_unabridged.ppt slide 72

CONFIDENTIAL-Internal use only

Differentiation vs. Home-made Kits

Risk of bodily fluid exposure from opening system and

system leaks
Measurement accuracy & reproducibility problems
Clinician time to build kits
Consistency of assembly and mounting

CONFIDENTIAL-Internal use only

Wolfe-Torys AbViser and Auto ValveTM

The AbViser system integrates with the patient's Foley catheter, transducer and
monitoring system. Its unique valves allow clinicians to infuse saline into the
bladder and measure Intra-abdominal Pressure.7

AbViser is registered trademark of Wolfe-Tory Medical, Inc.

Auto Valve is a trademark of Wolfe-Tory Medical, Inc.

CONFIDENTIAL-Internal use only

Wolfe-Torys Two Currently Available Models

ABV300

ABV100

CONFIDENTIAL-Internal use only

WT vs. BARD IAP Contents

AbViser IAP Monitoring Kit

Bard IAP Monitoring Kit

AbViser valve or AutoValveTM

Proprietary drain tube clamp

60 ml syringe with double check valve

Valve Port with integrated Culture Port

Tubing and spike for sterile saline bag

connection

30 ml syringe

Tubing and spike for sterile saline bag

connection

Infusion and pressure transducer

tubing with one-way valves

Infusion and pressure transducer

tubing

Zeroing stopcock

Dead-end transducer caps

Zeroing stopcock

Tape to secure urinary catheter to

AbViser valve

Dead-end transducer caps

StatLock FoleyTM Device

Instructions for use

Sterile drape

Instructions for use

CONFIDENTIAL-Internal use only

Differentiation vs. Competitive Kits

Closed System
Valve vs. Sample Port
Piston Syringe
Transducer

CONFIDENTIAL-Internal use only

References
1.

Wong, et al. Guideline for Prevention of Catheter-associated

Urinary Tract Infections. Centers for Disease Control &
Prevention. 1981.

2.

Malbrain, et al. Incidence and prognosis of intra-abdominal

hypertension in a mixed population of critically ill patients: A
multiple-center epidemiological study. Critical Care Medicine.
2005; 33:315-322.

3.

Verispan data analysis by ZS Associates (accessed 5/2006)

4.

The American Burn Association Burn Care Facilities Directory

(accessed 6/2006)

CONFIDENTIAL-Internal use only