Bundling Dural Grafts with EVD and Shunt Lines: A Portfolio Approach

A neurosurgery portfolio approach means offering dural grafts, external drainage and shunt products to the same department as one coordinated line. The same surgeons use all three, often for the same patients. For a distributor this spreads the cost of coverage; for a hospital it means fewer vendors, one documentation set and one manufacturer to call.

DESU manufactures each of these lines in its own cleanrooms: collagen dura membranes such as DURASHEET, external drainage systems such as the EVD-010 Series, the Depus shunt family and catheter kits including the ventricular catheter kit. This article looks at how a distributor can bring them together without turning a portfolio into a pressure tactic.

Why do these lines belong together?

Neurosurgery is a compact specialty. In most hospitals a small group of surgeons covers cranial tumors, trauma, vascular cases, hydrocephalus and a share of the spine work. The patient who has an external ventricular drain placed after a hemorrhage may later need a shunt; the patient who has a tumor resected may need a duraplasty and, if hydrocephalus develops, temporary drainage.

That clinical connection creates a commercial one. The surgeon who chooses the dural graft also influences which EVD system the neuro-ICU uses and which shunt valve is on the shelf. A distributor who covers only one of these lines meets the same people as a distributor who covers all three, but has far less to talk about.

There is also a practical overlap in the products themselves. Drainage systems and shunts rely on the same family of silicone catheters, and DESU’s catheter kits, connectors and antisiphon device sit naturally alongside both. A distributor who understands one part of the range already understands much of the next, which shortens training time for the sales team.

Where is each line used, and who decides?

Each line also involves people outside the OR. EVD systems involve the neuro-ICU nursing leadership and infection prevention. Shunts involve the clinic team that follows hydrocephalus patients and, for adjustable valves, the staff who use the Depus adjustment kit. Dural grafts involve the OR materials manager and the value analysis committee.

How does a portfolio help the hospital?

From the hospital’s side, the benefits are practical rather than dramatic, which is why they are persuasive. Supply chain teams in particular tend to welcome anything that reduces the number of vendors they qualify and manage for a single specialty.

• Fewer vendors to qualify, audit and manage for one specialty.
• One quality system behind several product lines, so certificates and quality documents are gathered once.
• One point of contact for questions about drainage, shunts and grafts, rather than three reps with three schedules.
• Coordinated education: an EVD in-service for the neuro-ICU and a graft in-service for the OR can be planned together.
• A single conversation about supply continuity across products that are all critical to the department.

How does a portfolio help the distributor?

For the distributor, the main gain is that the cost of coverage is spread across more revenue. The rep who visits the neurosurgery department for a dural graft evaluation can also review EVD usage in the ICU and follow up on a shunt case, without making three separate trips.

A portfolio also makes the account stickier. A hospital that relies on one distributor for drainage, shunts and grafts is less likely to switch all three at once, and the relationship has more points of contact with more people. Finally, one manufacturer relationship means one set of terms, one ordering process and one complaint route, which reduces administrative work for the distributor’s own team.

Which line should open the account?

There is no fixed rule, but each line tends to open a particular door.

Leading with external drainage

EVD systems are used frequently and are a recurring consumable. A distributor who supports the neuro-ICU well, with clear in-services on leveling, sampling and transport, earns credibility with nurses and surgeons who see the product every day. That credibility carries over when the same rep later presents a dural graft. The consensus statement on EVD insertion and management published in Neurocritical Care in 2016 is a useful shared reference for those conversations.

Leading with dural grafts

Dural grafts often have a formal evaluation path through value analysis, which gives the distributor a structured reason to meet surgeons, OR managers and supply chain together. A successful graft evaluation creates relationships that can be used to discuss drainage and shunts.

Leading with shunts

Shunt valves carry strong surgeon loyalty and change slowly. They are rarely the fastest way into an account, but a surgeon who decides to evaluate a valve family is usually a deeply engaged contact for the rest of the portfolio.

In practice, many distributors let the account choose the starting point. A short discovery meeting with the department chair or the OR manager usually reveals which line is causing the most friction today, whether a backordered graft, an EVD system the nurses find awkward or a shunt supply gap. Solving the current problem is the strongest possible introduction for the rest of the portfolio.

How do you run a portfolio account day to day?

A portfolio only creates value if it is managed as one account rather than three. That requires a little structure on the distributor’s side.

• One account plan that lists the surgeons, ICU leaders, OR contacts and supply chain contacts for all three lines.
• A shared calendar of in-services, evaluations and contract dates, so that visits can be combined.
• One inventory review covering grafts, drainage systems and shunt components, with expiry dates checked together.
• A single route for product questions and complaints back to the manufacturer.
• A quarterly summary for the department that covers all lines, showing usage, service and open issues.

This discipline is also what makes the portfolio defensible at renewal. The hospital can see, in one document, everything the distributor and the manufacturer have delivered across the specialty.

What should a bundle never do?

A portfolio offer should be a convenience, not a condition. Hospitals have their own contracting rules, and many group purchasing and IDN agreements limit how products can be tied together. A sound portfolio approach follows a few principles:

• Each product must stand on its own clinical merits; no line should be pushed because another one is purchased.
• Pricing across lines should be transparent, so the hospital can see what it pays for each product.
• The hospital should be free to adopt one line without the others.
• Clinical decisions remain with the surgeons and nurses who use the products.

A bundle built this way is easy to defend in a value analysis meeting, because it adds convenience and coordination without asking anyone to compromise on product choice.

Talk to a DESU product specialist

If you serve neurosurgery departments and want to explore how DESU’s dural graft, drainage and shunt lines could form one portfolio in your territory, DESU’s product specialists can help you plan it. Write to sales@desu.tr, use the contact page, or request a quote for the products you want to evaluate.