Purpose This study aims to analyze the narratives of growth during the initial stages of development of the medical device technological innovation system (TIS). This paper used micro/nanofluidic-based point-of-care testing (mnPOCT), a breakthrough technology in the health-care sector. Design/methodology/approach This study presents a framework that includes measures of knowledge breadth and sharing mechanisms based on cognitive and actor-based networks. The framework integrates bibliometric, network and statistics-based approaches with a focus on the first decade of mnPOCT development. Findings In addition to the typical patterns of technological emergence, the mnPOCT sector exhibits distinctive characteristics. This paper observed significant scientific content and a high geographic concentration. Although small- and medium-sized enterprises, particularly startups, detonate knowledge development, large companies play a subtle yet impactful role as innovation mediators. Interfirm alliances are sparse, reflecting the complementarities between startups and large firms throughout the innovation value chain. These alliances show a significant correlation with SME knowledge creation. Research limitations/implications This study provides researchers and practitioners with guidelines for assessing the dynamics of the growth of technologies in the earliest stages of growth through knowledge and implications for research strategy toward the development and deployment of effective system interventions. Originality/value The study of formative TISs presents challenges because of the nascent characteristics and uncertainties surrounding emerging technologies. Current discussions on the narratives of growth of emerging TISs are limited to broad descriptions, which hinder understanding of these formative stages. This study offers a unique approach to assessing the initial stages of technological evolution. Moreover, it contributes to the existing literature by providing guidelines for managing new technologies for R&D researchers and practitioners.