Category Archives: How to guide

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Removal Of Medium Molecules Makes Dialysis Safer!

Health is the Foundation of Life

Technology, Benevolen, Reverence for every Life

The theme of the 16th World Kidney Disease day is “Living Well With Kidney Disease”. The purpose is to advocate that people should not only pay attention to the symptom reduction, but also actively participate in work and social activities, improve the quality of life and pursue wonderful life in the process of treatment and management of kidney diseases.The latest epidemiological data show that the incidence rate of chronic kidney disease in China is 10.8%. Chronic kidney disease is a life-long chronic disease, which has a serious impact on the health and quality of life of patients. Once patients with kidney disease develop to uremia, they need blood purification treatment to extend their life

Generally speaking, patients with severe kidney disease or those who have been treated with long-term dialysis need more effective treatment to reduce the concentration of medium and large molecules in the blood, among which ß 2-microglobulin is the representative of the medium molecular solute. Since the kidneys cannot effectively clear β2-microglobulin, the accumulation of β2-microglobulin in dialysis patients can cause dialysis-associated amyloidosis, which can lead to death in severe cases.

High-flux hemodialyzer has the characteristics of good biocompatibility, effective removal of medium and large molecules as well as excess water, and can provide ions needed by human body through dialysate to maintain the balance of electrolyte and acid-base in human body. It can clear β2-microglobulin more efficiently, significantly improve the quality of life of patients, reduce the risk of cardiovascular disease, and reduce the occurrence of inflammation.

Precautions in the application of high-flux hemodialyzer: 

1.Reverse ultrafiltration and pyrogenic reaction; 

2. Effect on drug concentration.

Discover our Blood Purification Treatment Series Products on your online product pages.

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Hemodialysis catheter placement guideline

Placement guideline

1) Place the patient in a trendelenberg position (15 to 30 degrees head down) to reduce the chance of an air embolism, turn the patient’s head to the side contralateral to the site chosen.

2) mark puncture site

3) Anesthetize the spot by using needle, the angle between needle and skin shall be 30 to 45 degrees

4) when a flush of blood returns by advancing the needle, insert venous needle.

Remarks: pay attention to the direction of needle and color of blood returns during advancing seeker needle, meanwhile, pay attention to the direction of needle and depth of puncturing needle, the bevel of needle shall be faceup.

5) one hand hold the needle，another hand hold the syringe ,keep the pressure negative during the slow insertion. When you feel the needle placed into the vein, the blood will return smoothly.

6) Guidewire will be inserted through Y shaped syringe or hollow syringe.

Remarks: during the insertion of guidewire，please judge  the resistance , don’t withdraw the guidewire by force, withdraw the guidewire together with syringe if necessary.

7) withdraw syringe, and insert dilator by 1-2 cm under the skin for enlarge the track.

Remarks: During insertion of dilator, attention shall be paid to the direction and the force of dilator, especially the force transferring between dilator and guidewire, the driving force shall be increased gradually

8）Withdraw the dilator, implant the catheter from the end of guidewire, and saline shall be injected into to the catheter immediately.

9）Ensure the whole catheter implanted completely and then fixed the catheter at the final position.

10）Connect with other tubes and devices

Remarks: The force for inserting the catheter is related to enlarging of the track, if the resistance is big, the length of each insertion shall be shorter, and attention shall be paid to avoid kink of guidewire.

Nursing care after placement of the hemodialysis catheter

• check the fixation of catheter if reliable, breeding or not and make sure the catheter is through and the blood flow rate is satisfactory.
• disinfect the puncture site and catheter after each dialysis treatment, flush the catheter with 10-20ml saline, then inject 2-3ml sodium heparin, then, use new heparin cap or needless connector to lock the catheter (in case of serious cruor, increase the use of heparin, even use the original concentration of heparin). fix the catheter with dressing. at the beginning of new treatment, nurse shall withdraw the heparin and saline before connection with blood line.
• the original concentration of heparin can be maintained for 24 hours, while in use of saline and heparin, the catheter shall be flushed each 8 hours.
• The puncture site shall be kept dry and clean, once the dressing is wet or contaminated, it shall be change.
• infection: this is common issue, if the infection not caused by others factors, the catheter shall be removed and do the bacterial culture by using the tip.
• bleeding: bleeding occur at the site, or haematoma occurs, bleeding will become worse after usage of heparin, local compression shall be adopted to stop bleeding, and adjust the usage of heparin, if necessary, remove the catheter.
• thrombus: indwelling time is too long, patient is in the situation of serious cruor, lost of heparin or the catheter is twisted by compression, all these factors may cause thrombus, the catheter shall be removed, or use Urokinase to eliminate thrombus.
• drop off catheter: normally it caused by unfirm fixation or over indwelling time, in this case, detect the integrality of catheter under X -ray, then remove the catheter.
• Leakage of hollow syringe
  • there is difference between front end of hollow syringe and the taper of hub of needle
  • the connection between front end of hollow syringe and the hub of needle is not firmed
  • there is difference between handspike’s rubber and Cylinder
• Leakage of catheter
  • Defective material (outsourcing)
  • Technics of each part’s connection
  • physical damages to catheter during the operation
  • infuse hyperosmotic and corrosive medicine
• Insufficient flow rate:
  • the inside surface of catheter may not smooth or with flash.
  • lumen side become narrow because of over indwelling time and lost of heparin.
  • the puncture site not match the length of catheter
  • the side holes were touched by venous valve (femoral)

If you would like to know more about our hemodialysis catheter product, you can visit our dedicated page:

Link to our hemodialysis catheter product

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Central Venous Catheter Placement guidelines

Clinical use : 3 puncture sites

We can identify 3 puncture sites on the human body for  the central venous catheter.

Clinical use – Comparison

Placement procedure

1) Place the patient in a trendelenberg position (15 to 30 degrees head down) to reduce the chance of an air embolism, turn the patient’s head to the side contralateral to choose the site.

2) mark puncture site

3) Anesthetize the spot by using needle, the angle between needle and skin shall be 30 to 45 degrees

4) when a flush of blood returns by advancing the needle, insert venous needle.

Remarks: pay attention to the direction of needle and color of blood returns during advancing seeker needle, meanwhile, pay attention to the direction of needle and depth of puncturing needle, the bevel of needle shall be faceup.

5) one hand hold the needle, another hand hold the syringe, keep the pressure negative during the slow insertion. When you feel the needle placed into the vein, the blood will return smoothly.

6) Guidewire will be inserted through Y shaped syringe or hollow syringe.

Remarks: during the insertion of guidewire，please judge  the resistance , don’t withdraw the guidewire by force, withdraw the guidewire together with syringe if necessary.

7) withdraw syringe, and insert dilator by 1-2 cm under the skin for enlarge the track.

Remarks: During insertion of dilator, attention shall be paid to the direction and the force of dilator, especially the force transferring between dilator and guidewire, the driving force shall be increased gradually

8）Withdraw the dilator, implant the catheter from the end of guidewire, and saline shall be injected into to the catheter immediately.

9）Ensure the whole catheter implanted completely and then fixed the catheter at the final position.

10）Connect with other tubes and devices

Remarks: The force for inserting the catheter is related to enlarging of the track, if the resistance is big, the length of each insertion shall be shorter, and attention shall be paid to avoid kink of guidewire.

Nursing care after placement of the catheter

Factors which can cause blockage of catheter:

1. Mechanical factors
2. Non-embolism factors
   1. Continuous infusion: the change of body position cause return of blood
   2. Infusion of blodd porducts in case of part of catheter bloced, accumulated fibrin makes lumens smaller, even complete blockage
3. Patient’s factor: blood viscosity increase, blood stasis in vein, return of blood, overtime of measurement of CVP, increase of intracranial pressure, frequent vomit, cough and hiccup.
4. Catheter’s factors
5. The choice of puncturing site
6. Embolism factors
7. Leakage of introducer syringe
8. Leakage of catheter
9. Insufficient flow rate

If you would like to know more about our central venous catheter product, you can visit our dedicated page:

Link to our central venous catheter product

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How to choose a right dressing

Moisture wound healing theory

Moist wound healing is the practice of keeping a wound in an optimally moist environment in order to promote faster healing.

• Favorable for the dissolution of necrotic tissue
  A. Hydrate with exudate to release plasmin
  B. Dissolve the fibrous sheath around small blood vessels and restore normal nutrient exchange
  C. Immune cell chemokines, accelerate debridement

• Hypoxic condition of maintaining local microenvironment of wound

• Help cell proliferation, differentiation and migration
  A. Maintain cell and enzyme activity
  B. Rapid cell migration

• Retention of growth factors in exudates and promotion of their release.
  A. Stimulate the proliferation of fibroblasts
  B. Chemotactic agent for macrophages and neutrophils

• Keep wound temperature close or same as human body temperature:37
  A. The mitotic rate of cells increased by 108%.

• Keep wound moist
  B. No form scab and avoid twice machanical damage.
  C. Avoid exposure of nerve endings to air and reduce pain

• Lower infection rate
  A. Occlusive dressing, block outside microbe.
  B. Moist wound infection rate 2.6%
  C. Dry wound infection rate 7.1%

• The problem of saturated absorption or excessive stickiness of the dressing and staying on the wound:
  • Wound Maceration
  • Dressing leakage
  • Damage surrounding skin

Wound bed preparation

“Complex” wounds

“Wound bed” preparation

• Tissue management
• Infection management
• Exudate management
• Edge of wound

“Wound bed” preparation complete

“Normal” wounds

How to choose a right dressing

Dressings should be selected based on the characteristics of the wound.

Wound type by Color of wound

Black wound: Necrotic tissue lacking blood supply, soft or hard, scabby, with little or no exudate.

Red wound: Granulomatous tissue with healthy blood flow, clean, healing

Pink wound:

• pink epithelial tissues
• The neoepithelial tissue is delicate and in the stage of skin climbing.

Alginate dressing and CMC dressings, which are useful for moderate to heavily exuding wounds, are primary dressings designed for use on wounds with moderate to heavy drainage.
A superabsorbent dressing can be a primary or secondary dressing which manages moderate to heavy wound exudate.
CMC dressing, foam dressing, transparent PU dressing are secondary dressings.
The longer wear time of these dressings minimizes the number of times the wound bed is disturbed which may improve healing outcomes.
Cost effectiveness should always be considered when selecting a dressing, however the least expensive dressing may not be the most cost effective. Longer wear time reduces clinician labor costs, a significant factor in overall wound care costs.
Dressing selection should be based on the needs of the wound to obtain the best outcomes for healing.