Objective To explore the application efficacy and safety of oblique ultrasound-guided techniques in PICC puncture，in order to provide guidance and references for clinical application. Methods Through convenient sampling，654 patients from a tertiary A hospital in Zhejiang Province from March to December 2022 were selected as the study subjects. The random numbers were generated through Excel table functions and they were randomly grouped into 3 groups：A，B，and C. The ultrasound short axis method，long axis method，and oblique axis method were employed to guide PICC puncture catheterization，respectively. The success rate of PICC puncture，the number of subcutaneous adjustments of the puncture needle，puncture time，and the occurrence of puncture complications （such as hematoma，puncture of the posterior wall of blood vessels，accidental injury to arteries，and accidental injury to nerves） were recorded during the catheterization process in 3 groups. Results A total of 654 patients completed the study，including 215 in group A，219 in group B，and 220 in group C. The success rate of first-time puncture in the group C（86.36%） was higher than that in group A（73.95%） and group B（63.93%），and there was a statistically significant difference among 3 groups（P<0.001）. The subcutaneous adjustment frequency of the puncture needle was 1（1，1） in group C，1（1，2） in group A，and 1（1，2） in group B. The difference between 3 groups was statistically significant（P<0.001）；the puncture time of group C was shorter than that of group A and group B，and the difference was statistically significant（P<0.001）. There was a statistically significant difference in the puncture time between 3 groups（P<0.017）；the pairwise comparison of the number of subcutaneous needle adjustments and the success rate of a puncture between 3 groups showed that there was a statistical difference between group C and group A，and between group C and group B（P<0.017），while there was no statistical difference between group A and group B（P>0.017）.There was statistical significance（P<0.05） among 3 groups in terms of complications such as accidental nerve injury and puncture of the contralateral vascular wall by puncture needle，but there was no statistical significance in terms of accidental arterial injury and hematoma occurrence among 3 groups. Conclusion Compared with the short axis approach and the long axis approach，the ultrasound oblique axis approach guided PICC puncture has statistical differences in the success rate of a puncture and the incidence of puncture complications，etc. It is recommended to use the ultrasound oblique axis approach during PICC puncture.

Objective To retrieve，evaluate and summarize the best-quality evidence on traditional Chinese medicine nursing for patients with breast cancer-related lymphedema. Methods According to the “6S” model，we used an evidence-based nursing method to retrieve relevant literature. The literature included guidelines，expert consensuses，evidence summaries，clinical decisions，systematic reviews，meta-analyses and original researches. Selected publications were from the earliest date in the database to April 30，2023. There were 2 researchers who evaluated the quality of literature and extracted and integrated evidence from the included articles. Results In total，13 publications were included，involving 3 sets of guidelines，3 expert consensuses，3 evidence summaries，4 systematic reviews. Ultimately，we summarized 16 pieces of the best-quality evidence on the etiology and evaluation of edema，external application of traditional Chinese medicine，traditional Chinese medicine fumigation and washing，moxibustion，acupressure point massage，traditional Chinese medicine diet nursing，and sports guidance. Conclusion Traditional Chinese medicine nursing is an effective treatment for patients with breast cancer-related lymphedema and does not have adverse reactions. However，as the quality of methodology in this study might be not too high，this conclusion may need to be further confirmed by high-quality randomized controlled trials.

Objective To evaluate the quality and analyze the content of existing guidelines related to airway extubation in adult ICU patients,in order to provide evidence-based bases for the formulation of domestic guidelines. Methods Electronic resources,including websites of international guidelines,related organization websites and biomedical databases,were retrieved from inception to August 31st 2021. 2 reviewers independently evaluated the quality of the included guidelines by the appraisal of guidelines for research & evaluation Ⅱ reporting checklist （AGREE Ⅱ）,and then analyzed and summarized the contents of the recommendations of each guideline. Results A total of 8 guidelines were included,4 of which were rated level A and the rest 4 were rated level B. Recommendations involved 7 aspects,namely pre-extubation evaluation,making plans,pre-extubation preparation,implementation of extubation,post-extubation treatment,adverse reaction reduction and the treatment of special groups. Conclusion The overall quality of the included guidelines is high. However,there is a lack of guidelines specifically for ICU patients,and some recommendations are controversial. Local evidence-based guidelines in China should be developed to guide the implementation of airway extubation in adult ICU patients.

Objective To retrieve,evaluate and integrate domestic and foreign evidence on the prevention and nursing care of chemotherapy-induced alopecia in breast cancer patients,and to summarize the best evidence. Methods We systematically searched the evidence in databases such as UpToDate,Cochrane Library,JBI,BMJ,NICE,RNAO,SIGN,ASCO,ONS,MASCC,etc.,for high level evidence on prevention and nursing care of chemotherapy-induced alopecia in breast cancer patients,including guidelines,best practice information sheets,expert consensuses,systematic reviews and evidence summaries. The retrieval period was from the inception of databases to December 2020. Two researchers independently completed the quality evaluation of the included literature,and combining with the judgment of professionals,they extracted and summarized the evidence of the literature which the quality conformed to the standard. Results A total of 18 articles were incorporated,including 9 guidelines,4 systematic reviews and 5 expert consensuses. 19 aspects were summarized,including team building,assessment content,physical prevention,drug prevention,cosmetic,psychological care,health education and other hair changes. Conclusion The best evidence for prevention and nursing care of chemotherapy-induced alopecia in breast cancer can provide references for clinical doctors and nurses,but the best evidence should be selected according to the environment of the department and patients’ preferences. The symptoms of chemotherapy-induced alopecia should be managed in a scientific way,in order to improve the quality of nursing care and the quality of life of patients.