Objective:To construct the tunnel-type peripherally inserted central catheter (PICC) catheterization procedure guided by ultrasound and intracavitary electrocardiogram positioning, so as to provide guidance for clinical practice.Methods:From May to July 2021, the first draft of the tunnel-type PICC catheterization procedure guided by ultrasound and intracavitary electrocardiogram positioning was formed through literature review and expert meeting. The convenience sampling method was used to select 18 experts from 8 provinces/municipalities across the country to conduct Delphi expert consultation, solicit expert opinions, and then discuss in groups to determine the final draft of the tunnel-type PICC catheterization procedure. The degree of enthusiasm, authority, and coordination of opinions of experts were expressed by the effective recovery rate of the questionnaire, the ratio of experts who put forward opinions, the expert authority coefficient, Kendall coordination coefficient, and the coefficient of variation.Results:A total of two rounds of expert consultations were carried out. The effective recovery rates of the questionnaires were 90.00% and 100.00%, respectively. The ratio of experts who proposed revisions were 83.33% and 5.56%, respectively, and the expert authority coefficients were both 0.90, Kendall coordination coefficients were from 0.112 to 0.170 ( P<0.05) , and the coefficient of variation was 0 to 0.122. In the second round, the mean score of importance of each level of operation steps was 4.64 to 5.00. The final constructed tunnel-type PICC catheterization procedure guided by ultrasound and intracavitary electrocardiogram positioning includes 4 first-level operation steps, 19 second-level operation steps and 39 third-level operation steps. Conclusions:The tunnel-type PICC catheterization procedure guided by ultrasound and intracavitary electrocardiogram positioning is reliable and of high quality, which has important guiding significance for clinical catheterization practice.

Objective:To systematically evaluate the difference in the clinical effect of tunnel peripherally inserted central catheter (PICC) and non-tunnel PICC.Methods:Computer retrieval of The Cochrane Library, PubMed, Web of Science, Medline, Scopus, China National Knowledge Infrastructure (CNKI) , WanFang, VIP and China Biology Medicine disc was carried out, and the retrieval time limit was from the establishment of the database to December 31, 2021. After quality evaluation, RevMan 5.3 and Stata 15.0 were used for meta-analysis.Results:A total of 3 050 patients were included in 11 articles. Meta-analysis showed that compared with the control group, tunnel PICC could effectively reduce the incidence of catheter related infection [ OR=0.28, 95% CI (0.15, 0.52) , P<0.01], venous thrombosis [ OR=0.18, 95% CI (0.06, 0.55) , P<0.01], blood leakage [ OR=0.30, 95% CI (0.21, 0.42) , P<0.01], phlebitis [ OR=0.48, 95% CI (0.26, 0.88) , P=0.02], the ectopic rate of catheter [ OR=0.27, 95% CI (0.18, 0.41) , P<0.01], and did not increase the incidence of nerve and artery injury [ OR=0.49, 95% CI (0.10, 2.35) , P=0.37]. There were no significant differences in the incidence of catheter blockage ( OR=0.56, 95% CI: 0.20, 1.59) and medical adhesion-related skin injury ( OR=0.57, 95% CI: 0.21, 1.55) between the two groups ( P>0.05) . Conclusions:Subcutaneous tunnel technology can effectively improve the clinical effect of PICC, and has good clinical promotion value. However, high-quality and large-sample randomized controlled trials (RCTs) are still needed to be confirmed in the later stage.

OBJECTIVE：To study the toxic effect of the extract from Tripterygium hypoglaucum on pregnant animal and embryo-fetal development . METHODS ：Successfully mated New Zealand female rabbits were randomly divided into solvent control group，positive control group （cyclophosphamide，20 mg/kg）and T. hypoglaucum extract high-dose ，medium-dose and low- dose groups（15.0，7.50，3.75 g/kg，by the amount of crude drug ）according to their body weight ，with 18 rabbits in each group at least. The female rabbits in solvent control group and T. hypoglaucum extract groups were given water or the corresponding T. hypoglaucum extract solution from 6th to 18th day of pregnancy ，5 mL/kg，once a day. Positive control group was given cyclophosphamide subcutaneously into the neck from 10th to 13th day of pregnancy ，1 mL/kg，once a day. According to the related requirements of Technical Guidelines for the Study of Drug Reproductive Toxicity ，the general situation ，body weight ，body weight increase and food intake of female rabbits were observed and recorded during the experiment ，and euthanasia was carried out on 28th day of pregnancy ；the relative indexes of main organs ，fetal uterus ，placenta uterus ，placenta，ovary，implantation gland ， absorption fetus ，stillbirth，live fetus and corpus luteum were observed and recorded after anatomy ；the relative indexes of body weight，appearance，visceral and skeletal alterations of the fetus were detected . RESULTS ：Compared with solvent control group ， the body weight ，body weight increase ，food intake ，main organs ，pregnancy of pregnant rabbits ，as well as reproductive function，embryo formation ，fetal growth and development ，appearance，visceral and skeletal development indexes in T. hypoglaucum extract groups had no significant abnormal changes （P＞0.05）；above indexes in the positive control group had significant changes （P＜0.05），and significant maternal toxicity and embryotoxicity were found. CONCLUSIONS ：T. hypoglaucum extract 15.00-3.75 g/kg（by the amount of crude drug ）have no significant maternal toxicity ，embryotoxicity or fetal development toxicity to New Zealand rabbits.