A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?

Complications of central venous access include thrombosis and malpositioning. Assessing localized edema requires objective measurement to quantify the extent of the vascular compromise. Nurses must apply the nursing process by performing a comprehensive assessment before implementing interventions or notifying the medical provider. Choice A rationale Measuring arm circumference provides baseline data to evaluate the severity of edema and possible deep vein thrombosis. Comparing bilateral measurements allows the nurse to quantify swelling, which is a critical assessment step before reporting findings to the physician. Choice B rationale Notification is necessary but should occur after the nurse has gathered objective data. Providing the clinician with specific measurements of arm circumference facilitates accurate clinical decision-making regarding potential complications like venous thrombosis or catheter-related mechanical infiltration. Choice C rationale Nurses generally do not remove PICC lines without a specific provider order unless there is an immediate, life-threatening emergency. Early removal without assessment might destroy vital venous access unnecessarily before the underlying cause of swelling is determined. Choice D rationale Cold packs cause vasoconstriction, which might be contraindicated if the swelling is due to a clot or specific medications. Interventions should only follow a complete assessment and verification of the underlying cause of the localized tissue swelling.