A central venous catheter has been inserted in the right subclavian vein of the client. Which of the following would be the priority nursing action before total parenteral nutrition (TPN) can be started?
A) Assess for swelling, redness, and drainage of the site.
B) Allow the TPN solution warm to room temperature.
C) Call for portable chest x-ray.
D) Assess blood sugar via glucometer.
C
Feedback:
Insertion of a central venous access device in the subclavian can result in an accidental puncture of the pleural membrane, resulting in a pneumothorax. Verification of the insertion site is completed before TPN is started. Swelling, redness, and drainage are symptoms of infection which would not be present immediately following insertion. Hyperglycemia is a common occurrence with the use of hypertonic solutions such as found in TPN, but because the TPN has not been started, this is not a priority assessment. Cold solutions can result in venous spasms but not the priority.
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