After inserting a central venous access device in a malnourished client, what is the immediate next step?

Inserting a central venous access device requires confirmation of the device's correct placement to prevent complications such as pneumothorax or improper infusion. The most immediate next step after the insertion is to verify its position, which is typically done by obtaining a chest x-ray. A chest x-ray allows healthcare providers to visualize the placement of the central line in relation to the heart and major blood vessels, ensuring it is in the correct position, especially in a malnourished client where anatomical landmarks might differ.

This step is crucial because improper placement may lead to serious complications, including vascular trauma or air embolism, which can occur if the line is incorrectly placed or if there is a rupture in the vascular lining. Once the correct placement is confirmed, the healthcare team can safely proceed with further actions, such as starting infusions or monitoring lab values.

In contrast, checking the client's blood glucose level, hanging parenteral nutrition, or infusing normal saline, while part of the care plan following insertion, should only occur after proper confirmation of the catheter's position. If the position is not verified first, there's a risk of complications that could jeopardize the client's safety.