What is the best next management step for a patient with arm swelling and erythema after PICC line placement?

After a patient has a peripheral inserted central catheter (PICC) line placed and presents with arm swelling and erythema, the best next management step is to perform a duplex ultrasound. This imaging technique is highly effective in evaluating the blood vessels in the affected arm to check for complications such as thrombosis or venous occlusion, which can commonly occur following PICC line placement.

The presence of swelling and erythema raises suspicion for conditions such as superficial thrombophlebitis or deep vein thrombosis (DVT). A duplex ultrasound allows for real-time imaging and can assess both venous patency and blood flow, helping to inform subsequent management decisions.

In this context, while other options like CT angiography may provide similar information regarding vascular anatomy and flow, they are more invasive and not the first-line study for suspected thrombosis in this scenario. Immediate catheter removal could be warranted if there were signs of infection or severe complications, but the ultrasound helps determine the necessity of this action. Anticoagulation therapy is typically not initiated without confirming a diagnosis of thrombosis, making it premature as a first step.

In summary, performing a duplex ultrasound is the most direct and effective way to assess for the underlying cause of the symptoms after PIC