During a central venous line insertion via the right subclavian vein approach, the needle is directed toward the sternal notch. Inadvertent arterial puncture would most likely enter which artery?

• A Right internal carotid artery
• B Right vertebral artery
• C Right brachiocephalic (innominate) artery
• D Right subclavian artery ✓

Explanation

The subclavian vein runs anterior and inferior to the subclavian artery, separated by the scalenus anterior muscle. During subclavian vein cannulation, if the needle is directed too posteriorly or superiorly, it can enter the subclavian artery, which runs in the posterior scalene triangle. The subclavian artery lies posterior to the anterior scalene muscle while the subclavian vein lies anterior to it. Complications include hematoma, hemopneumothorax, and arteriovenous fistula. The right internal jugular vein is the safer alternative for right-sided central access because the thoracic duct is on the left.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.