errors in SC CVC

Q: All of the following are the common errors while putting subclavian (SC) central venous catheter (CVC) EXCEPT? (select one)

A) improper identification of anatomic landmarks

B) improper needle insertion site

C) too deep a needle trajectory

D) insertion of needle through periosteum of clavicle bone

Answer: C

The objective of this question is to highlight the undue fears and myths associated with insertion of SC-CVC. SC vein continued to be the favored site over the internal jugular (IJ) and femoral to insert CVC (not counting PICCs). 

The biggest fear house-staff encountered while inserting SC-CVC is causing pneumothorax by going too deep in the chest. Due to this fear, one of the most common errors while inserting SC-CVC is keeping too shallow a needle trajectory. The other common errors are as described in choices A, B, and D, i.e., inadequate identification of anatomic landmarks, improper needle insertion site, and piercing the needle through the periosteum of the clavicle.

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Reference:

Kilbourne MJ, Bochicchio GV, Scalea T, Xiao Y. Avoiding common technical errors in subclavian central venous catheter placement. J Am Coll Surg 2009; 208:104.