With all due respect to the above posters, don't try US for Subclavian lines. Also, I disagree that any complication will be an open your checkbook type of incident. Presumably your only two immediate technical complications are pneumo, which can be solved with a pneumocath, or arterial puncture, which isn't a big problem if you don't dilate. If you dilate, that's kind of a different problem (not recognizing arterial puncture).
US guided SCV, particularly the supraclavucular approach, is a much more technically difficult procedure, plus, depending on the footprint of your linear array probe, you potentially have to adjust your insertion site which can further complicate things.
Learning how to do US guided IJs will help, too. Learning the muscle memory, way to stabilize your hand, getting smooth with the needle and guidewire, getting comfortable taking the syringe off the needle without letting your needle move, etc will all help.
As above, the appropriate site of insertion and angle are super important. Also, patient selection is quite important. I really like subclavian lines, but they are more difficult on certain patients and US-guided IJ may be more appropriate. As with all procedures, patient position and bed height are are important. If the patients shoulder is in the wrong position and the bed is too low, you're setting yourself up for failure.
Start on the patient's left if you're right handed. It's a technically easier approach. It also gives you the ability to get the line in fairly deep, which I like not having much line outside of the skin.
Ask for someone experienced to watch you. This is invaluable.
Tough lines are a function of millimeters, most novices overadjust when theyre off.
Keep your needle fairly horizontal to the skin. When people are too shallow and angle down instead of dropping the syringe and needle, that's what causes pneumos.
Find someone who already has a pneumo and a chest tube. They're great to learn on.
