Standard central access for lung transplantation includes a right internal jugular Cordis with pulmonary artery catheter and a left subclavian central line. Left-sided access preserves the right IJ for possible ECMO cannulation. Ultrasound guidance for subclavian access reduces complication rates, particularly for inexperienced operators. Common complications such as arterial injury and iatrogenic pneumothorax can lead to major instability if not recognized.