Aim and background: Central lines are an integral part of resuscitation in a collapsing patient in the emergency department (ED). The common sites for insertion of central venous access are the internal jugular vein, femoral vein, and subclavian vein. The most frequently encountered complications in internal jugular access are pneumothorax, carotid artery puncture and cannulation, guidewire entrapment, and hematomas. Case description: We present a case of a 60-year-old female with arch of aorta cannulation leading to brachial artery thrombosis and limb ischemia. Conclusion: Arch of aorta cannulation and acute limb ischemia are vascular emergencies. Proper evaluation of landmarks, positioning of the patient, use of ultrasound-guided approach, correlation of arterial/venous blood gas analysis, proper anatomical acknowledgment on chest radiography and waveform analysis may prevent complications. Clinical significance: The complications associated with aortic cannulation increase the risk of stroke and arterial injury, which can further lead to complications such as hematoma formation, pseudoaneurysm, fistula, and even death. Manipulating the aorta during cannulation can cause a tear in its layers, leading to aortic dissection. We need to remember that accidental arterial puncture occurs in a small percentage of cases during jugular or subclavian approaches for central venous catheter (CVC) placement. While CVCs are essential for various medical purposes, proper technique, vigilance, and awareness of potential complications are crucial for patient safety.