Pediatric Ultrasound-Guided Internal Jugular Central Venous Catheter (CVC) Insertion for Chemotherapy Delivery
Yuki Noguchi, MD, PhD; Kohga Masuda, MD, PhD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital

Central venous catheterization is a commonly performed procedure in pediatric surgery, requiring both appropriate device selection and meticulous technique to ensure long-term function and minimal complications. This article reports the technical considerations of tunneled central venous catheter placement in a pediatric patient with neuroblastoma.

A two-year and four-month-old boy with neuroblastoma required central venous access for chemotherapy. Preoperative evaluation confirmed patency of the right internal jugular vein and other central veins. A cuffed tunneled external catheter was selected, as it allows continuous access without repeated needle puncture and is suitable for multi-lumen use, including drug administration and blood sampling. Although routine blood sampling via central venous catheters is not generally recommended, our experience suggests that the associated risks are infrequent and clinically acceptable.

The catheter was inserted via the right internal jugular vein. The anterior chest wall exit site was determined using anatomical landmarks, specifically the triangle formed by the sternal notch, right acromion, and right nipple, with the entry point positioned near its center. Key technical considerations included creation of a broad, curved subcutaneous tunnel to prevent catheter kinking, secure fixation using a cuff with additional circumferential suturing to reduce early dislodgement, and accurate tip positioning at the junction of the superior vena cava and right atrium. In practice, the optimal tip location was estimated as approximately 1–2 vertebral body units below the carina. Careful hemostasis and postoperative compression were performed to minimize hematoma formation.