The authors discuss the real-time ultrasound-guided supraclavicular approach technique to the central vein in pediatric patients. Topics covered include targeting the innominate vein, positioning the ultrasound probe for the skin puncture, and fixing the central vein catheter inserted by the left supraclavicular approach on the left shoulder. Avoiding placement of the tip of the central vein catheter at the anastomatic region during congenital heart disease operations is also mentioned.