Central venous placement in the superior thoracic orifice can be performed safely and effectively by familiarizing oneself with the anatomy and following sound principles. The subclavian and internal jugular veins converge medially at the anterior border of the superior thoracic orifice to form the right and left cephalic brachial veins behind the sternal stalk, and the two cephalic brachial veins converge to form the superior vena cava. The second rib meets the sternal angle and corresponds to the midpoint of the superior vena cava, and the third rib corresponds to the superior vena cava-right atrium junction. The ideal location of the catheter tip is between the 2nd and 3rd ribs, which can be used to estimate the depth of catheter insertion. Knowing the approximate course of the vein, the operator can make a single stroke. Each failed puncture increases complications, and extravasation of blood and hematoma formation compressing the vein also make puncture more difficult. The first puncture has the highest success rate. Venipuncture at the junction of the middle and outer third of the clavicle along an imaginary vein course has a high success rate. The end of the axillary vein lateral to the costoclavicular ligament is the ideal entry point. If the subclavian vein is entered too close to the proximal end, the catheter is easily squeezed by the clavicle and rib cage, with the risk of fracture and central embolism. Subcutaneous puncture should consider needle length and vein depth to ensure adequate entry depth into the vein. Two key angles are necessary for three-dimensional positioning: the angle of entry along the vein in the frontal plane and the angle of entry in the transverse plane, which must be mastered with an understanding of the relationship between the subclavian vein and the skin. The subclavian vein is located posterior to the inner third of the clavicle and is at least 2 cm deep subcutaneously (in lean individuals). The subclavian vein is located at the anterior border of the 1st rib, and because the 1st rib crosses the clavicle posteriorly, the subclavian vein crosses the 1st rib posteriorly. It can be seen that there is no subclavian vein between the 1st rib and the clavicle, only the costoclavicular ligament and subclavian tendon occupy it. Accurate puncture of the end of the axillary vein requires the needle tip to be at an angle of approximately 30 degrees to the frontal surface and to follow the course of the vein on the frontal surface. Therefore, the actual direction of needle insertion is directed toward the 1st thoracic vertebrae located at the inner edge of the superior thoracic orifice, with slow insertion and maintenance of negative pressure, stopping once the anterior wall of the vein is punctured to avoid injury to deep structures. This method increases the success rate of the first puncture. A study of the anatomy of the internal jugular vein revealed that there is a small incision at the supraclavicular margin about 0.5 cm medial to the head of the sternocleidomastoid muscle, where the internal jugular vein passes and joins the right subclavian vein, making the internal jugular vein easy to puncture successfully.