Surgeons are frequently called upon to place central venous catheters for various purposes. With the increasing used of central vein hyperalimentation, these catheters have become quite widely used. Often, critically ill patients require simultaneous infusions of vasopressors, fluids, blood and/or blood products, and hyperalimentation. In patients who have had peripheral intravenous catheters indwelling for king periods, often no peripheral access routes are available. Central venipuncture carries a definite risk of pneumothorax, hemothorax, and arterial puncture. The technique presented here allows the placement of multiple centra1venous catheters via a single venipuncture. Each catheter is a completely separate venous conduit and may be used to infuse any number of substances alone or concurrently with others.Materials needed for this technique are:One 18-gauge Thinwall needleTwo 20-cc Luer tip syringesTwo 16-gauge 8″ or 12″ intravenous cathetersTwo separate bags of infusion fluids and tubingsOne bottle 1% xylocaineTwo .035″ floppy end spring guidewires, 40 cm longOne 8 French percutaneous dilator-introducer kitOne 11 knife bladeOne mosquito curved hemostatSterile towels, gauze sponges, sutures of choice, antiseptic