The use of totally implantable central venous catheters with reservoir
s has grown steadily over the past few years These systems mitigate ma
ny of the inherent problems associated with catheter systems that prot
rude from the skin. Totally implantable systems are easily cared for a
nd permit activities such as swimming. These features have led many su
rgeons and patients to favor their use. However, some surgeons have re
sisted their use because of the added technical difficulty in placing
the reservoir. The technical problem in seating a subcutaneous reservo
ir can be solved by utilizing the technique described below. It is esp
ecially useful in the pediatric patient, where the operative field is
confined.