Objective To evaluate the anatomical factor and risk assessment of right internal jugular vein (IJV) puncture-related damage to the vertebral artery (VA) at different neck planes in pediatric patients.Methods Two hundred and ten pediatric patients of both sexes,aged 6 months-10 yr,with body mass index less than 28 kg/m2,undergoing elective surgery,were enrolled in this study.At the cricoid cartilage plane,supraclavicular area plane and intermediate plane,the right IJVs and VAs were examined using ultrasound.The VA position relative to the IJV,diameters of IJVs and VAs (the diameter ratio of VAs to IJVs was calculated),extent of overlap between IJVs and VAs,and horizontal and vertical distance from VAs to IJVs were recorded,and the risk coefficient of accidental VA puncture was calculated.Results Ninety-seven percent of VAs lay deep and lateral to right IJVs.There was no significant difference in each parameter of VA position relative to IJVs between the three planes (P＞0.05).The diameter ratio of VAs to IJVs was decreased with the decreasing neck plane,the horizontal and vertical distance from VAs to IJVs was significantly shortened,the overlapping rate between VAs and IJVs was increased,and the risk coefficient of accidental VA puncture was increased (P＜0.05 or 0.01).The vertical distance from VAs to IJVs was not correlated with age,body weight or height (P＞0.05).The risk coefficient of VA damage was not correlated with age,body weight or height at the cricoid cartilage plane and intermediate plane (P ＞ 0.05).The risk coefficient of VA damage was positively correlated with the weight of pediatric patients at the supraclavicular area plane (P＜0.05,r=0.215).Conclusion Right VAs come nearer IJVs with the decreasing neck plane;the risk of VA damage increases gradually with the lowering of neck planes in pediatric patients.