Central venous catheterization is essential in the management of critically ill patients seen in the Emergency Department (ED). It allows for fluid resuscitation, central venous pressure monitoring, pacemaker placement, and administration of vasoactive medications. Complications such as arterial puncture, hematoma, pneumothorax, hemothorax, and air embolus have been reported to occur in 5% to 20% of patients.1–3 Unsuccessful cannulation has been reported in up to 20% of cases.4,5 Central venous catheterization has traditionally been performed using surface anatomic landmarks as a guide to locate the veins. Catheterization is not always successful using the landmark method due to anatomical variations or obscured landmarks. Other factors such as obesity, shock, dehydration, intravenous drug abuse, congenital deformities, thromboses, and scarring can complicate the procedure. Ultrasound (US)-guided vascular access is widely supported in current medical practice. The use of US guidance for central venous cannulation has been endorsed by several medical societies and supported by numerous trials in the literature. US guidance has been shown to improve cannulation success rates, reduces mean insertion attempts, and reduce placement failure rates.6–11 US guidance allows the Emergency Physician to more precisely locate target vessels and also provide real time visualization of needle placement.