Vascular access involves central and peripheral vein accesses and arterial accesses. Central venous catheterization is widely used in clinical practice for diverse purposes, including hemodialysis for end stage renal failure, invasive hemodynamic monitoring, radiological studies, infusion of drugs that cannot be administered via peripheral vessels, administration of parenteral nutrition, vascular access in patients whose peripheral veins are difficult to be catheterized and for miscellaneous purposes that require access to large caliber vessels.

Arterial cannulation is used for invasive arterial pressure monitoring and to ensure access for diagnostic and therapeutic interventions.

In the United States and United Kingdom, guidelines have recommended the use of ultrasound guidance to reduce complications and improve success in central venous catheterization.

Inclusion Criteria:

• · Adult patients who need vascular access (arterial or venous)

Exclusion Criteria:

• · Patients with local infection in the area targeted for vascular access.

  • Patients with severe generalized infection and other skin diseases or lesions.
  • patients with history of DVT of the target vein and or pulmonary embolism.
  • Patients with untreated coagulopathy (INR >1.5 or platelets <50000mm3)