POCUS has the potential to make procedures safer and more efficient by reducing the duration, the number of attempts, and complication rates Ultrasound can be used as an adjunct either before the procedure to identify landmarks and important anatomic structures (static technique) or during the procedure (dynamic technique), allowing for real-time guidance CENTRAL AND PERIPHERAL VENOUS CANNULATION POCUS is an important aid in obtaining intravenous (IV) access for difficult peripheral IV cannulation and for all cases of central venous (CV) access Ultrasound allows clinicians to identify the intended vein for cannulation and to differentiate veins from nearby anatomic structures such as arteries and nerves Of note, most superficial peripheral veins are not paired with arteries However, deeper veins like the brachial veins and veins used for central access, such as the femoral and internal jugular, have arteries alongside them Central Venous Cannulation Central vascular access is among the most commonly performed ultrasoundguided procedures The Agency for Healthcare Research and Quality has stated that ultrasound for CV access is a clear opportunity for safety improvement and listed it as one of the “Top 11 Highly Proven” patient safety practices It is considered standard of care according to multiple subspecialty policy statements and published international evidence-based consensus recommendations In adults, POCUS for central line placement increases success rates and decreases procedural complications Similar reports exist in the pediatric population In a recent meta-analysis, US-guided CV placement decreased the number of attempts and improved success rates The evidence in both the adult and pediatric population, along with the generalizability of the procedure, suggests that ultrasound is a necessary skill for the practitioner who places CV lines in children Technique The sonographic technique for identifying vessels is similar whether placing a peripheral IV or a CV catheter A high-frequency linear transducer is the probe of choice Relevant anatomy for the particular site chosen (femoral, internal jugular) should be reviewed Preprocedure steps are important to maximize success, including adjusting the height of the bed, positioning the patient, positioning the ultrasound machine, and having equipment and extra personnel ready for assistance For CV access, aseptic technique should be used with sterile probe covers and sterile gel (if probe covers are unavailable, a sterile glove will suffice)