Pressure of blood in the thoracic vena cava, near the right atrium of the heart is defined as central venous pressure (CVP). It reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Central venous access is defined as placement of a catheter such that the catheter is inserted into a venous great vessel. The main great vessels are the superior vena cava, inferior vena cava and brachiocephalic veins. The role of ultrasound (US) has expanded to such an extent in day to day practice that time will come when people will use it as audio visual stethoscope. This chapter includes a brief discussion on advantages and disadvantages of ultrasound, basic principles of central venous cannulation, indications and contraindications of central venous cannulation, specific indications for ultrasound guidance of central venous cannulation, equipment specification, general protocol for central line placement, general consideration for us guided vascular access, US guided vascular access line placement, and documentation.