The use of ultrasound to guide central venous access has been suggested as one of the most important measures we can incorporate into our daily practice to improve patient safety. Though many physicians have embraced this recommendation, up to 41% do not agree that ultrasound guidance should be the standard of care for placement of central venous catheters in the internal jugular vein. This likely stems from a lack of knowledge of the relevant data as well as unfamiliarity with the technique. This chapter will review the evidence supporting ultrasound guidance for central venous access, review the technique, and suggest a program to allow for sufficient training.