The availability of ultrasound (US) devices has refined techniques for vascular access. The resident trainee's ability to learn US techniques depends upon device availability, skills, and motivation of instructors. We hypothesized that hands-on teaching program of US techniques for vascular access would have a positive impact on the trainee's perceptions. After IRB approval, PGY3 anesthesiology residents with limited prior experience in US-guided vascular access underwent close supervision by attending staff as they performed US-guided Internal Jugular Vein (IJV) central line placements. A total of 66 land mark (LM) and 75 US-guided IJV cannulation performed by 19 residents were supervised. Residents completing the study were more proactive with 68.4% agreeing to use US based techniques for an anticipated difficulty in accessing central lines. The graduating residents involved in the study all strongly agreed that US imaging for vascular access was within the scope of practice of all anesthesiologists, and that training guidelines be established and incorporated in their practice. Fifty eight percent of residents stated that their confidence and skill levels had significantly improved. Teaching US-guided techniques resulted in an increase employment of such techniques by graduating residents with no impediment attributed to knowledge deficits or inexperience. Residents were more proactive with using US for anticipated difficulty in IJV placement. A short neck, poor landmark, anticoagulation, morbid obesity favored US use by residents. Systematic teaching of US techniques is justified as it significantly improves the resident's perceptions and confidence.

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will likely perform a limited number of described techniques; the physician who inserts continuous nerve catheters, for example, may not perform elbow steroid injections for chronic pain. Nevertheless, the text is a useful addition to the library of any physician who uses, or aims to use, ultrasound to perform pain-management related procedures. Admirably, the text acknowledges the real limitations of sonography, including limited resolution and artifacts, and it effectively compares ultrasound use with current imaging modalities for each technique. It urges physicians who use these techniques to seek formal mentorship so ultrasound enhances safety and so the recipients of these approaches are helped-and are not harmed-by the ever-expanding application of this technology. Both patients and providers would benefit from a more rigorous examination of the education and training required to demonstrate competency in these techniques. To that end, a useful addition to the text would be an interactive media component to facilitate learning the complex multidimensional anatomy at hand. Inclusion of such would only enhance the 'atlas' designation of the text.