BACKGROUND Central venous catheterisation is a vital intervention in critically ill patients. The proper route of insertion is essential for its success. Objective of this study is to compare procedural parameters and complications associated with anterior and posterior approaches of internal jugular venous cannulation. MATERIALS AND METHODS Our study was conducted as prospective randomised clinical trial in 100 patients posted for elective, emergency surgeries and critically ill patients in intensive care unit. Patients were randomly allocated into two groups of 50 patients each. Demographic data, number of attempts, procedural parameters and incidence of complications were compared in both groups. RESULTS Time for identifying the vein, number of attempts, duration for cannulation and incidence of complications like carotid puncture and haematoma were less in posterior approach when compared to anterior approach. CONCLUSION Posterior approach in internal jugular vein cannulation is safer and it has a better success rate as compared to anterior approach.