Introduction
Ultrasound guided vascular access has been described for cardiac implantable electronic device (CIED) implantation for over two decades (1). The growing availability of ultrasound machines in cardiac procedure labs, improvement of imaging technology including the decreasing size of linear probe footprints, and increasing number of published descriptions has aided this technique in becoming a highly coveted skill amongst implanting cardiologists (2-9). Furthermore, there is now randomized trial data demonstrating safety and efficacy in operators who were never formally trained (10) which should encourage more operators to attempt to adopt ultrasound guided access. This step-by-step guide will describe a technique using both short-axis and long-axis ultrasound views and a twisting needle cutting motion, as opposed to the standard jabbing motion, all of which should enhance the efficiency and safety of vascular access for all CIED implants.