Central venous catheters are widely used for vascular access and Internal jugular vein is the most preferred site. Traditionally the puncture has been using the landmark technique but recently ultrasound guided puncture has been used. This study was conducted to compare the two methods of access. This was a prospective randomised controlled study conducted between April 2003 and March 2004.Group A patients underwent the procedure with landmark technique while Group B underwent ultrasound guided puncture. A total of 28 patients were included with 14 in each group. There were 5 failures in Group A but all of them had successful procedure with subsequent use of ultrasound. After exclusion of children <2 yrs, success at first attempt in group A (16) was 43.8% with overall success rate of 68.8%. In Group B (13) first time success was 61.5% with overall success rate of 100% (p <0.037). The no of attempts were significantly less in the ultrasound group (p <0.046)