Inclusion Criteria:  · Adult patients who need vascular access (arterial or venous)  Exclusion Criteria:  · Patients with local infection in the area targeted for vascular access.  Patients with severe generalized infection and other skin diseases or lesions. patients with history of DVT of the target vein and or pulmonary embolism. Patients with untreated coagulopathy (INR >1.5 or platelets <50000mm3)