Background: The study was done to compare the technique for internal jugular vein canullation by landmark and ultrasound guided in major sugeries in adult patients. Materials and Methods: Approval of institutional review committee and informed consent were taken. 60 patients of ASA grade II OR III, scheduled for elective major gastrointestinal surgeries, cardiothoracic and vascular surgeries requiring central venous pressure monitoring or central venous access were included in this study and randomly divided in two groups (anatomical landmark group (LM group) and ultrasound guided (US group ) of 30 each. Results: The overall complication rate was higher in the landmark group than in the ultrasound-guided group . Carotid puncture rate and haematoma were more frequent in the landmark group than in the ultrasound-guided group (.The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased time observed in the landmark group. Although there were a higher number of attempts , longer access time, and a more frequent complication rate in the landmark group, success rate was found to be comparable between the two groups. Conclusion: We conclude that use of ultrasound makes cannulation of the IJV a much safer technique, especially in high-risk patients, and leaves almost none to minimal chances of any complications. With experience, expertise and under real-time vision, the contra-indications to a central line insertion are almost nullified