This meta-analysis evaluates the clinical effectiveness of ultrasound-guided central venous cannulation compared to the anatomical landmark method. The study included 18 randomized controlled trials involving 1646 participants. The results showed that real-time two-dimensional ultrasound guidance significantly reduced the failure rate and complications associated with central venous catheterization, particularly for the internal jugular vein in adults. Limited evidence also favored two-dimensional ultrasound guidance for subclavian and femoral vein procedures. Doppler ultrasound guidance was more successful for internal jugular vein cannulation but less so for subclavian vein procedures. The study concluded that two-dimensional ultrasound guidance is more effective and safer for central venous access, leading to reduced complications and faster access. Economic modeling indicated potential savings for the NHS due to fewer complications and reduced time spent on successful cannulation.This meta-analysis evaluates the clinical effectiveness of ultrasound-guided central venous cannulation compared to the anatomical landmark method. The study included 18 randomized controlled trials involving 1646 participants. The results showed that real-time two-dimensional ultrasound guidance significantly reduced the failure rate and complications associated with central venous catheterization, particularly for the internal jugular vein in adults. Limited evidence also favored two-dimensional ultrasound guidance for subclavian and femoral vein procedures. Doppler ultrasound guidance was more successful for internal jugular vein cannulation but less so for subclavian vein procedures. The study concluded that two-dimensional ultrasound guidance is more effective and safer for central venous access, leading to reduced complications and faster access. Economic modeling indicated potential savings for the NHS due to fewer complications and reduced time spent on successful cannulation.