When looking at building a sustainable Vascular Access Program/ Vascular Access Team we often get asked “where do we start”? There are 4 things needed to get you started: 1) Formal education, 2) The right gauge and length of catheters (PIV, Midline, PICC/CVC), 3) Max barrier bundles (cap, masks, gowns, gloves, insertion supplies) and 4) The ultrasound. There are many products on the market and deciding on what is best for your facility and budget can be a challenge. We have many years experience with building programs. We know that learning to place vascular access devices under ultrasound is one of the biggest learning curves the inserter will face. We recommend you start with PIV insertion, find a vein that you can visualize and palpate and grab the ultrasound. Get proficient in this skill with PIV devices, then move onto the others. We like to bundle our approach and supplies, standardize our insertion technique and present a cost effective program to our administrators and decision makers.