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The purpose of our study was to review the rate of pneumothorax following central venous access, using real-time ultrasound guidance.Data related to ultrasound-guided venous puncture, for central venous access, performed between July 1, 2004 and June 30, 2008 was retrospectively and prospectively collected. Access route, needle gauge, catheter type, and diagnosis of pneumothorax on the intraprocedure spot radiographs and or the postprocedure chest radiographs, were recorded.A total of 1262 ultrasound-guided jugular venous puncture for central venous access were performed on a total of 1066 patients between July 1, 2004 and June 30, 2008. Access vessels included 983 right internal jugular veins, 275 left internal jugular veins, and 4 right external jugular veins. No pneumothorax (0%) was identified.Due to an extremely low rate of pneumothorax following ultrasound-guided central venous access, 0% in our study and other published studies, we suggest that routine postprocedure chest radiograph to exclude pneumothorax may be dispensed unless it is suspected by the operator or if the patient becomes symptomatic.