In this presentation, we will review the uses of the handheld ultrasound device to enhance vascular access assessments, and ultrasound guided needling and troubleshooting when clinically managing the arterio-venous fistulas (AVF) and arterio-venous grafts (AVG) for hemodialysis patients. Management strategies of AVF/AVG are evolving to include the routine use of ultrasound guided needle insertion, which has been shown to offer short- and long-term health benefits for vascular access. We will review the use of ultrasound for clinical assessment, and how this tool can both enhance best practice and vascular access safety. The presentation will demonstrate how ultrasound can be used for routine assessment of AVF /AVG pre dialysis to help the nurse with troubleshooting general access problems including needle repositioning needle during dialysis, as well as its use for ultrasound guided needling. The simplicity and ease of use, of a small handheld ultrasound, makes this device easy to learn, handle and use. We will include training tools to assist with developing staff training for routine ultrasound to promote vascular access management and health.