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We have been using rapid infusion devices like EIDs (Emergency Infusion Device from Arrow not Electronic Infusion Device) or Abbocaths, which can be used as central lines (mainly femoral) but still facilitating rapid infusion of fluids. They are quick to site and effective too mainly at times when you are struggling to get access but can't find or get one!!!

And don't forget IO access for patients in extremis. This has become even more easy with some of the latest gizmos like EZIO, FAST-1 and BIG (already out of fashion!!!)

When your options are limited, venous cut-down could still be the last resort.....