In emergency situations or specific clinical scenarios, considering alternative vascular access approaches to secure venous access is often necessary. In modern medicine, knowledge of the available techniques and devices is essential to provide the best therapeutic strategy for the patient. Given these considerations and considering the central role of ultrasound guidance in placing vascular devices, we have analysed contexts in which the standard approach is not feasible. We considered situations involving emergencies or depletion of venous access options, where alternative techniques such as surgical isolation or intraosseous access may be the only viable options. Vascular access for haemodialysis deserves special attention due to the unique characteristics of these patients and the need for specific vascular devices. The goal is to understand the techniques and devices needed to optimise dialysis treatment and enhance patient comfort. By being prepared with a range of vascular access techniques and understanding the indications and limitations of each, healthcare providers can ensure the best possible care in challenging clinical situations.