Establishing venous access in the Emergency Department (ED) or Intensive Care Unit (ICU) can be challenging. Trauma, burns, obesity, may dramatically decrease the peripheral or central veins available for cannulation. The axillary vein (AXV), a large vessel traditionally used for insertion of pacemaker leads, offers an additional, valuable, but widely unacknowledged, insertion site for central catheters. The AXV is renamed to subclavian vein after the outer border of the first rib, and its cannulation encompasses several advantages compared to the use of a subclavian catheter, the main one being that it is performed under real-time ultrasonographic guidance. We present a case of a multiple trauma patient who required external fixation of pelvis and insertion of chest drain due to a large pneumothorax in the ED; the initial CT scan also revealed an unstable fracture of the second cervical vertebra. The patient suddenly became hemodynamically unstable requiring vasopressor support. The presence of pelvic external fixation pins and hard cervical collar hindered access to the femoral and jugular veins respectively; due to the presence of pneumothorax and chest drain, inserting an ipsilateral subclavian catheter using the anatomical landmarks technique was attempted multiple times but failed. Finally, an ipsilateral to the pneumothorax and chest drain axillary venous catheter was safely inserted using ultrasound. Conclusively, the unique characteristics of each individual patient may substantially decrease the sites available for line insertion; the axillary vein is a valuable alternative, especially when cannulation of other central veins is prohibited or has failed.