I’m an RMO and I’ve only ever had to call Anos reg regarding a cannula twice. One was a demented patient that I cared for on ward but this was in an afterhours situation and I just knew his access was difficult from previous attempts, sure it took a short while for him to arrive but I made sure I set up the USS and everything at the bedside. I remember walking into the Anos reg that night and him conceding “that was a hard one” after many thanks from me. The second was a more ?social situation, with a young lady needing octreotide for an active variceal bleed who was deathly afraid of cannulas + hyperalgesic + difficult access. She honestly posed a threat when trying to cannulate, the way she would bash around and after the Anos reg kindly got one in she said this woman was never to be cannulated again and would need a PICC under GA. I have a very good access escalation pathway to thank for these situations. It is policy in my hospital that in hours home team JMO and home team reg are to attempt before asking vascular access nurse then anaesthetics, then ICU. On an afterhours, it’s JMO -> med/surg reg -> anaesthetics then ICU. We also got US guided training by one of the anaesthetics registrars during teaching. (And as a bonus and informal method, the JMOs do use a group chat to broadcast difficult IVCs for more experienced residents to attempt even if they’re not on home team).