So, what do we do when we don't have ultrasound? Then you're left with the decision to do subclavian or femoral.
Well, ultrasound-guided subclavians are well-described in the literature, and this is an article from our critical care colleagues with 400 subclavian access attempts - half with landmarks and half with ultrasound. Fewer complications, fewer attempts, less time to access. Hard to argue with that. If you aren't getting familiar with ultrasound, I would start thinking about ways to become more comfortable.