Well, since nobody else had an opinion on this subject, I think I'll vote for #2. The triple-lumen central venous catheter, this device is a work horse. I don't know how anybody survived in the bad old days before this was invented. It's really a shame that it's so difficult to get surgeons or radiologist to put these things in; when they will obviously improve the outcomes of these critically ill patients.
I had a patient with a coagulopathy. PT 18, INR~2, PLTs 80s. Patient needed emergent surgery. Everybody's hitting the ball back and forth, nothing is getting accomplished. I have the RBCs, the FFP, the Pooled Platelets ready to go but nobody wants to touch this patient with a needle. No periperal IV access.
I called over to the OR and an Anesthesiologist with cajones walked right up to that patient...bam...one stick, clean as a whistle IJ. God bless him. This all happened at 1 o'clock in the afternoon. The patient was in surgery by 5pm. I had each port going with a blood product. The patient survived and left the ICU sitting up.
O_S