Clinical complications in patients on hemodialysis who require temporary or permanent catheters can be life-threatening. Since vascular access is highly valuable, the main goal is always to preserve the access site. Losing this access complicates renal replacement therapy and often leads to the development of unconventional access methods and procedures designed as a last resort to maintain treatment. We present clinical cases from the Nephrology Congress of the Latin American Society of Nephrology and Hypertension.