Despite recommendations by various national guidelines advocating arteriovenous fistulae as the access of choice in patients undergoing hemodialysis (HD), the use of central venous catheters (CVCs) remains widespread among both incident and prevalent HD patients. Unfortunately, long-term use of CVCs is fraught with complications, which are a major cause of morbidity and death in this patient population. Complications include a high rate of infections, as well as thrombus and sheath-related mechanical dysfunction. This review addresses prevention and management of noninfectious catheter-related dysfunction.