The use of tunneled hemodialysis (HD) catheters as vascular access are not decreased recently, despite of the intensive effort to reduce the catheter dependence. Advanced age of HD patients, comorbid conditions causing difficulty of arteriovenous access creation and the limited life expectancy significantly contributes the long-term use of catheters. Indeed, Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines for vascular access indicated that the long-term use of tunneled HD catheters is acceptable in specific conditions, which includes severe heart failure, over 85 years of age, awaiting living donor kidney transplantation and less than 6 to 12 months of life expectancy. These KDOQI recommendations revealed the epidemiologic trends of aging patients and increasing comorbidity and reflect that the selection of vascular access should be individualized based on end-stage renal disease life-plan. Therefore, careful management of tunneled HD catheter should be needed for the long-term use of catheter and the prevention of catheter-related complication.  The catheter thrombosis and fibrin sheath are the most common complication in the use of long-term catheter. In addition, catheter-related bacteremia, exit-site infection and tunnel infection are frequently observed in patients with indwelling catheters. The long-term placement of catheter within central vein results in the continuous injuries to inner vascular layer and it leads to central venous stenosis. The occurrence of central venous stenosis causes serious outflow disturbance in critical organs and makes the obvious disruption to the next plan of vascular access. In this review, we try to find out how to reduce and manage the catheter-related complication.