Obtaining vascular access for dialysis can be challenging in long-term haemodialysis patients who have exhausted all traditional access sites as a result of multiple catheter placements. Transhepatic dialysis catheter insertion is potentially life-saving for those with access failure. This study aims at evaluating the functionality and safety of transhepatic venous catheters in haemodialysis patients. Eight patients (3 male and 5 female, aged 59+/-17 years ) had transhepatic tunnelled dialysis catheters inserted in our haemodialysis unit in the past 3 years. The insertion method, type of catheter use, functional duration of catheters, maximum blood flow rate achieved, catheter complications and reasons for catheter removal were evaluated retrospectively. A total of eleven transhepatic catheters were placed in eight patients between January 2016 and November 2018. All the patients were on long term dialysis, with a mean dialysis vintage of 160 months. Most patients started with peritoneal dialysis, and switched to haemodialysis after peritoneal failure. The average heamodialysis duration was 85 months (range 14-144 months). Nine catheters were placed successfully (9/11, 82% technical success). Catheter insertion failed due to development of subphenic haematoma in 1 patient and the negotiation of the catheter into the proper venous position was unsuccessful in the other. One catheter was placed under general anaesthesia while the rest were done under local anaesthesia. RetrO® Long-Term Hemodialysis Catheter (BARD Access Systems) was used in 10 out of 11 of the procedures, and Permcath™ (Medtronic) was used in 1 case. Seven of the 9 functional catheters were placed in the portal vein while the remaining 2 were placed in the hepatic vein. The functional duration of transhepatic catheters ranges from 32 to 551 days, with a mean of 298 days. Of the 9 catheters, 2 were still in use at the end of the study (2/9, 22.2%). One patient died with a functional catheter. Six of the catheters were removed(6/9, 66.6%) . Arteriovenous fistular was created in 1 patient, while 3 catheters were removed due to catheter thrombosis (3/9, 33.3%). Two patients were noted to have catheter dislodgement into the pleural cavity (2/9, 22.2%), both presented with shock and haemothorax. Poor blood flow was the most common complication during the use of transhepatic catheters. Catheter revision was required in 2 cases. The maximum blood flow rate achieved for each catheter ranged from 150ml/minute to 250ml/minute, with a mean rate of 186ml/minute. The maximum blood flow rate was below 200ml/minute in 4 of the catheters (4/9,44.4%). Bleeding at the catheter site necessitating hospital admission occurred in 3 cases (3/9, 33.3%), catheter exit site infection occurred in 2 (2/9, 22.2%), but there were no catheter related sepsis. For patients who have exhausted access options for dialysis, transhepatic catheter placement is an alternative with potentially good long-term functionality. However, limitations in blood flow rate, and the high thrombosis rate with the need for high level of maintenance to preserve patency should be noted. Furthermore, physicians need to be cautious about potentially life-threatening complications such as catheter dislodgement.