While there is robust data comparing outcomes for temporary catheters in the ICU based on insertion site, there is a paucity of literature on long-term catheters, which may be subject to different environmental and patient-related factors. Therefore, the purpose of this study was to compare rates of infection and dysfunction for tunneled hemodialysis catheters inserted via the femoral versus internal jugular veins. Review of our procedural database for tunneled hemodialysis catheter insertions in either the common femoral vein or internal jugular vein revealed a total of 544 patients (294 male, 250 female; mean age 55.6 years). Demographic information was recorded as well as presence or absence of comorbidities at time of catheter placement. The date and reason for removal or catheter exchange was ascertained from the medical records. The freedom-from infection or dysfunction intervals were calculated with the Kaplan-Meier technique and compared with the logrank test. Analysis was performed on 409 internal jugular vein catheters and 134 femoral catheters. There was no significant difference between the two groups in proportion of patients with diabetes, HIV, steroids, chemotherapy, or cancer. History of DVT/PE was present in 21% of patients with femoral catheters, vs 14% of patients with IJ catheters (p = 0.08). The median infection-free interval for IJ catheters was 363 days, compared with 174 days for femoral catheters (p = .007). The infection rate was 0.38 per 100 catheter days for the femoral group, compared with 0.20 for the IJ group. The mean dysfunction-free interval was 862 days for IJ catheters vs 520 days for femoral catheters (p = .09). The dysfunction rate was 0.21 per 100 catheter days for the femoral group, compared with 0.10 for the IJ group. The catheter-associated infection rate was significantly higher for patients with tunneled femoral hemodialysis catheters versus IJ catheters but with a similar dysfunction rate. However, the infection rate for femoral catheters is well within the acceptable rate for catheter-related infection.