Many dialysis patients rely on tunneled central venous catheters for long-term vascular access. Hemodialysis catheter dysfunction (HCD) caused by intraluminal thrombosis is a common problem often necessitating replacement. We have noticed increasing prescription of thrombolytic therapy for HCD across our health service in recent years. Thrombolytic agents are relatively costly and evidence for their use and cost-effectiveness in treating HCD is sparse. Given budgetary considerations in our health service, we sought to examine this subject by auditing our hospital records. We intended to observe local practices regarding HCD and evaluate whether adherence to standard guidelines improves the efficacy of thrombolysis.