The permanent central venous catheter (CVCp) for vascular access is increasingly common in patients on hemodialysis. The main problem related to CVCp is the biofilm, which leads to malfunction and an increased risk of infections. In recent years lock solutions for the CVCp have become popular. Heparin should be abandoned because it induces rapid biofilm development and exposes the patient to the risk of bleeding due to overspill of heparin into the bloodstream. Citrate solution (3.8%) is associated with the best risk/benefit ratio for CVC functioning but offers no advantages in terms of reducing infections. The use of hypertonic citrate (46.7%) or antimicrobic solutions (AML) should be reserved for patients with a high incidence of infection and in cases where it is not possible to replace the CVCp. AML should be used for short periods only because of the risk of the development of resistance. The results of ongoing trials will be needed to establish the usefulness of the solution with ethanol. In the correct management of the CVCp, whichever lock solution is used, continuing staff training and widespread application of hygiene measures is of the utmost importance.