Background: Vascular access is critical for hemodialysis (HD) patients. Traditional catheter insertion techniques rely on anatomical landmarks, which correlated with higher failures and increased rates of complications. The procedure's efficacy and safety could be optimized by utilizing real-time ultrasound guidance during HD central venous catheter placement. Objective: The aim of the current study was to evaluate the effectiveness and safety of ultrasound-guided permanent internal jugular vein (IJV) catheterization in serving hemodialysis patients. Patients and methods: A total of 150 patients suffering from end-stage renal disease (ESRD) who had ultrasonography (US)-guided IJV permanent HD catheters implanted in our university hospital, from March 2015 to March 2016 were recruited. Patients were examined for their catheter insertion site, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered high-operative risks. Results: All patients experienced the technical success of the 150 catheters, and 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal-risk group and 72.5% for the high-risk group (P=0.006). IJV cannulation took less time in the normal-risk group compared to the high-risk group (21.2±0.09 minutes vs 35.4±0.11 minutes, P<0.001). No serious complications were reported. Only 4 (6.4%) patients experienced arterial puncture in the high-risk group. Conclusion: A low complication rate and a high success rate are associated with the US-guided placement of a catheter into the IJV, even in the high-risk group.