Catheter-related bacteremia is an important source of morbidity and mortality in hemodialysis patients. A number of well-designed, controlled, prospective trials using antimicrobial catheter lock solutions to prevent catheter-related bacteremia have shown a dramatic, statistically significant decrease in not only infection but also mortality related to catheter-related bacteremia. Despite evidence of significant benefit, these locks are not routinely used in the United States. This review describes the epidemic problem of catheter-related bacteremia, reviews recent clinical trials with antimicrobial catheter lock solutions, and discusses current options and potential indications for catheter lock solutions in the hemodialysis population.