Purpose Tunnelled dialysis catheters are intended as temporary access, yet in regions with high dialysis demand they frequently become the default rather than a bridge to definitive access. This reliance carries implications for patient outcomes, surgical workload and resource allocation. This study examines tunnelled dialysis catheter insertion over a three-year period at a high-volume centre, aiming to characterise utilisation patterns, access pathways and clinically relevant outcomes. Methodology A retrospective review was undertaken of all tunnelled dialysis catheter insertions performed over a three-year period at a tertiary hospital servicing a high dialysis-burden population. Data collected included patient demographics, indications for catheter insertion, insertion site and setting, operator specialty, early complications, catheter dwell time and progression to definitive vascular access, including arteriovenous fistula or graft formation. Descriptive analysis was used to identify practice patterns and potential areas for service improvement. Results Tunnelled dialysis catheters were widely utilised for both urgent dialysis initiation and ongoing access in patients without immediate alternatives. Preliminary review suggests prolonged catheter dependence in a substantial proportion of patients, reflecting access delays, patient comorbidity and system constraints. While major procedural complications were uncommon, catheter-related morbidity remained clinically relevant. The procedural volume highlights the significant and sustained surgical workload associated with catheter-based access in high-demand settings. Conclusion: Prolonged permacath use was common in this cohort. While no association was observed with age or diabetes, prolonged catheter dependence was associated with delays in access creation and progression through the access pathway. These findings suggest that factors beyond patient characteristics may contribute to extended catheter use. In this context, tunnelled dialysis catheters may not consistently function as short-term bridging access and, in some cases, may represent an initial or sustained mode of dialysis access. Further work is required to better characterise where delays occur within the access pathway and to determine whether targeted system-level interventions may reduce catheter dependence and improve patient outcomes.