A case of ESRD on HD who is referred for placement of tunnel hemodialysis catheter insertion because his arterialvenous fistula is still immature to be used for HD. He had had 3 TDC placed in the right IJ on previous occasions. His angiogram revealed stenosis of the internal jugular vein at its junction with subclavian vein. After 3 failed attempts at right internal jugular vein cannulation the Supraclavicular approach of the SCV cannulation was achieved with ease overcoming the stenosis in the right internal jugular vein. The case is 68 years Caucasian male with end stage renal disease secondary to renal cell carcinoma and hypertension. He had three tunnel hemodialysis catheters (TDC) placed in the right internal jugular vein and failed radialcephalic arterial-venous fistula in the left forearm. He had recently placed brachial-cephalic AVF in the left arm which was not matured to be used in HD. He was referred to the Dialysis Access Center of Pittsburgh, PA for placement of right internal jugular vein tunneled hemodialysis catheter. Three attempts were made to place TDC in the right IJ vein were without avail due to stenosis in the origin of the right IJ at its junction with the sub-clavian vein as illustrated in the angiogram. A decision was made to place the TDC using the supra-clavicular approach as described below to overcome the stenosis in the right IJ. The procedure was accomplished without difficulty using the ultra-sound- guided cannulation of the subclavian vein and the supra-clavicular approach. Supraclavicular placement of tunnel dialysis catheter is easy and safe method to overcome stenosis in the internal jugular vein.