Objective To evaluate the associations of the tip position of right femoral tunneled cuffed hemodialysis catheters with primary catheter patency and catheter-related complications. Methods This single-center retrospective cohort study included maintenance hemodialysis patients who underwent right femoral tunneled cuffed catheter (TCC) placement at the Hospital of Chengdu University of Traditional Chinese Medicine between August 2019 and August 2024. Catheter tip position was determined by postprocedural venography or fluoroscopy and classified as the inferior vena cava (IVC) group (catheter tip positioned within the lumen of the IVC) or the non-IVC group (atheter tip located in the iliac vein or more distal veins). Propensity score matching at a 1∶1 ratio was performed using age, sex, and dialysis vintage as covariates; catheter length distribution was compared after matching. Follow-up data were obtained from outpatient and inpatient records, dialysis-center records, imaging data, and telephone follow-up. The primary outcome (primary catheter patency) and secondary outcomes (catheter dysfunction and catheter-related complications) were compared between the two groups. Results A total of 66 patients were included. After matching, 26 patients were included in each group. In the non-IVC group, 18 patients (69.2%) used 23-cm catheters and 8 (30.8%) used 28-cm catheters; in the IVC group, 10 patients (38.5%) used 23-cm catheters and 16 (61.5%) used 28-cm catheters, and the difference was statistically significant (χ2=4.950, P=0.026). Primary patency did not differ significantly at 1 month (96.2% vs. 100.0%, P=1.000), whereas the IVC group had higher primary patency at 3, 6, and 12 months than the non-IVC group (88.5% vs. 61.5%, P=0.025; 80.8% vs. 50.0%, P=0.020; 57.7% vs. 23.1%, P=0.011). Kaplan-Meier analysis showed a significant difference in dysfunction-free catheter survival between groups (log-rank P=0.013). Catheter-related thrombosis, central venous stenosis, and catheter-related infection did not differ significantly between groups (P>0.05). Multivariable Cox regression showed that height ≥169 cm was a risk factor for catheter dysfunction [hazard ratio (HR)=6.06, 95% confidence interval (CI) (2.02, 18.16), P=0.001], whereas catheter tip placement in the IVC was protective [HR=0.30, 95%CI (0.12, 0.72), P=0.008]. Conclusion In patients receiving right femoral TCCs, tip placement in the IVC may improve primary catheter patency and reduce catheter dysfunction; further prospective multicenter studies with larger samples are needed.