BACKGROUNDː The increasing prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) has heightened the demand for central venous catheter (CVC) placement in hemodialysis patients. Two primary techniques—real time ultrasound (USG-RT) guidance and vascular mapping (Mix-method)—are utilized, each with distinct advantages and limitations. USG-RT enhances accuracy and reduces complications, while the Mix-method offers practicality. This study compares these techniques in CVC placement success and complication rates, aiming to optimize patient safety and procedural efficacy in hemodialysis care. METHODSː This cross-sectional study at Dr. Wahidin Sudirohusodo Hospital, Makassar (July 2023 – July 2024) included CKD and AKI patients needing temporary CVC placement. USG-RT and Mix-method techniques were compared for first-attempt success and complications. Data were analyzed using IBM SPSS 25, with Chi-Square and Fisher’s Exact tests (p < 0.05). RESULTSː The Mix-method posed higher risks than USG-RT. Arterial puncture risk was nearly five times higher (OR 4.99, p = 0.00), affecting 87.50% of cases. Hematoma risk was also elevated (OR 3.81, p = 0.00), occurring in 84.60% of Mix method cases. All misplacement cases (100%) were observed in the Mix-method (p = 0.03). Repeated puncture risk (OR 2.35, p = 0.00) was also higher in the Mix method (75.80%). CONCLUSIONSː The Mixed method poses higher risks of arterial puncture and hematoma than USG-RT, while USG-RT has a greater risk of misplacement. Repeated puncture risk remains unclear. Due to greater safety and efficiency, USG RT is preferred. Further research is needed to assess clinical factors affecting CVC placement efficacy.