Central Venous Catheters (CVC) play a pivotal role when it comes to managing critical patients for Central Venous Pressure (CVP) monitoring and administration of inotropes, pressor agents, blood products, and for frequent blood sampling. Ultrasound (USG) guided central venous cannulation is nowadays a preferred modality, due to lower errors while insertion and lesser complication rates.^[1][2] However, it does not prevent or help to detect catheter misplacement.

We present a case of a 37-year-old female, known case of carcinoma cervix posted for Wertheim’s hysterectomy. After induction of anaesthesia, it was decided to perform central venous catheterization. The right internal juglar vein (IJV) was cannulated with help of USG using the Seldinger’s technique with a 7 Fr double-lumen indwelling catheter. During guide wire insertion, no cardiac arrhythmias were seen. Blood was aspirated from the proximal as well as the distal port of the CVC. However, atrial waveforms were not seen during CVP tracing. This raised our index of suspicion, and a Chest X-Ray was done to confirm the catheter placement. The X-ray revealed only a part of the CVC which was seen retrograde in the ipsilateral IJV, however the tip was not seen. Another X-ray of the neck was done which revealed the tip of the CVC near the superior juglar venous bulb. The catheter was then removed and successful re-catheterisation was done. We postulate that the upward direction of the J-tip guidewire along with trendelenburg position might have contributed to the retrograde IJV cannulation.^[3][4]