Sir,The article reporting central venous catheter (CVC) misplacements by Venugopal et al. made for interesting reading.[1] I agree that post procedure chest X-ray will remain the gold standard for discovering misplacement at most centres in our country as availability of transesophageal echocardiography for all cannulations even in tertiary care centres is not likely to be feasible in the near future.The authors have described in detail, the correct location of the CVC tip on chest X-ray. I would like to add to their observations.We know that the direction of the J-tip of the Seldinger guide wire influences the path taken by the CVC.[2] It is also known that the guide wire tip may get deflected by any obstruction during its insertion.[3] Factors like a twisted guide wire[3] or a stenosis due to previous catheterisation[4] may contribute to this deflection and ultimately misplacement of the CVC. It appears to me that in the cases numbered 1-5 described by Venugopal et al., guide wire deflection may have been responsible for the misplacements, particularly in those accessed through the central routes.If we keep the J-tip of the guide wire pointing toward the direction that it should take during catheterisation, we can somewhat avoid the misplacement. During guide wire insertion, it will be prudent to feel for any obstruction or change in resistance that may denote change in direction or coiling. However, it takes awareness and experience to develop this feel. A manoeuvre to prevent misplacement of subclavian CVC into ipsilateral internal jugular vein due to guide wire deflection has been described.[5] Manual occlusion of ipsilateral internal jugular vein in the supraclavicular area during guide wire insertion has been found to be effective in preventing such misplacements. Finally, electrocardiography guidance during insertion and image intensifier after insertion, as suggested by the authors, will detect these misplacements quickly and is mostly available.