Hemodialysis catheter placement, particularly Internal Jugular Catheter insertion, is a very common procedure for patients who require urgent access to renal replacement therapy. Most of these procedures are done under ultrasound guidance as recommended by KDIGO 2019 vascular access guidelines. However, catheter tip misplacement can still occur even in the experts’ hands and despite the use of ultrasound. In this case report, we will discuss a hemodialysis catheter tip placement in the right internal mammary vein and how we managed it.Central venous placement is an important procedure not just for access to hemodialysis patients but also for critically-ill patients, for infusion of intravenous fluids, medications, and central venous pressure monitoring. Over 80% of new hemodialysis patients are initiated with hemodialysis catheters, despite guidelines recommending early planning for arteriovenous access to minimize catheter use . Ultrasound guidance is highly recommended in performing these procedures, but it is not without risks