We report a case of hemoptysis occurring after subclavian vein puncture for pacemaker implantation. Hemoptysis related to injury of lung parenchyma is a rare complication of subclavian vein access and is usually self limited, but can affect prognosis in critically ill patients. Venogram-guided or even better wire-guided venous puncture allow safe access to the subclavian vein in difficult cases. A review of the pertinent literature is also presented.