Subclavian venous catheterization is common technique for a variety of purposes, but this procedure is associated with complications that include damage to the lung, pleura, thoracic duct, nerve and subclavian artery. We recently encountered a case of the tracheal puncture and endotracheal cuff perforation during the subclavian catheterization in a 67-year-old female who was scheduled for tracheal reconstruction. Tidal volume was escaping from around the endotracheal tube during the subclavian catheterization, however, repeated inflation of the cuff failed to maintain the necessary cuff pressure to seal the trachea. After the operation, by using the fiberoptic bronchoscope and injecting dye into the cuff, we confirmed the site of tracheal puncture and endotracheal cuff perforation which caused by the introducer needle of the central venous kit. We suggest that tracheal puncture and endotracheal cuff perforation be added to the list of complication of subclavian catheterization. This complication should be suspected whenever the cuff pressure cannot be maintained during or after an subclavian catheterization.