The primary aim is to assess the length of hospitalization due to iatrogenic pneumothorax as a main complication of totally implantable venous access device (TIVAD) implantation. Secondary aim is to analyze the thrombogenic effects of different catheter diameters on the subclavian vein. Pneumothorax is a rare and may be underestimated, underdocumented, but serious complication in TIVAD of implantation using the subclavian vein puncture method. A total of 1155 consecutive patients with TIVAD implantation were assessed retrospectively over a 14-year time period. As primary outcome the length of hospitalization due to iatrogenic pneumothorax and as secondary outcome subclavian vein thrombosis (SVT) in relation to different TIVAD catheter sizes were analyzed. Pneumothoraces occurred 6 times (0.52%) and only when the subclavian vein was punctured. The median hospitalization for these patients was 8 days (5 of the 6 patients needed a chest drain). No pneumothoraces occurred when a peripheral vein was used for access (980 patients). SVTs were detected in 13 patients (1.1%) without any correlation to the diameter of the catheter. There was no significant correlation detected between the different tumor types and the complication rates. Iatrogenic pneumothorax may lead to hospitalization of 1 week or more. The costs then increase with additional chests x-rays, chest drain insertions, and hospitalization days. When making the choice for surgical venous cutdown or subclavian vein puncture to implant TIVAD, the consequences of iatrogenic pneumothorax should be considered as pneumothorax is a rare but serious complication of TIVAD implantation inherent to subclavian vein puncture.