• Hyerim Kim, Jee-Eun Chang, Dongwook Won, Jung-Man Lee, Tae Kyong Kim, Seong-Won Min, Chanho Kim, and Jin-Young Hwang.
• Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
• Am J Emerg Med. 2021 Dec 1; 50: 561-565.

ObjectiveHead and shoulder positioning may affect cross-sectional area (CSA) and location of the subclavian vein (SCV). We investigated the CSA of the SCV and the depth of the SCV, depending on the head and shoulder positions.MethodsIn 24 healthy obese volunteers, the short axis ultrasound images of the SCV and adjacent structures were obtained in three different head positions (neutral, 30° turned to the contralateral side, and 30° turned to the ipsilateral side) and two different shoulder positions (neutral and lowered). Images of the right and left SCVs were obtained in the supine and Trendelenburg positions. Subsequently, the CSA and depth of the SCV were measured.ResultsSignificant differences were found in the CSA of the SCV in different head positions (30° turned to contralateral side vs. neutral: -0.06 cm2, 95% confidence interval [CI], -0.10 to -0.02; Pcorrected = 0.002, 30° turned to contralateral side vs. 30° turned to ipsilateral side: -0.16 cm2, 95% CI, -0.22 to -0.11; Pcorrected < 0.001, Neutral vs. 30° turned to ipsilateral side: -0.10 cm2, 95% CI, -0.14 to -0.07; Pcorrected < 0.001). The CSA of the SCV was significantly different, depending on shoulder positions (neutral vs. lowered: 0.44 cm2, 95% CI, 0.33 to 0.54; Pcorrected < 0.001), and body position (supine vs. Trendelenburg: -0.15 cm2, 95% CI, -0.19 to -0.12; Pcorrected < 0.001). However, the depth of the SCV did not differ with respect to head, shoulder, and body positions.ConclusionsIpsilateral 30° head rotation, neutral shoulder position, and Trendelenburg position significantly enhanced the CSA of the SCV in obese participants.Copyright © 2021 Elsevier Inc. All rights reserved.

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