Journal of Anesthesia

, Volume 31, Issue 5, pp 789–793 | Cite as

A novel technique for ultrasound-guided central venous catheterization under short-axis out-of-plane approach: “stepwise flashing with triangulation”

  • Toshinori HoriuchiEmail author
  • Chie Okuda
  • Naoko Kurita
  • Ayako Yamaguchi
  • Kazuhiko Kitagawa
  • Masafumi Takeda
  • Keiichi Sha
  • Toshihiro Nagahata
Short Communication


In ultrasound-guided central venous catheterization, there is no standard technique either for the needle tip visualization or for the adequate needle angle and entry to the skin with short-axis view under out-of-plane technique. In the present study, we propose a novel technique named “stepwise flashing with triangulation”, and the efficacy of this technique is assessed. Before and after a didactic session in which the technique was explained, 12 novice residents were asked to position the needle tip on or into the imitation vessels and to avoid deeper penetration by using an agar tissue phantom with ultrasound guidance. “Stepwise flashing” technique was for stepwise visualization of the needle tip, and “triangulation” technique was for adequate needle angle and entry to the skin. After the session, the success rate was increased and a deeper penetration rate was decreased. This technique will help us to facilitate vascular access and to avoid complications in clinical settings.


Ultrasound-guided central venous catheterization Out-of-plane approach Needle tip visualization Stepwise technique Triangulation 



The authors thank all residents (Bun M, Hara T, Higashi Y, Yonezawa H, Yoshizawa H, Fujita N, Fukui Y, Matsuda K, Tsuchihashi K, Uematsu M, Yoneda S, Yoshimura M) who participated in this study.

Compliance with ethical standards

Financial support

Support was provided solely from institutional and department souses.

Conflict of interest

There are no conflicts of interest to declare.

Supplementary material

Supplementary material 1 Video 1 “Stepwise flashing with triangulation” technique. The phantom includes three imitation vessels and the depths of the anterior wall of them from the phantom’s surface were 7, 14, and 21 mm. The needle angle from the skin was from 30° to 45°; therefore, the needle entry should be apart from the edge of ultrasound probe at a distance of 1–1.5 times the depth of anterior wall of the vessel to position the needle tip on the anterior wall of the vessels on the image plane. The dot appears and disappears in turn and it gets close to the anterior wall of the vessel stepwise (MPG 32930 kb)


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Copyright information

© Japanese Society of Anesthesiologists 2017

Authors and Affiliations

  • Toshinori Horiuchi
    • 1
    Email author
  • Chie Okuda
    • 1
  • Naoko Kurita
    • 1
  • Ayako Yamaguchi
    • 1
  • Kazuhiko Kitagawa
    • 1
  • Masafumi Takeda
    • 1
  • Keiichi Sha
    • 1
  • Toshihiro Nagahata
    • 1
  1. 1.Department of AnesthesiaBellland General HospitalSakaiJapan

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