-Case Reports-

Use of a Compact, Lightweight X-ray Unit to Reduce the Risk of Five Invasive Procedures in the Emergency Room

Yutaka Igarashi¹, Shimpei Ikeda^1,2, Kunio Hirai³, Naoki Tominaga^1,4, Taiki Mizobuchi¹, Kenta Shigeta¹, Hiromoto Ishii¹ and Shoji Yokobori¹

¹Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
²Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
³Division of Radiological Technology, Nippon Medical School Hospital, Tokyo, Japan
⁴Department of Emergency and Critical Care Medicine, Saitama City Hospital, Saitama, Japan

Background: Many invasive procedures performed in the emergency room (ER) have potential risks and complications. Because of their limitations, in particular size, portable X-ray devices are generally not used during such procedures. However, miniaturized units enable physicians to obtain X-ray images without assistance.
Methods: We developed a safe, compact, and lightweight X-ray unit that was used during five invasive procedures in the ER. In all procedures, a chest X-ray image was obtained, to confirm the utility of the unit.
Results: Case 1 (central venous catheter placement): After needle and guidewire insertion and catheter placement, the location of the catheter could be confirmed. Case 2 (chest tube insertion): During insertion of a chest tube into the pleural space, the tip of the thoracic tube was confirmed to be at the correct location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, the guidewire was visualized in the right main bronchus and was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach.
Conclusions: The portable X-ray unit improved medical safety during invasive procedures frequently performed in the ER.

J Nippon Med Sch 2022; 89: 555-561

Keywords
thoracic radiography, complications, central venous catheters, chest tubes, tracheotomy

Correspondence to
Yutaka Igarashi, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
igarashiy@nms.ac.jp

Received, March 7, 2021
Accepted, August 4, 2021