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affected

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After a question in the CALS section that I can't answer from experience, I thought I would start a thread and ask here.

I am specifically asking those who have had a RIG insertion instead of PEG - can you explain to me how you are able to use your bipap face mask during the procedure, since all is going down the throat, and how you can actually open your mouth wide and hold it open if you have bulbar issues?

The RIG is being put forward as the better option for PALS here and these questions really have me wondering how it is managed.
 

gooseberry

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Steve had a peg but.....as long as they could keep his o2 sats high enough they did not use the trilogy only oxygen. Perhaps that is the answer.
 

affected

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I think my question really revolves around the patient being awake.

I know there is no way in hell Chris could have held his mouth open without anaesthetic as he had clonus and jaw clamping, and also excessive saliva on any kind of oral stimulation - right from very early in the disease.

Let alone having a bipap connected - as how does a PALS lay flat if they don't have their bipap mask on.

I may be totally misinterpreting everything about how the procedure is done, but aussies concerns made me really think about the difference between the procedures and I'm trying to figure how any bulbar PALS could possibly have a RIG done.
 

Nikki J

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My sister had a RIG but we never discussed the actual procedure. I don't understand the reason why mouth needs to be open. For a RIG there is a nasogastric tube and fluoroscopy, I am virtually certain not CT scan as Aussie said at least in the US but Ct scanner would not seem practical. The radiologist needs to be able to access the area and see what s/he is doing in real time I think with the ng you would have a little leak but could still use a mask though probably not nasal pillows

I hope someone can share their experience who has had one
 

affected

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Thanks Nikki, I'm really curious now as to how it has been done in any PALS here that can explain. Not just for my curiosity but so we can really help people making this decision by knowing just how it all happens.

If it is done NG that would make far more sense to me!
 

Nikki J

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They use the ng to instill air into the stomach to make it larger and more accessible
 

affected

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But they pass the tube through the mouth?
Or they inflate the stomach and then just place the tube from the outside in, rather than a peg where they go in through the mouth with an endoscope?
 

Nikki J

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Through the outside. They see the stomach radiologically use local anesthetic and place the tube. The ng is there to inflate the stomach. That is why I do not understand why it would be necessary to have the mouth open
 

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I think the whole thing about the mouth open is my misunderstanding of the procedure, as with the peg (which Chris had) the mouth has to be kept propped open as there is an endoscope in place.

But it seems that as this is not done, I can see that mask can be over the face for the bipap, even if they have to tape a bit to prevent leakage where the NG tube goes under the mask, and the mouth isn't involved.

Still would love to have any PALS that had a RIG placed tell us a bit about the details, because I would really like us to be able to give correct information to those considering!

Thanks for that link Nikki :)
 

Diane H

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Just to clarify, RIG is the same as a PRG, with the RIG being the commonly used name in England and other countries. PRG is is the name used in the United States.
 

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@Diane - PRG? I haven't heard that term?
 

Nikki J

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I wonder if it is regional? I have heard RIG here but maybe both are used in my area and I just haven't heard
 

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My hubby had a feeding tube inserted through interventional radiology. He had an ng tube inserted through his nose and a wedge was used so he didn't need to lay flat. I believe that once that ng tube was inserted he was able to use the trilogy during portions of the procedure. They took the trilogy with them into the radiology room--he used it after the ng tube was inserted and I was there for that portion. I never asked for other specifics, but will ask him. They gave him a small amount of Versed for medication, but no other anesthetic.
 

Diane H

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PRG, Percutaneous Radiographic Gastrostomy. The nasogastrictric tube used to inject barium/air is quite small, and is softer and flexible. It can be put through the mouth (swallowed) or through the nose. A BiPAP nose mask would need a bit of tape to seal any leak it caused. The endoscopy tube is a friggin’ garden hose by comparison so you are zonked when they put it in, and, from my two experiences with it, no memory of it when you wake up.
 
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