Rig

[pittsburghgal]

A thin nasogastric tube is placed into the stomach through the nose. This is used to administer barium so the stomach can be seen under fluorscopy in the radiology suite. Sometimes a preliminary CT scan of the abdomen is done to exclude any organs overlying the stomach, such as he left lobe of the liver or the transverse colon.

The stomach is inflated with a lot of air through the nasogastric tube so it extends below the rib cage and a smooth muscle relaxer medication is given so the stomach does not move. The stomach is then punctured with a needle and dilators are passed over a guide wire until the opening is large enough to place the gastric tube.

PRG has almost a 100% success rate.

 

[ehd42]

Hi everybody,

I thought you might find the following three websites interesting and relevant.
The first one demonstrates the method used for placing the gastrostomy tube during a RIG. As you can see no endoscope is needed.
The second website describes the Janus mask which can be used to provide NIV during the use of an endoscope or even a bronchoscope so that noninvasive ventilation is possible during these procedures. The third web reference reveals the superiority of a RIG over a PEG.

https://www.youtube.com/watch?v=trZ0p3jrWl4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712032/

https://www.ncbi.nlm.nih.gov/pubmed/23286755


best wishes

Eliot

 

[ehd42]

Hi everybody,

I thought you might find the following three websites interesting and relevant.
The first one demonstrates the method used for placing the gastrostomy tube during a RIG. As you can see no endoscope is needed.
The second website describes the Janus mask which can be used to provide NIV during the use of an endoscope or even a bronchoscope so that noninvasive ventilation is possible during these procedures. The third web reference reveals the superiority of a RIG over a PEG.

https://www.youtube.com/watch?v=trZ0p3jrWl4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712032/

https://www.ncbi.nlm.nih.gov/pubmed/23286755


best wishes

Eliot

Considering this matter, I see no reason why a person undergoing RIG can't use mouthpiece ventilation during the procedure.

ELIOT

 

[bigmark1954]

My mom was in a rest home for several years. In the final year she quit eating and they put a RIG in, thru her nasal passage and down into the stomach. The RIG pumped a high protein semi-liquid automatically throughout the day.

I got the impression it was not meant for long term usage. One major drawback is the diameter of the tube used (under .25 inches).

Disclaimer: I could be completely off base on this, and one of the resident experts will be along shortly an share the actual facts.

 

[affected]

Mark I'm not an expert here but that's a NG - naso-gastric tube.

A rig is a peg that is inserted using xray

We are just trying to define exactly what the procedure is, kind of step by step. It started because a PALS is scared to have it done and I'm not sure if they were given misinformation.

 

[bigmark1954]

Mark I'm not an expert here but that's a NG - naso-gastric tube.

A rig is a peg that is inserted using xray

We are just trying to define exactly what the procedure is, kind of step by step. It started because a PALS is scared to have it done and I'm not sure if they were given misinformation.

OK.......just keepin everybody on their toes.

 

[vw-fl]

Here's another link about the differences between Peg and Rig and how they are inserted Feeding Tubes for Patients with ALS - Massachusetts General Hospital, Boston, MA

vw-fl

 

[lgelb]

Eliot,
Please don't quote extensively from any posts, including your own. It's hard to read for many to read/scroll so much. You can summarize the point that you are amplifying.

There is no reason not to have continuous flow BiPAP for RIGs and in the case series with low FVCs/ NMD it was part of the procedure tested. Even if someone has been using a full face mask, a nasal mask is an obvious option.

It's hard to generalize step by step because terminology seems to vary by country, with some countries doing "RIGs" in the operating theatre. I would definitely want an interventional radiologist who has done these before in MND, as the positioning of the tube given weak muscles in different areas is going to vary as well. From what I can see from literature, though, the concern that FVC decline is a proxy for not being able to place the tube due to "the stomach being in the wrong place" is largely unfounded in experienced hands. We see this in many interventional procedures, that those who are best at it are the most willing and able to "color outside the lines."

 

[affected]

I started this thread in response to what someone was told would be the procedure, which did not seem to quite add up.

Even if procedures vary a little, it would be great if PALS who have had a RIG could tell us about the procedure so that we can help the aussie CALS who is struggling with her PALS and making this decision.

 

[lgelb]

Sorry, Tillie, catching up on a week's worth -- is the decision RIG vs. PEG or to tube at all, or??

mndaust.asn.au has a fact sheet on the RIG in Australia (another example of what seems weird, that they specify several days in hospital, whereas in the States it may be 0 or 1 with no complications). They discuss the fine-gauge tube (thus not precluding PAP) and its taking about an hour.

 

[affected]

Thanks Laurie that fact sheet was really helpful to some of the specific concerns raised originally. (it's in the roll call thread)

We are lucky that they recommend keeping the PALS in hospital for at least a couple of days. It makes sense.

They make sure that they can tolerate a small amount of water about 4 hours post procedure, then a bit more another 4 hours later. They keep them on a drip that whole day and night so they remain hydrated and they keep an eye on the stoma and pain.

Next day they make sure the CALS is really confident with doing the feeds, and the PALS is tolerating them and the dietician visits and does the prescription for the supplements so that you can purchase them cheaper. The stoma nurse also visits and sets up if you need any community nursing help for the first week or so and how to get help from where if the stoma has any issues. If there is any issue, they try different formulae or investigate whatever.

So what it means is if something goes wrong (and usually things are most likely to go wrong in that first 24-48 hours), you are right there, you don't have to call an ambulance or turn up at an ER facing possible hours of waiting.

If you are doing brilliantly the day after they may say you can go home if you want. If you need that extra day of support you have it.

Then you have to remember that we have public health so the procedure and the hospital stay are without financial charge unless you have private insurance and elect to go through a private hospital.

The two times we had the peg changed we were discharged once Chris was fully awake (he elected anaesthetic).

 

[lgelb]

I agree it comes down to support for the P/CALS in the feeding, Tillie, wherever setting it's delivered.

 

[Vincent]

I had a RIG put in last Thursday at Sunnybrook in Toronto. THe procedure went like this; I was given antibiotics and pain meds. NG tube inserted to inflate stomach. They couldn't find my colon so had to inflate me from the other end. My stomach was frozen and a small incision was made in the abdomen and a wire was passed through to my mouth. Then the fun begins. The tube, with a silicone mushroom end, was pulled down my throat and out my stomach. Not a pleasant experience, but over quick enough. Then the external fixation was done. Procedure finished. No food and water for 24 hours. I started out with water and meds, all good. My stomach is still tender but better every day. The only issue i am having is really bad reflux, causing coughing fits. Not good with a weak diaphragm and recent piercing. I hope that improves.
Vincent

 

[affected]

Thank you so much for describing the entire procedure Vince.

I read it twice, and tried to imagine Chris tolerating that with his bulbar issues and couldn't.

I could imagine myself tolerating it, though would rather not

Really appreciate the description.

 

[Nikki J]

Vincent that does not really sound like a standard RIG?? The ng tube yes, but the feeding going from inside out- that is not what I think usually happens. It is inserted from the outside abdomen into the stomach I am virtually certain? As in Eliot's first link. I am not at all disputing what happened to you just wondering if for some reason, even though using radiology, they had to modify the procedure, perhaps because of their difficulty locating your intestines?