Radiologically Inserted Gastrostomy (RIG)
- Interventional Radiology
About this procedure
This guide provides information about a radiologically inserted gastrostomy (RIG). It includes details about what is involved, how to prepare and what to expect during and after the procedure. Please use this in addition to information from your doctor and nurse.
A RIG is performed in an interventional radiology suite at IntraCare Epsom. Your interventional radiologist will be assisted by our nurses, and other highly skilled personnel.
Both IntraCare and Allevia Hospital will be involved with your care for this procedure. Allevia Hospital is responsible for your admission, preparation and aftercare.
What is a RIG?
RIG stands for radiologically inserted gastrostomy (RIG), it is a tube that is placed in the stomach and is an alternative means of providing liquid nutrition, fluids and medications when a patient’s condition or medical treatment prevents them from maintaining adequate nutrition through oral intake.
A RIG is inserted using X-ray guidance to guide the tube into the correct position. It is held in the stomach with a balloon filled with sterile water.
Before the procedure
Pre-procedure phone call
A nurse from IntraCare will call you 24–48 hours prior to your procedure to discuss the following information:
- Your admission time.
- When you should stop eating and drinking.
- Medication instructions.
- Allergies (including medications, contrast dye, dressings/plasters and food).
- Answer any further questions.
Fasting instructions
To ensure your safety during the procedure, it is important that you follow the fasting guidelines below:
Food – Stop 6 hours prior to procedure. Do not consume any of the following within 6 hours of your planned procedure time:
- Solid food
- Milk-based products
- Soluble fibre
- Jelly
Fluids – Clear (transparent) fluids are encouraged up to 2 hours before your planned procedure time. These include:
- Water
- Clear juices
- Cordials
- Black tea or coffee
Avoid fluids containing milk, pulp, or jelly.
Sip-Til-Send (STS) Protocol*
- Unless advised otherwise, you can sip up to 200ml of water per hour in the 2 hours before your planned procedure time.
* Your nurse will confirm during your pre-procedure phone call whether this protocol is suitable for you.
Anticoagulation (blood thinner)
If you are taking any blood thinners (e.g. Warfarin, Clexane, Pradaxa, Rivaroxaban), please make this known to IntraCare staff at the time of booking. Your interventional radiologist or vascular surgeon will advise you if you need to stop this medication temporarily for a few days before the procedure.
Other regular medications
Please continue to take these unless advised otherwise by your interventional radiologist or surgeon. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone), you may need to withhold this on the morning of the procedure. It is important that you let us know if you are taking the following medications: Liraglutide (Victoza™, Saxenda™) Dulaglutide (Trulicity™), Semaglutide (Ozempic™, Wegovy™), Tirzepatide (Mounjaro™).
Reminders for the day of your procedure
- If you are on regular medication, please bring this with you in its original packaging.
- Please leave all your jewellery and valuables at home. You are welcome to bring your mobile phone in with you.
- We recommend wearing loose-fitting clothing and shoes that are easy to slip on/off.
- You are encouraged to bring a friend or a family member as a support person before and after your procedure.
- This is an overnight procedure, please bring an overnight bag with you.
- The planned procedure time is an estimate only and may vary. We will keep you informed of any unexpected delays on the day.
Informed consent
As with any procedure, there are potential risks involved. Your interventional radiologist will explain the procedure, discuss possible risks and answer any questions you may have. Your whānau or support person are welcome to be part of this discussion. You will then be asked to sign the consent form. This will occur either at an earlier appointment or on the day of your procedure.
Your procedure
A RIG procedure is performed under conscious sedation and can take 60 minutes.
Preparation
You will be collected by an IntraCare nurse from Admissions Unit (ADU), Allevia Hospital to IntraCare for your procedure. A small intravenous (IV) line will be inserted into a vein in your arm to administer conscious sedation along with Hyoscine Butylbromide, which helps prevent stomach spasms. These medications will help
you relax and keep you comfortable throughout the procedure.
Other devices for monitoring blood pressure, heart rate and oxygen levels will be fitted to ensure your safety during the procedure.
The procedure
You will be positioned on your back on the table. If you do not already have one inserted, a small tube will be placed through your nose into your stomach. This is called a naso-gastric tube and will be used to fill your stomach with air so that it is clearly visible on the X-ray pictures. The interventional radiologist will complete pre-procedure imaging using either ultrasound or fluoroscopy (x-ray) guidance.
The access area (abdomen) will then be prepared with an antiseptic solution before placing sterile drapes around the access site, and over the rest of your body to ensure sterility is maintained.
You will feel the local anaesthetic injections around the access sites, which will sting for approximately 30 seconds then rapidly wears off. If at any time you feel pain, or discomfort, please inform the doctor immediately, and more local anaesthetic can be given.
The interventional radiologist will then pass a thin needle into your stomach using x-ray as a guide. Once the needle is in position, a guide wire will be introduced through the needle into your stomach. The needle is then removed, replaced with a series of small tubes to dilate the passage from the skin into your stomach. The RIG tube is then passed over the guide wire into your stomach once the passage is dilated wide enough. The guide wire is then removed.
Once the RIG tube is in place, it will be secured to the muscles underneath the skin with anchoring sutures (RIG buttons) to prevent the RIG from falling out. Sterile water is then injected into the RIG balloon to help hold the tube in place in the long run.
After your procedure
You will be transferred to Stella Maris ward, Allevia Hospital where you will recover overnight. If appropriate you will be discharged home the next morning.
You will also be reviewed by a Dietitian on the ward before discharge. You will need to be on bedrest for 2 hours post procedure; the nurses on Stella Maris ward will monitor you every 30 minutes for 4 hours.
The Dietitian will give you specific instructions on how to maintain your RIG tube.
Please use this booklet in conjunction with the Allevia Hospital “How to care for your gastrostomy tube” patient booklet.
Recovery and discharge
- Following your procedure, it is important that you do not drive for 24 hours.
- Please ensure you have a family member or friend to drive you home from the hospital, as you may still be under the effects of anaesthesia or sedation.
- You will need to arrange someone to be at home with you on the day of your discharge and overnight to support you in your recovery.
- Due to the sedation, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure:
- Do not do any activity requiring strength, concentration, or full alertness.
- Do not make any legal decisions or sign legal documents.
Exercise/movement
- Do not do any exercises that involve forceful reaching or stretching.
- Avoid participating in any strenuous exercise such as golf, tennis, swimming, or aerobics while you have the RIG in place.
- It is important not lift any heavy objects (>5kg) for 2 weeks.
Follow-up
This will usually be with your oncology specialist or practice nurse, but you are welcome to contact IntraCare with any questions.
Medication
Your interventional radiologist will give you a prescription for pain relief (analgesic) to take home. Please use this should you experience any dull aching pain for the following few days.
If you are on blood thinners, your interventional radiologist will inform you of when you can recommence these.
Procedure site care
The tube will be covered with gauze and transparent waterproof dressings. The Dietitian will give you further care information once you return to the ward post procedure.
You must go to your local emergency department immediately, if you start to experience:
- Increased abdominal pain despite analgesia.
- Feeling faint.
- Fever (temperature greater than 38.5 degrees).
- Bleeding from the puncture site.
Seek immediate medical attention (dial 111 for an ambulance) if there is excessive bleeding from the puncture site or if you are experiencing severe chest pain.
If you have any concerns, please contact IntraCare:
In case of emergency, always call 111.
FAQs
Who do I contact if I have concerns following the procedure?
If you have concerns in the first few days, contact your interventional radiologist, vascular surgeon, or a nurse at IntraCare.
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