PEG and RIG

[Guest]

Could someone please explain the difference between a PEG and a RIG to me? My husband is going for an assessment next week with a view to having a feeding tube fitted in the very near future. I would like some info as to which of the two procedures is better to have. Thanks.

[Terry]

Hi SR8;

They both do the same job and can look very similar from the outside.

A RIG is put in from the outside and a water filled little balloon holds it in. They are normally changed about every 4 months and the balloon water is changed every week which is quite simple. The nurse will charge the tube.

In a PEG opp, the tube is put in from the inside, it has a plastic stopper to stop it coming out and there is vertualy no maintaince. The tube stays in for about 2 years and then easily replaced with a RIG tube.

I believe that a PEG is a bit better in a few ways but they won't normally do it if they think that the breathing is not so good. A RIG can be done when breathing is poor and is a common opp for us with MND.

Love Terry

[Ellie]

Hi S,

This link is good at explaining the difference between the PEG & RIG procedures in feeding tube placement.

https://www.ouh.nhs.uk/services/departments/neurosciences/neurology/mnd/support/peg-rig.aspx#top

If you want more info on what having a feeding tube entails, an ALS/MND-specific site is http://mytube.mymnd.org.uk/

Love Ellie.

[SR8]

Thanks for your prompt reply Terry and Ellie. You two have been most helpful

[Guest]

I had a visit from my mnd nurse yesterday and we discussed that it may be time to think about having a peg fitted. I'm now having to stop for a breath when I'm speaking and noticing when I drink I'm also having to stop for a breath. Then this was followed by my speech therapist who wanted to check my swallow. Everything was looking good until I had to eat a sandwich. Omg I ended up choking! Frightened her to death! (I was also shook up) she was telling me to cough!! Not a chance. So yes she's spoke to my nurse and sent a referral to have a peg fitted. I knew it was coming but like anything, it's something else to get my head round. Would like to know how many of you friends have one and are you glad you did? X

[Barry52]

Hi Pink,

I’m sorry to hear that you are struggling with breathing and swallowing. I hope you get the medical treatment promptly and that it improves your life. Your choking may have been worsened by panic as I find this happening, especially when someone is trying to help. I have a cup with a lid which measures 5 or 10 ml of liquid and it is helpful. My speech therapist ordered it.

I can’t offer any advice on pegs but many friends will contribute on this subject.

Barry x

[Guest]

Hello
I have a RIGG fitted and the week after it is replaced I get bowel problems. My wife says it is because I have a sensitive stomach
Chris

[Terry]

Hi Pink;

I had my RIG feeding tube fitted about 4 years ago and I haven't really needed it. However it was useful when I had coughs and viruses as you can take food and water through it without any problems. I would found it impossible to drink for over a day otherwise. So it gives me peace of mind knowing that.

When you eat or drink, do it slowly, finish everything in your mouth before any more goes in as you probably can't move things around in the mouth so easily. Think about what you eat and drink, try not to mix textures. Flavored drinks or hottish or chilled drinks are quite often easier to swallow.

I get things stuck in my throat, it is distressing but a lot less now as I know my airway is free and clear. If you get the same there's no point on anyone slapping your back or doing a more serious manover.

Love Terry

[JAY TEE]

SR8. I had a PEG fitted 14 months ago and mostly don’t need it as can still drink and swallow mashed up food. I do have one bit of food through daily so getting enough. Can still drink normally. The PEG is easy to clean with flush through with water and it is turned twice a week. I was formally diagnosed with MND 4yrs ago and glad had PEG done early. Best wishes John

[Ellie]

As you say Pink, even though you knew that someday you'd get a feeding tube, it's a slap in the face to hear it said out loud by healthcare professionals

On a practical level, if your swallow isn't great, a tube makes life so much easier and less stressful, not just for you but also for those around you.

You don't have to stop eating or drinking if you have a tube, that's why it's highly recommended to get one before it becomes a critical intervention. Even though the PEG & RIG procedures are straightforward, it will take something out of you, so the stronger you are having it done, the easier/quicker your recovery will be.

It is the epitome of "short term pain for long term gain"

I don't ever regret regret getting my feeding tube (button) - I would be long dead without it!!

Your SLT will give you advice on how to eat safely depending on how your assessment goes. You might find toasties, paninis or even use toasted brown in sandwiches easier to eat than ordinary sandwiches.

Love Ellie.

[Guest]

Thanks for the advice people. I was told the process of referral takes around 2months. Hopefully I will be recovered from bad tummy and feeling fitter x

[SR8]

Because my husband's breathing is not very good, it was decided that he should have a RIG so that is what he had fitted last week. He has been in considerable pain because of the air that is pumped in before the surgery. As my hubby is totally bed ridden and cannot sit up, it is taking longer for the air to come out - he has been advised to take peppermint tea to help with the bloating and to enable the air to come out. Nevertheless, he is happy he has had it done. He doesn't need to use it just now as he can still swallow as long as the food doesn't have breadcrumbs (fishcakes are out for that reason) and the food is cut into small pieces; it will be a week tomorrow since he had the RIG fitted and the dietician is coming tomorrow to see if he needs a small amount of food to supplement his diet.

[Ellie]

Glad it's over now SR - big relief it's fitted in advance of your husband losing much weight.

Let's hope the peppermint tea works! If you've a heat pack, gently heat it and put it on his lower tummy *IF* it's not too tender from the RIG procedure and it may help the wind.

Love Ellie.

[Guest]

Had my consultation re:having feeding tube fitted. Came away petrified when he told me the risks! He also said because of the way I'm breathing he's certain it will be a rig and not a peg. He's waiting for results of lung function tests to confirm. He said it will help with getting nutrients into me but can't guarantee I won't choke on my saliva!! Devil and the deep blue sea!! Had my respiratory clinic on Wed's and came back with a nippy to try again. I'm confused though as I'm struggling to take a breath in but oxygen levels in blood is good. So I'm not really sure if the machine is going to help or not!! Heads in a whirl x

[Ellie]

Hi Pink,

You have to be told of the risks associated with the procedure, but these are minimal really if it's done by an experienced doctor. The risk of not having a feeding tube is probably higher.

It's only natural to be apprehensive but, as procedures go, a RIG or PEG is straightforward.

When your consultant said about "choking" on saliva, I imagine he meant it going down the "wrong way" and inducing a coughing fit which, unpleasant though that is, is incredibly unlikely to cause you to choke to death. There are meds to reduce saliva production which minimises the chance of saliva getting into your lungs - that can cause aspiration pneumonia, which is to be avoided!!

He sounds very negative, or, like many people, your mind just focused on the scary things???

Re breathing - if your breathing muscles are weak, you'll struggle to take a deep, satisfying breath like before. (I can't even do a decent yawn any more) My SATS are still pretty good at 95%, but that figure is deceptive...

The aim of a BiPAP/Nippy machine is to increase the amount of CO2 you breath out, by maximising gaseous exchange in supporting your respiratory muscles as you breathe.

It's more about how you feel and your energy levels, apetite and mood, and less about figures and percentages.

Love Ellie.