Advice after your nerve block for surgery
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Introduction
We have given you this factsheet because you have an appointment for a radiology
procedure on the gastrointestinal (GI) tract. Please make sure you read this information and follow the instructions carefully before your procedure. If you have any further questions, please speak to a member of your healthcare team who will be able to advise you.
A radiologically inserted gastrostomy (RIG) is a procedure in which a gastrostomy tube (small feeding tube) is inserted through the skin directly into the stomach under fluoroscopy guidance by a radiologist (doctor specialising in medical imaging). The tube is inserted so that you can have liquid food, fluids and medication without needing to swallow. Associated procedures include unblocking or replacing a gastrostomy or extending the tubing beyond the stomach.
What is Fluoroscopy?
Fluoroscopy is a process that uses X-rays to produce a real time moving image on a
television monitor.
Before your appointment
Please let us know if:
- you are taking any medication which impair the bloods ability to clot (anticoagulation or blood thinning drugs) e.g. Warfarin or clopidigrel, or, if you are aware that you may have bleeding problems. The radiologist who will be performing your examination can be notified and may need to discuss this with you and your hospital consultant before your appointment can be confirmed as the medication may need to be stopped or changed before the procedure. The Interventional nursing team can be informed on 0300 613 2161 (Frimley) or 0300 615 3544 (Wexham).
Please also let us know if:
- you have limited mobility and will require assistance to get on and off the scanner.
- you will need an interpreter. We are not able to use family members or friends to interpret.
- there is any possibility that you may be pregnant. All patients from 12-55 years of age (regardless of gender) who will undergo a Radiology procedure will be asked about the possibility of them being pregnant.
- you are diabetic - please note that you are required to starve before the examination. You may be given an early morning appointment or alternative medication will be given on the ward In order to make your appointment run more smoothly, please let us know if any of these apply, in advance, by calling our bookings team (contact details are displayed on the main Radiology page).
On the day of procedure
Diabetic patients - If you are diabetic you should have received an early morning
appointment. If not please contact the department to rearrange your appointment time to the next appropriate and available appointment. Do not take your diabetic tablets or insulin, but bring them with you. You also may want to bring a snack with you to eat after your examination
Eating and Drinking
You should have nothing to eat 6 hours prior to the time of your procedure. You can continue to drink clear fluids (water) up to 2 hours prior to the procedure but then nothing should be consumed.
What to bring with you
You will usually be admitted for the procedure as a day case. Occasionally it is necessary for patients to stay overnight in hospital after the procedure. For this reason we advise that you prepare an overnight bag and bring this with you.
Please bring with you to your appointment any sprays or inhalers that you are taking. Please bring a list of any regular medications you are taking
During the procedure
Referral and consent
You will be asked to sign a consent form confirming that you understand the procedure and are aware of the risks and benefits involved. Where practical this is usually done on the ward, before you come to the Radiology Department or in an outpatient clinic environment before your admission to the hospital.
The procedure is normally done as a planned procedure and you should have plenty of time to discuss the situation with your doctor or the nurse specialist looking after you before you sign the consent form. When you arrive for the procedure you will also discuss the procedure with the radiologist who will be performing the procedure who will again sign the consent form with you.
If after discussion with your hospital doctor or radiologist, you do not want the procedure carried out, then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then they will explain this to you and they will communicate with the referring doctor who will review your situation as soon as possible. At all times the radiologist and referring doctor will be acting in your best interests.
The Procedure
Your procedure will be performed by a radiologist who will be working in a team with a radiographer and a nurse.
Once called, you may be asked to change into a gown. You will be taken into the Interventional radiology room and helped onto the X-ray table.
The radiologist will perform an ultrasound scan of the liver before starting the procedure.
The skin over the stomach area will be cleaned and drapes placed to keep the area as
sterile as possible. An X-ray camera suspended over the table will be used to take images during the procedure which will come close to you but will not touch you.
You may be given a sedative and painkillers though a cannula in your hand/arm.
A nasogastric tube is passed through the nose and down the oesophagus into the stomach and used to inflate your stomach with air to make it clearly visible on ultrasound and on X-ray.
The radiologist will inject the area over your stomach with a local anaesthetic to make it numb. This may cause some stinging, but it will only last a short time.
Stitches will initially be inserted into the stomach through a small needle and secured on the skin with small buttons. These will secure your stomach to the abdominal wall to try and reduce the risk of infection. We will then pass a fine needle and wire in between these buttons and then use this to insert the gastrostomy tube into the stomach. The tube will usually be held in place by a balloon at the end of the tube filled with water to help prevent the tube from falling out.
If the procedure is planned on a gastrostomy already in place this may be to use imaging to guide replacing a tube or replacing it with a longer tubing internally.
The procedure takes around 30 minutes, but please expect to be with us for an hour or so in total.
After the Examination
You will be taken back to the your ward, where you will need to rest. You will have your pulse, blood pressure and, if necessary your temperature, taken to ensure there have been no complications.
Your throat may feel sore and it is common to feel bloated after the procedure because air in the stomach is passing through the bowel. The feeding tube is flushed with sterile water after the procedure and if satisfactory the nasogastric tube will be removed.
After the tube flush you will be allowed to eat and drink, or the tube will be used to give feed and fluid.
The buttons attached to your stomach will stay in place for up to 4 weeks. They will usually fall off on their own, but a nurse may come and remove them before then.
Do not rotate the buttons or gastrostomy tube for the first two weeks after placement.
You will be taught how to manage and care for the feeding tube by the dietician or nutrition nurse who will also arrange for feed and equipment to be delivered to you at home when required.
Risks
A RIG is generally a safe procedure. However, as with any procedure, some risks or
complications may occur:
- Minor bleeding may occur which does not usually require additional treatment. The risk of this is 1-3%.
- Infection can occur at the tube insertion site. Antibiotic treatment would be required and careful monitoring of the tube and insertion site.
- Leakage may occur around the RIG site resulting in red and sore skin. If this happens, see the section on skin care in this leaflet, or seek advice from one of the contact numbers at the end of this leaflet.
- X-rays are a type of radiation. We are all exposed to natural background radiation every day from the sun, food we eat, and the ground. Exposure to medical X-rays carries a small additional risk, but your doctor feels that this risk is outweighed by the benefits of having the test and the amount of radiation you will receive is kept to as low as reasonably possible.
Contact us
If you have any queries relating to this information, please contact the Radiology service.
About this information
Service:
Radiology
Reference:
PILS-IR.24
Approval date:
2 October 2024
Review date:
2 October 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.