Colonoscopy Preparation - Standard

Colonoscopy Preparation - Standard

Please read ALL the following information regarding your upcoming procedure (both front and back pages). These are your doctor’s specific instructions. Reviewing and following these instructions will ensure you are properly prepared for your procedure.

About Colonoscopy

A colonoscopy is a procedure your doctor will perform to examine the lining of your colon (large intestine). The doctor will insert a flexible tube into the rectum and through the colon, looking for abnormalities. Prior to the procedure, you will be given a sedative and pain medication through an IV. Following the procedure, you will be groggy for a few hours and therefore, should not schedule anything else for the remainder of the day. You are NOT allowed to drive for the remainder of the day. It is recommended to have a person over the age of 18 stay with you for 6-8 hours after your procedure.

7 days prior to your procedure

• Please arrange for a driver who is 18 years of age or older who will accept responsibility for bringing you and taking you home from your procedure. Please let your assigned driver know they will need to be within a 15 minute driving distance from our facility. They will be notified when your procedure is over and MUST be present at your discharge time to receive discharge instructions. You are NOT allowed to take a bus, taxi, Access a Ride, or walk home. If you do not have a responsible driver to take you home, your procedure will be cancelled or

rescheduled.

• Plan on being at our facility for at least 2 hours.

• Please note you will need to bring your PHOTO ID and INSURANCE CARD with you the day of your procedure.

• Please prepare and bring a list of your current medications (including non-prescription) and allergies. (A “Patient Medication List” form has been attached at the end of these instructions for you to use).

5 days before your procedure

Discontinue fiber supplements and medications containing iron.

• AVOID high fiber foods such as: Nuts, seeds, dried fruits, raw vegetables, beans,

whole- grain cereals, and oatmeal.

• BEGIN a low-fiber diet which includes the following foods: White bread, white rice,

pasta, skinless potatoes, plain crackers, low fiber cereals, fish, white meat chicken,

eggs, creamy peanut butter, tofu, cooked carrots, cooked green beans, cooked

spinach, applesauce, bananas, canned peaches, milk, plain yogurt, cheese.

3 days before the procedure

• Stop taking COUMADIN (WARFARIN). Please call the doctor that prescribes this medication to ensure it is safe for you to stop. If you are unable to stop Coumadin prior to your procedure, your doctor may prescribe an alternative therapy.

• If you need to cancel or reschedule your appointment, you MUST do so 3 business days

prior to your appointment date or a cancellation fee may be assessed.

2 days prior to your procedure

• Stop taking PRADAXA, XARELTO, or ELIQUIS. Please call the doctor that prescribes this medication to ensure it is safe for you to stop.

• If you are unable to stop Pradaxa, Xarelto, or Eliquis prior to your procedure, your doctor may prescribe an alternative therapy.

The following medications may be continued prior to your procedure:

• Plavix

• Persantine

• Ticlid

• Effient

• Brilinta

• Pletal

• Aggrenox

• Agrylin

• Aspirin, and/or anti- inflammatory medication(s).

*If you have any questions regarding medications, you may call our office at 303-604-5000.*

The day before the procedure

You may have a light, low-fiber breakfast before 9:00 a.m. That includes:

• White bread

• Low-fiber cereals

• Eggs

• Tofu

• Bananas

• Applesauce

• Milk

Your Clear Liquid diet options for the day before your procedure:

Tea and Coffee Clear Juices Powdered Lemonade Water/

Vitamin Water Carbonated Beverages Such as apple or white grape NO DAIRY NO PULP NO RED OR PURPLE NO PULP NO RED OR

PURPLE COLORED NO DARK Sports Drinks Popsicles Jell-O Broths/

Coconut Water Honey/Sugar Hard Candy

WITHOUT MILK OR ADDED FRUIT

NO RED OR

PURPLE NO RED OR PURPLE NO RED OR PURPLE NO RED OR PURPLE

It is very important to drink plenty of water and other clear liquids throughout the day in order to avoid

dehydration and to flush the bowel.

The day before your procedure

Stay near a toilet after you start the prep, you WILL have diarrhea. If you feel nauseous or vomit, rinse your mouth with water and take a 30 minute break, then continue drinking the solution. Use alcohol- free wipes or hemorrhoid creams to ease skin irritation. You may see results after the first half of the solution; however it may take the entire prep to have the desired outcome.

1

TIME

3:00 PM the day before your procedure

Mix the two packets of Gatorade with 64 oz.

(1/2 gallon) of water and chill in the refrigerator.

DO NOT ADD ICE

2

TIME

3:00 PM the day before your procedure

Take 4 Bisacodyl with a glass of water.

*Please note you will only need 4 tablets total.

(Please dispose of the extra tablet)

3

TIME

5:00 PM the night before your procedure

Mix together the ENTIRE BOTTLE of Polyethylene

Glycol 3350 (238 g) with 64 oz. of the chilled

Gatorade.

4

TIME

5:00 PM the night before your procedure

Begin drinking HALF OF THE MIXTURE (32 oz.)

Drink an 8 oz. glass of the solution every

15 minutes until gone.

The morning of the procedure

Remember no solid food, clear liquids only

5

TIME

Four hours prior to your procedure, drink the

OTHER HALF OF THE MIXTURE (32 oz).

Drink an 8 oz. glass of the solution every

15 minutes until gone.

FINISH NO LATER THAN 3 HOURS PRIOR TO

YOUR PROCEDURE

The day of the procedure

3 hours before your procedure:

_{Nothing by mouth}

•

Nothing to eat or drink until after your procedure.

You may take your morning medications with a sip of

water with the exception of blood thinners.

Day of the procedure reminders:

• Please bring your PHOTO ID and INSURANCE CARD.

• Please bring a list of your current medications (including non-prescription) and allergies. • Please make sure you have a driver who is 18 years of age or older who will accept

responsibility for bringing you and taking you home from your procedure. Please let your assigned driver know they will need to be within 15 minute driving distance from your facility. They will be notified when your procedure is over and MUST be present at your discharge time to receive discharge instructions. You are NOT allowed to take a bus, taxi, Access a Ride, or walk home. If you do not have a responsible driver to take you home, your procedure will be cancelled or rescheduled.

Cancelation/ “No Show” Advance Notice Requirement and fee Schedule

cancellation and “no show” activity to a minimum. In order to do this, cancellation and “no show” fees will be charged.

Cancellation Notice Requirements:

Office Visit: Three business days advance notice

Failure to provide the required advance notice will result in a cancellation fee of $50.00 Procedure Visits: Three business days advance notice.

Failure to provide the required advance notice will result in a cancellation fee of $150.00

There will be a $50 charge from Gastroenterology of the Rockies for a physician fee and a $100 charge from Denver West Endoscopy Center or Endoscopy Center of the Rockies for a facility fee, depending on which facility you have your procedure.

Cancellations can be made at any time by calling: 303.604.5000

Check In:

Please check in using the white phone located in the lobby

• Boulder – phone is located to your left, next to the door with a stop sign.

• Lafayette – phone is located to the right of the receptionist’s desk.

• Longmont – phone is located on a small table on the east side of partition in the lobby.

• Lakewood – located to the left of the door in the endoscopy waiting room.