Please read the following instructions now. A thorough colon cleansing is key to its success.
Insurance Information
Please check with your health insurance provider to ensure your "Endoscopic exam with MAC Anesthesia" is covered by your insurance plan.
Dr. Ollington (NPI: 1821258195)
Orthopedic Surgical Center of The North Shore (NPI: 1285746263)
If biopsy is needed, tissue is taken to Beverly Hospital Pathology Department.
Beverly Hospital (NPI: 1316917941)
Colonoscopy (CPT Code 45380)
Ask if Anesthesia is covered.
Name: Propofol (Code: J2704 For 10mg IV)
Introduction
This guide covers the steps to take before your colonoscopy, including:
Important information to know before your visit
Instructions for specific colon-cleansing solutions
It is important to follow all the instructions in this guide.
If you do not, your procedure will be delayed or rescheduled for another time. If you have questions after you read this or are not sure how to prepare for your colonoscopy, please contact your healthcare provider.
What to Know Before Your Visit
About Sedation
You receive sedation prior to and during your colonoscopy. Sedation helps you relax and feel comfortable during the procedure but may impair your ability to function normally and/or make decisions for hours following the exam. You must follow the post-procedure instructions listed below or your procedure may be delayed or canceled.
CPAP & BiPAP
If you use a Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP) machine to help you sleep: Bring your machine and mask with you. These may be used during and after the procedure.
Transportation Arrangements
Arrange to have an adult family member or friend accompany you to your procedure, pick you up from the procedure unit, and drive you home. Please note that taking a taxi or transportation service by yourself is not permissible. The absence of a responsible adult will result in a delay or cancellation of your procedure if plans have not been made for your after-procedure travel.
Do not drive for the rest of the day. Unaccompanied air travel on the same day as your procedure is not permitted. This is for your safety and the safety of others. If you use an external medication infusion pump (ex. an insulin pump), arrange to have a responsible adult drive you home and stay with you for the rest of the day.
Medication Instructions
5 days prior to your colonoscopy you should hold:
Fish oil
Iron medication
Vitamin E
Ibuprofen
Fiber supplements
If you have diabetes:
Hold oral diabetic medications the evening prior to and the morning of the procedure.
If you take a daily long-acting insulin, continue your current dose.
If you take short-acting insulin, take 1/2 of your usual dose or dose the insulin per carbohydrate, when you are limited to clear liquids.
Monitor your blood sugars throughout the day, especially if you are having unexplained weakness, sweating, etc.
Consume plenty of water and electrolytes throughout the colon preparation.
If you take blood-thinning medications:
Blood-thinning medications affect clotting and bleeding. Both the healthcare provider who manages these medications and the provider doing your procedure will need to decide if your medications need to change.
Some examples of generic and brand-name medications that affect blood thinning are:
Warfarin (Coumadin, Jantoven)
Clopidogrel (Plavix)
Prasugrel (Effient)
Ticagrelor (Brilinta)
Ticlopidine (Ticlid)
Cangrelor (Kengreal)
Cilostazol (Pletal)
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)
Heparin
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Fondaparinux (Arixtra)
Aggrenox
Vorapaxar (Zontivity)
Fish oil Curcumin
Aspirin 81 mg per day should NOT be stopped IF you have had a heart attack, angina, TIA, or stroke.
Contact the healthcare provider who manages your anticoagulation and ask them about when and for how long you can stop taking them (usually 3-7 days before the exam, depending on the half-life of the drug). Following the procedure, you will be informed when to restart your anticoagulation.
Diuretics should be taken up to the day before the exam. You should not take your diuretic on the morning of the procedure but should resume it that evening. You should take your blood pressure medications the morning of the exam.
Eating & Drinking Instructions
Eating and drinking instructions are the same for all colon-cleansing preparations.
5 days before your procedure
Do not eat foods high in fiber.
Examples are whole grain breads and cereals, fruits, nuts, seeds, quinoa, popcorn, and cooked or raw vegetables.
Do not take any fiber supplements.
1 day before your procedure
Do not eat any solid foods.
Do not eat or drink any red-colored beverages or gelatins.
Drink only clear liquids.
Clear liquids include water, clear fat-free broth, gelatin, and clear fruit juice such as apple or white grape. You also may have ice pops without pulp, carbonated beverages, sports drinks, and tea and coffee (with or without sugar).
Do not eat or drink any dairy products.
Examples include milk, yogurt, cheese, ice cream, and cream or milk in coffee or tea.
Do not drink alcohol.
The day of your procedure
Do not eat any solid foods until after your procedure.
Medication Instructions
If you take daily medication(s), you may do so up until 2 hours before your scheduled report time with small sips of water or other clear liquid.
If you have diabetes, follow the Diabetes Medication Instructions for Tests, Procedures and Surgeries in your Patient Appointment Guide. If you take blood thinners, follow the instructions your healthcare provider gives you.
About ALL Colon-Cleansing Preparations
All preparations work best when you take them as a split dose. This means you take the first dose the evening before your procedure. You take the second dose on the day of your procedure.
It is very important to drink all of the preparation solution.
Colon-cleansing preparations cause frequent, liquid stools.
You may have your first bowel movement about one hour after you start to drink the solution.
You may continue to pass liquid stools up to 3 hours after you finish the solution.
In patients with a history of constipation, it may take longer to have the first bowel movement after starting the prep.
TIPSFind it hard to tolerate the taste of the solution?
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Side Effects from the preparations may include bloating, stomach cramps, nausea, and vomiting. You also may have chills, headache, and irritation of your anal area. If you have severe cramps, nausea,a or vomiting, drink the solution more slowly until your symptoms improve.
If you develop a skin rash or itching, stop drinking the solution. Call your healthcare provider right away. These may be signs of a serious allergic reaction.
Plan ahead for your second dose.
Note how your body reacts to the evening dose of the preparation solution.
Give yourself plenty of time the next day to finish your morning dose and travel to your appointment.
Specific Colon-Cleansing Preparation Instructions
There are a number of different colon cleansing preparations. The prep recommended for you is based on factors such as your medical condition and insurance coverage.
Click on the colon-cleansing preparation you've been instructed to use to view information.
Miralax
Purchase the following over the counter:
Miralax 8.3 ounce bottle (238 grams
96 fluid ounce of non-red Gatorade/Powerade
4 Senna (8.6 mg) or Dulcolax (5.0 mg) laxative tabs or capsules
2 Simethicone (Gas-x) 125 mg
Prepare the solution:
Mix 96 ounces of room temperature “non-red” colored Gatorade, Powerade or any clear liquid with the entire 238 grams of Miralax powder. Recommended - divide the mixed Miralax solution into 64 ounces and 32 ounces for a total of 96 ounces.
Refrigerate the prepared solution.
The evening before your procedure:
At 5 pm:
Take 4 Senna or Ducolax pills with water
At 6 pm:
Take one 125 mg tablet/capsule of the Simethicone (GasX) and start drinking the 64 ounces of the miralax solution, drinking about 8 ounces every 20-30 minutes.If you become nauseated then stop for 30 minutes and then resume drinking the prep.
The day of your procedure:
Between 2:00 am and 3:30 am
Drink the remaining 32 ounces of the Miralax mixture and take 1 tablet/capsule of the 125 mg dose of the Simethicone (GasX). You should not consume any liquids after you finish the remainder of the prep, unless you take medications (see The Day Before Your Procedure above). If you consume liquid within 5 hours of your procedure arrival, the exam may be delayed or canceled. (again, unless you need to take medications, as stated above in the The Day Before Your Procedure)
PLEASE NOTE: The directions on the Miralax box may differ from the directions in this section. Read and follow the instructions in this section. Side effects from the preparations may include bloating, stomach cramps, nausea and vomiting.
If you have severe cramps, nausea or vomiting, drink the solution slower. If you develop a skin rash or itching, stop drinking the solution. Call your healthcare provider right away, this could be signs of an allergic reaction.
GoLYTELY, PEG-3350, Colyte, TriLyte, NuLYTELY or GaviLyte-C
Purchase the following over the counter:
GoLytely, PEG-3350, Colyte, TriLyte, NuLytely, and GaviLyte
(All equivalents)- see Pharmacist.
4 x Senna tabs/caps 8.6 mg- Over the counter
2x Simethicone (gas-x) 125 mg- Over the counter
PLEASE NOTE: The directions on the cleansing preparation box may differ from the directions in this section. Read and follow the instructions in this section.
Prepare the solution:
All of these colon cleansing preparations come as a powder in a jug.
Dissolve the powder in water before you drink the solution.
Fill the jug about halfway with lukewarm water.
Warm water dissolves the powder better than cold water.
Shake the jug well to dissolve the powder.
Add cold water to the fill mark on the jug. Again, shake the jug well. The full jug contains sixteen 8- ounce cups of solution.
Do not add ice or any flavorings to the solution.
Keep the jug away from heat and direct light.
You may refrigerate the jug or keep it on ice until you drink all the solution.
Use the solution within 24 hours after you mix it.
The evening before your procedure:
At 5 pm:
Take four 8.6 mg senna pills with 8 ounces of water.
At 6 pm:
Shake the jug of mixed solution well.
Drink one 8-ounce cup (240 milliters) of the solution. Drink it quickly. The solution will not work as well if you sip small amounts.
Every 10 to 15 minutes, quickly drink another cup of solution.
Do this until you drink 8 cups of the solution. This will take about two hours.
After consuming 8 cups take 1 125 mg dose of Simethicone (gas-x) with next 4 cups of the solution you should drink 12 cups of the prep total and will take 3 hours to complete the night before.
Keep the rest of the solution to drink on the day of your procedure. Keep the jug away from heat and direct light. You may refrigerate the jug or keep it on ice.
The day of your procedure:
Between 2 am and 3:30 am take the 2nd dose of the prep.
Shake the jug of mixed solution well and take one 125 mg of simethicone (gas X) with a sip of water.
Quickly drink one 8-ounce cup of the solution.
Every 10 to 15 minutes, quickly drink another cup of solution.
Do this until you drink the rest of the solution.
You should not consume any liquids after you finish the remainder of the prep.
If you take daily medication(s), you may do so up until 2 hours before your scheduled report time with water or other clear liquid.
Suprep
Purchase the following over the counter:
Suprep- see pharmacist.
4 x Senna tabs/caps 8.6 mg- Over the counter
2 x Simethicone (gas-x) 125 mg- Over the counter
PLEASE NOTE:
The directions on the Suprep box may differ from the directions in this section. Read and follow the instructions in this section.
Suprep comes with two 6-ounce bottles of solution and a 16-ounce mixing container.
The evening before your procedure:
At 5 pm:
Take 4 senna 8.6 mg pills with water.
At 6 pm:
Pour one bottle of solution into the mixing container.
Add cold water to the 16-ounce (480 milliliter) line on the container and mix.
Do not drink Suprep without adding water.
Drink all the mixed solution in the container.
Over the next hour, drink two 16-ounce containers of water and take one 125 mg dose of simethicone (makes colon less bubbly).
This step is important. It keeps you hydrated and helps the solution cleanse your colon better.
The day of your procedure:
Between 2 am and 3:30 am take the 2nd dose of the prep.
Pour the second bottle of solution into the mixing container.
Add cold water to the 16-ounce (480 milliliter) line on the container and mix.
Drink all the mixed solution in the container.
Take one dose of simethicone 125 mg and drink two 16-ounce containers of water
You should not consume any liquids after you finish the remainder of the prep.
If you take daily medication(s), you may do so up until 2 hours before your scheduled report time with water or other clear liquid.
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