Microsoft word - colonoscopy instructions

• Your appointment for colonoscopy • Please arrive at The Corvallis Clinic Surgery Center at • Must be accompanied by a designated driver. • An information session regarding COLONOSCOPY is presented at 4 p.m. every other Thursday. The first timers are strongly encouraged to attend. • To reserve a seat, please RSVP to (541) 754-1988 and present yourself at The INTRODUCTION Colonoscopy is the examination of the interior of the large intestine, colon. When an abnormal area is identified, using a forcep, a small sample is removed for microscopic examination, a procedure known as biopsy. During colonoscopy, abnormal growth is removed by using an electric wire loop. The procedure is known as polypectomy. All tissue samples removed during colonoscopy are submitted for microscopic examination. The procedure employs an instrument, colonoscope, which is a flexible tubing of 160 cm (slightly longer than 5 feet) long. It contains an illuminating apparatus and an electronic camera at the tip of the scope. There is also a channel through the length of the scope allowing passage of instruments for sampling and other works. PREPARATION To achieve optimal examination of the colon, it is imperative to completely remove all fecal matter before the procedure. Inadequate cleansing of the colon leads to a prolonged and difficult examination with ambiguous results as well as higher risk of complication. Therefore, please exercise your best effort to adhere to the directions for bowel cleansing. If you are unable to tolerate the type of laxative recommended in this document, please notify us on the day before the examination, so the procedure may be rescheduled or an alternative laxative may be recommended. DIRECTIONS: FOR PEOPLE WITH COLONOSCOPY IN THE MORNING Four days before the colonoscopy • Avoid any foods with seeds or nuts --- Examples are strawberries, tomatoes, sunflower seeds, peanuts, and corn kernels • Avoid high fiber foods such as leafy vegetables, fruits, whole grain wheat bread or cereal, oatmeal, Metamucil or any fiber supplements The day before the colonoscopy – no solid foods • Drink plenty of light-colored clear liquids for breakfast, lunch and dinner • Clear liquids are liquids that you can see through. Examples are water, apple juice, 7-up, Gatorade, light colored Jell-O, soup made from chicken or beef bouillon. • Avoid any red, orange, purple, green, and blue colored drinks • Fill the laxative jar to the gallon (or 4 liter) mark (adding two packets of Crystal • Beginning at 5 p.m. drink 2 liters (half) of the laxative in 2 hours • Drink only light-colored clear liquids afterwards The day of the colonoscopy • You may take your medication with water. • You may drink the laxative solution and water only. • Beginning at 4 hours before the scheduled arrival time, drink the remaining 2 liters of the laxative solution. Try your best to finish it within 2 hours. (If you live more than 30 minutes away, start 5 hours before arrival time to avoid residual laxative effect during travel) • STOP DRINKING ANYTHING OR CHEWING GUM 2 HOURS BEFORE YOUR Timeline for the day of colonoscopy
4 hrs 2 hrs before arrival time before arrival time arrival time

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----- Drink 2 L laxative---------
///////nothing by mouth///////

FOR PEOPLE WITH COLONOSCOPY IN THE AFTERNOON
Four days before the colonoscopy
• Avoid high fiber foods such as leafy vegetables, fruits, whole grain wheat bread or cereal, oatmeal, Metamucil or any fiber supplements • Avoid any foods with seeds or nuts --- Examples are strawberries, tomatoes, sunflower seeds, peanuts, and corn kernels The day before the scheduled colonoscopy – no solid foods • Drink plenty of light-colored clear liquids for breakfast, lunch and dinner • Clear liquids are liquids that you can see through. Examples are water, apple juice, 7-up, Gatorade, light colored Jell-O, soup made from chicken or beef boullion. • Avoid any red, orange, purple, green, and blue colored drinks • Fill the laxative jar to the gallon (or 4 liter) mark (adding two packets of Crystal • Beginning at 5 PM drink 2 liters (half) of the laxative in 2 hours • Drink only light-colored clear liquids afterwards • You may take your medication with water. • You may drink the laxative solution and water only. • Beginning at 7 a.m., drink the remaining 2 liters of the laxative solution. Try your best to finish it within 2 hours. (If you live more than 30 minutes away, start at 6 a.m. to avoid residual laxative effect during travel) • May drink water until 2 hours before arrival time. • STOP DRINKING ANYTHING OR CHEWING GUM 2 HOURS BEFORE YOUR Timeline for the day of colonoscopy
9 AM arrival time arrival time

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// Drink 2 L laxative// water OK //nothing by mouth//

Please Note: With this preparation, diarrhea and mild degree of nausea and abdominal cramping are not unexpected. However, if you develop severe nausea, vomiting or intolerable abdominal pain, please notify us right away. INSTRUCTIONS REGARDING MEDICATION • Blood thinners such as Coumadin (warferin) should be stopped 5 days before the examination. Please consult your primary physician for the need of supplementing with Fragmin. • FRAGMIN should be STOPPED the day before and the day of the examination. • Plavix should be STOPPED one week before the exam. Please clear with your • primary physician. • NSAIDs, such as Aspirin, ibuprofen (Motrin, Advil), Aleve, Naprosyn, Votaren, Feldene etc. should be stopped 5 days prior to the exam. • If polyps are removed during colonoscopy these medications may have to be held for a few more days after the procedure. • Medications for High Blood Pressure or Heart Diseases SHOULD BE taken as prescribed EVERY DAY without interruption. • Oral medications for diabetes should be skipped the day before and the day • Insulin dose should be halved the day before the exam and taken after the FOR PEOPLE WITH PACEMAKER OR DEFIBRILLATOR You must consult the pacemaker clinic regarding the possible effect of electrocautery on your specific pacemaker and fax a document to the SURGERY CENTER (541) 738-2072 before the day of the procedure. The procedure can not proceed without this document. PROCEDURE • Please present yourself to the registration personnel at the designated location • A small plastic catheter will be inserted into the forearm for IV access. Sedatives are usually given to alleviate anxiety and to reduce discomfort. They may also have the amnesic effect (partially erasing the memory of the procedure). Using this sedative PROPOFOL, most people are in deep sleep and will not have recollection except the last few minutes of the procedure. Nearly everybody tolerates the procedure very well. • The colonoscope is then inserted into the rectum and advanced with a combination of gentle pressure and deflection of the tip of the scope. Because of the natural looping of the colon, periodically the nurse will apply hand pressure to your abdomen or turn you to different positions in order to facilitate the advancement of the scope. For complete examination, the scope is advanced from the rectum, by the left colon, transverse colon, to the right colon into the cecum. Whenever possible, the scope is also advanced further into the last segment of the small intestine, the terminal ileum. • During the exam, when abnormal colonic lining is identified, a small sample is "pinched off" and sent to a pathologist for microscopic examination, a procedure known as biopsy. No discomfort is associated with biopsy. Small amount of bleeding may or may not be noticeable in the bowel movement following the exam. If a growth on the colonic lining, known as a polyp, is noted, an electro-cauterizing wire loop is used to lasso, cut and cauterize the cut surface. The polyp is then retrieved for microscopic examination. • Colonoscopy usually lasts 20 to 30 minutes. • After the exam you will be transferred to the recovery room for further observation. When your nurse determines that you are fully alert and safe to leave, they will recommend your discharge from the unit. • Discharge instructions are given to you before you leave the recovery room. On this instruction is also the description of the findings and all procedures performed during the examination of your colon. • In general, a light meal is recommended after the procedure. If you do not experience any discomfort after the first light meal, you may resume normal diet thereafter. If sedatives are given during the procedure, driving or operating any heavy equipment on the day of the examination is dangerous and should be avoided under all circumstances. RESULT DISCUSSION • If no tissue is removed during the examination, your instruction sheet contains the final result of the colonoscopy. No further communication will be issued. • If either a biopsy is taken or polyps are removed, a letter regarding the final pathology report, as well as the recommendation for follow up will be mailed to you within two weeks • Although colonoscopy is considered a very safe procedure, on rare occasions complications do occur. Over-sedation with depression of respiratory drive may occur. Aspiration of stomach content into the lung can lead to pneumonia. Bleeding is usually mild, and rarely requires intervention. The extremely rare cases of perforation almost always require surgical repair. For patients with heart diseases, the risk of cardiac complications, including but not limited to heart attack, irregular heart rhythm, cardiac arrest or even death, though extremely low, cannot be absolutely eliminated. If a complication occurs, steps will be taken immediately to control the effects. On occasion, hospitalization will be recommended. Lastly, in spite of being considered the gold standard of examination of the colon, colonoscopy is by no means perfect. Not infrequently, polyps smaller than 1 cm in diameter hiding behind the nooks and crannies of the colon may elude detection. Occasionally, even larger polyps can be missed. • A nurse will call you the day after the colonoscopy to inquire of your recovery after the procedure. If any unusual event such as severe pain, significant bleeding or others should develop, which is worrisome to you, please be insistent in reaching myself or any physician on call for me and discuss the occurrence. If the situation is urgent, please present yourself to the Emergent Room of the hospital without delay.

Source: https://www.corvallisclinic.com/files/colonoscopy%20instructions.pdf