Patient Info: Colonoscopy Instructions

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Using Klean-Prep

For your convenience, these Colonoscopy Instructions Using Klean-Prep are also available as a Adobe PDF file. To view and print the PDF file, you can download the free Adobe Reader if you don't already have it, or if you want to upgrade to the latest version.

Please see Appointments below for important reasons why you should not change or cancel your appointment without due notice. Also, please read the Precautions set out below.

Preparation

For your convenience, you can listen to the following preparation instructions on the phone by calling any of our clinics and selecting option #8.

Ahead Of Time

  • An information package will be sent to you when your appointment has been booked. Please read the entire information as soon as you receive it and read again 5 (five) days before your appointment.
  • Complete the questionnaire in the package (3 pages) and bring it with you on the day of the appointment.
  • You may notify the doctor who has referred you about this appointment since most doctors would like to be informed about your care. Your doctor will receive a report from us, usually approximately two weeks after your appointment.
  • Purchase 1 box of Klean-Prep and 4 Dulcolax tablets at your drugstore. If you need a prescription for insurance purposes, you may pick up a prescription from the clinic reception, or we can fax it to you or to your pharmacy before your appointment.
  • For the colonoscopy to be thorough and safe, your bowel must be completely empty. Klean-Prep is a solution that is not absorbed into your system and it works by washing the bowels clean because of the large volume you consume. You should weigh yourself before and while taking the laxative and drink even more fluids if you lose 3 lbs. or more.
  • Optional: Zinc ointment will help ease chaffed anal skin.
  • Optional: Gravol for nausea.
  • Obtain a supply of clear drinks: water, clear juices (such as apple, white grape, white cranberry), or ginger ale.
  • If you will be sedated for the procedure, please see After the Procedure below for instructions on arranging for transportation after the procedure because you cannot drive until the following morning.

Four Days Before Your Appointment

Stop eating all seeds and nuts in breads, fruits, tomatoes, cucumbers, grapes, watermelon, etc., as they could plug the instrument during the procedure.

How To Take Klean-Prep

  • Dissolve the first sachet of Klean-Prep in one litre of a clear drink mentioned above (most people use water) and start drinking at the rate of one glass every 10 minutes. You may drink slower if you prefer. When the first sachet is finished, dissolve the second sachet and follow the same drinking pattern until all 4 sachets are finished.
  • If you find Klean-Prep difficult to take, try chilling it and drinking with a straw or sipping slowly. You may also start the preparation earlier. This gives more time to consume the Klean-Prep and may avoid fullness and nausea.
  • If you get nauseated easily, Gravol 50 mg (1 tablet) may be taken ½ hour before taking Klean-Prep.
  • Diarrhea-like bowel movements will start usually after the second sachet. It is normal for the bowel movements to initially become clear and later turn to a yellow colour.
  • If you weigh less than 55 kg (120 lbs.), 3 sachets of Klean-Prep should suffice.

Morning Appointments

The Day Before Your Appointment

  • You may have a light breakfast, before 9:00 a.m.
  • After breakfast and until the procedure is finished, you must remain on a diet of clear fluids. No solid foods. You may take as much clear fluids as you can. Do not take black coffee, soup or consommé, even if they look clear.
  • At 6:00 p.m., take 4 Dulcolax tablets, all at once.
  • Between 6:00 and 11:00 p.m., take 3 litres of Klean-Prep. You may start earlier if you wish.
  • It is important that you take at least 3 sachets (3 litres) of Klean-Prep. If you have difficulty with the 4th sachet, you may take it the morning of the test, but you must finish taking the solution at least 2 hours before the appointment time. See above for details about How to Take the Klean-Prep.

The Day Of Your Appointment

  • Two (2) hours before your appointment time: stop taking any fluids.

Things To Remember

  • Bring your Ontario Health Insurance card and a list of your current medications.
  • Bring this information package with the questionnaire on the last 3 pages completed.
  • Bring something to drink.
  • Do not wear nail polish.

Afternoon Appointments

The Day Before Your Appointment

  • You may have a light breakfast, before 9:00 a.m.
  • After breakfast and until the procedure is finished you must remain on a diet of clear fluids. No solid foods. You may take as much clear fluids as you can. Do not take black coffee, soup or consommé, even if they look clear.
  • At 6:00 p.m., take 4 Dulcolax tablets, all at once.

The Day Of Your Appointment

  • At 6:00 a.m., start taking the Klean-Prep. You must start sufficiently early so that you finish all four (4) litres at least two (2) hours before your appointment time. See above for details about How to Take the Klean-Prep.
  • Two (2) hours before your appointment time: stop taking any fluids.

Things To Remember

  • Bring your Ontario Health Insurance card and a list of your current medications.
  • Bring this information package with the questionnaire on the last 3 pages completed.
  • Bring something to drink.
  • Do not wear nail polish.

The Procedure

The procedure is extremely well tolerated with little or no discomfort. However, some patients who are extremely sensitive suffer from Irritable Bowel Syndrome, have a loopy large bowel or severe diverticulosis may experience discomfort and will require sedation. The procedure usually takes 5-30 minutes. Major effects of the sedation wear off in about one hour.

Are There Any Complications?

Colonoscopy is safe and is associated with very low risk when performed by physicians who have been trained and are experienced in this procedure. Complications can occur, but they are rare. Local discomfort usually disappears at the end of the procedure.

Bleeding may occur from the site of biopsy or polyp removal. Perforation (a small hole in the lining of the bowel) may also occur rarely. These complications are usually mild but rarely may require blood transfusions or surgery.

After The Procedure

  • You will remain in the recovery room for close observation for approximately ½ hour.
  • A bloated feeling and flatulence can occur after the procedure if air was used to improve visibility. You can usually get rid of excess gas by sitting on the toilet with your head down.
  • You will be able to resume your normal diet after the procedure, unless you are instructed otherwise.

If you were sedated for the procedure:

  • You cannot drive until the following morning and must arrange to have someone else drive you home after the procedure. If you choose to go by taxi or public transit, you must be accompanied by someone.
  • For safety reasons, the person who drives or accompanies you must meet you inside the clinic after the procedure. You cannot leave the clinic on your own.
  • Due to the sedation, you may feel disorientated or forgetful for a short time after the procedure. We recommend that you do not sign any legal or other important documents until the following day.

Precautions

Please carefully read and follow these instructions if you are on any of the medications listed below:

  • If you are on Aspirin (including Bufferin, Novasen), discontinue the medication 10 days prior to your procedure. It may be restarted the next day if no biopsy was done. Otherwise, restart 3 days after the procedure.
  • If you take Plavix (clopidogrel), discontinue the medication 7 (seven) days before your procedure and restart the next day (or 3 days in case of biopsy). You should confirm with your doctor that it is safe to be off this medication.
  • If you take iron supplementation, discontinue 5 days before the procedure.
  • If you are on anti-inflammatory medications (Indocid, Motrin, Advil, etc.), stop the day prior to the procedure. Celebrex and Vioxx are alright to take.
  • If you need to take medication for pain or headache, use plain Tylenol unless you are on chronic medication.

Only if you are on Coumadin (Warfarin): You must discontinue this medication 5 (five) days prior to the procedure. You should confirm with your doctor that it is safe to be off this medication.

  • You must have an INR test done before 12 noon on the day before your procedure and have the lab FAX the result directly to us at 905-607-0013 or 416-597-2912. Patients in the Ottawa region, please ask the lab to FAX the result to 613-216-1824.
  • If you have not received an INR requisition form, please contact us immediately so we can mail it to you. We require the results by 8 a.m. on the day of the procedure.
  • If your doctor/cardiologist feels that it is unsafe for you to discontinue blood thinners (Coumadin) or if your INR results are not available to us due to any unforeseen event we can still go ahead with your test, but without doing polyp removals or biopsies because of the danger of bleeding.
  • If we find polyps in those circumstances we can reschedule your procedure for a later time with proper steps taken to ensure that chances of complications are minimized. Your physician can arrange for injections of Lovenox (Enoxaparine) that can act as a bridge therapy while you discontinue Coumadin.

Antibiotics: Antibiotics should be taken if you have a history of endocarditis, artificial heart valves, or had a joint replacement in the last 6 months. Please obtain a prescription for the antibiotic from your family doctor and get it from your local pharmacy prior to the procedure.

Oral antibiotics should be taken 1 hour before the procedure. If the antibiotic is given intravenously, please bring the antibiotic to the clinic and advise us at the time of booking. In this case you need to arrive at the clinic 1-½ hours before your appointment time so that we can administer the antibiotic at the clinic prior to the procedure.

Diabetics: Please ensure that you are booked early in the day for your procedure.

  • If you are on oral medication (pills) for control of your diabetes, only omit your morning dose on the day of the procedure.
  • If you are on insulin, please discuss with your doctor about cutting the morning dose in half on the day of the procedure. You can take Ensure as a meal supplement.

Other medications: Medications such as pills for blood pressure, thyroid, and cholesterol should be taken in the morning with sips of clear fluids.

Appointments

We make every effort to give you a firm date and time for your appointment. A procedure room and a surgeon, anesthetist, nurses and support staff are booked just for you. Therefore, please let us know as soon as possible if you have to change or cancel the appointment so we can give this time to another patient who may be urgently waiting for a procedure.

Appointments can be changed or cancelled only by calling our Contact Centre during working hours, 8:00 a.m. to 4:00 p.m., Monday to Friday. One of our representatives will approve the change or cancellation and provide you with a confirmation number. We cannot accept voice messages for changing or cancelling appointments.

  • To avoid a $250 Fee for a changing or cancelling a colonoscopy appointment, you must notify us at least three (3) business days before the day of your appointment. This fee is not covered by OHIP.
  • A Cancellation Protection Plan (CPP) is available as an option to protect you against charges in the event that you are unable to give us 3 days advance notice. This plan costs $37.50 per appointment, and it must be paid at the time of booking your appointment.
  • A Rescheduling Fee of $25.00 will be charged if you change your appointment (date, time or clinic location) more than one time. This fee must be paid at the time of rescheduling your appointment.

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