Download PEG 2-Liter Preparation - Charlottesville Gastroenterology Associates

PEG 2-LITER PREP FOR COLONOSCOPY
Charlottesville Gastroenterology Associates
Modified May-12
Chart#
You will only take HALF of the 4-liter jug. Please follow instructions carefully.
You have been scheduled to have a colonoscopy on ____/_____/____ at _____:_____ am/pm. To prepare
for the exam, you will be given a prescription for a Colyte, NuLytely or GoLytely bowel preparation jug.
 Please purchase your bowel preparation several days in advance
 Purchase four (4) Dulcolax (bisacodyl) 5 mg tablets – available without prescription
______________ 5 Days Before Exam
Stop taking vitamin E, iron or iron containing supplements. Continue your routine
medications unless otherwise instructed.
______________ Day Before Exam Drink only clear liquids. Do not eat any solid food.
 Clear liquid diet includes tea, coffee without dairy products, clear sodas, ginger ale, water, bouillon,
apple juice, Gatorade, lemon/lime Jell-O. Do not drink anything colored red, blue or purple.

Morning

12:00 pm Take all four (4) Dulcolax (bisacodyl) 5 mg tablets. Diarrhea may begin within 1 hour.

4:00 pm Drink FOUR 8-ounce glasses of the preparation, one glass every 15-20 minutes. Store
remainder in refrigerator.

Evening
Add cold water to the 4-Liter bowel preparation jug and refrigerate.
Drink at least 16 ounces of additional clear liquids during the evening. We encourage you
to drink more liquids to stay well hydrated.
What to Expect
Diarrhea usually starts between 1 and 3 hours after starting to drink the fluid and
may last up to 3 hours, but should then stop.
______________
Day of Exam
____:____ am/pm Drink FOUR 8-ounce glasses of the preparation, one glass every 15-20
4 hours
minutes. Drink at least 16 ounces of additional clear liquids of your
before exam
choosing (see list above).
Please take your usual morning medications unless otherwise instructed.
You may have clear liquids until 2 hours before your test.
Stop liquids at ____:____ am/pm
Special Instructions: _______________________________________________
Arrive at:
____:____ am/pm
 Martha Jefferson Hospital, 500 Martha Jefferson Drive, Charlottesville
 Digestive Care Center at CGA, 1139 E. High St Lower Level, Charlottesville
I have read and understand the above instructions.
____________________________
Patient Name (Print)
______________________________________
Patient Signature
BRING A DRIVER AND YOUR MEDICATIONS WITH YOU
Please sign and return the yellow copy to the office
__________
Nurse Initial
SEE BACK 
Charlottesville Gastroenterology Associates
Modified PEG Prep
Modified May-12
COLONOSCOPY
Frequently Asked Questions
1. How quickly will the diarrhea start after drinking the mixture?
Typically, diarrhea begins 1 to 3 hours after starting to drink the fluid. However, some
patients take longer. If you have no diarrhea by 10:00 pm or you are experiencing
abdominal pain, severe nausea or vomiting, please call the doctor for further instruction at
434-817-8484.
2. The mixture makes me sick to my stomach. What should I do?
If you experience nausea or vomiting while drinking the mixture, stop drinking for one hour
then resume drinking at a slower rate – 4 ounces every 15 minutes. If you have no bowel
movement or vomiting persists, call the doctor for further instruction.
3. How long will the procedure take?
The procedure typically takes 20 to 30 minutes but may take longer if a polyp is removed or
a biopsy is performed. You should allow several hours for your entire visit.
4. Can I drive after the colonoscopy?
No, you may not drive the day of the procedure. This is because we will give you
medication to help you relax during the procedure. Please bring a driver with you.
5. Will I have pain after the procedure?
Most patients experience mild abdominal cramping after the procedure. This usually
resolves within several hours once the gas passes out of the colon. If you have severe pain
or pain for more than 24 hours, call the doctor.
6. How will I learn the results of my test?
If a biopsy was performed, we will post the results to your DialTell account as soon as the
physician has reviewed them. If you have misplaced your DialTell card, the office staff can
provide you with a new one.
7. What do I do if snow or dangerous weather makes traveling difficult?
We are committed to staying open at both our office and hospital locations unless severe
weather prevents safe travel. Please call the office or doctor on call for further instruction.
IF YOU HAVE ANY FURTHER QUESTIONS, CALL THE DOCTOR AT:
(434) 817-8484
Cancellation Policy: We will automatically charge a $100 fee to any account where cancellation
notice was not provided at least 72 business hours prior to your exam. Example: Notification on
Friday for a Monday procedure would not constitute ample notification.