Download Colonoscopy instructions for Miralax/ Gatorade/Mag citrate /4 Liter

Procedure locations:
Patient Name: ___________________________
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The Vancouver Clinic- Ambulatory Surgery
Center: 700 NE 87th Avenue, Suite 320
Vancouver, WA 98664
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Legacy Salmon Creek Hospital:2211 NE 139th St.
Vancouver, WA 98686 (2nd floor, Surgery
Patient Check-in)
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Peacehealth SW Washington Hospital:400 NE
Mother Joseph Place Vancouver, WA 98664 (5th
Street entrance Short Stay Unit)
Appointment Date:_______________________
Arrival time: ____________________________
Provider: _______________________________
Please call our office at (360)397-3805 with any questions
Colonoscopy instructions for Miralax/ Gatorade/Mag citrate /4 Liter PEG
Solution (Trilyte, Golyte, Colyte)
Bowel preparation (cleansing) is needed to perform a high-quality colonoscopy. Any stool remaining in
the colon can hide important findings and result in the need to repeat the procedure. It is critical that
you follow the instructions as directed. It is important that you follow the prep instructions as below, and
not those located on the prep packaging.
Prior to and during the procedure you will receive sedation (unless you request otherwise) through an
IV. The sedation interferes with forming memories, so most patients do not even remember the
procedure.
Your physician will discuss any findings of your procedure with you in the recovery room. If biopsies are
taken or polyps removed, you will receive a letter or MyChart message in 2-3 weeks detailing the final
results and recommendations. If your results require a change in your current treatment plan, you may
receive a phone call from the office.
We make every effort to keep your appointment at the scheduled time, however unexpected delays may
occur and your wait time may be prolonged. Please note that you may be asked to come in earlier than
your scheduled time to accommodate changes that occur in the schedule. We give each patient the
attention needed for his or her procedure and appreciate your flexibility.
Make sure that you have arranged for an adult to drive you home from your procedure (you will not be
able to drive for 24 hours after procedure). Your procedure will be postponed if you do not have a driver
who is over 18 years of age present. Taxis, Uber, Lyft and public transportation is not allowed unless
you have an adult traveling with you. Medical transport is an option.
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Please review the following information if you are diabetic or take any of the following
medications: Coumadin, Plavix, Effient, or any other anticoagulants:
Diabetes:
Check with your health care provider who manages your diabetes if you have questions. Inform your
doctor that you will be on clear liquids the day prior to your procedure. Check your blood sugar
frequently while taking the prep solution and on the morning of your procedure.
2 days prior to the procedure,
 DO NOT TAKE ANY DIABETES PILLS.
 REDUCE YOUR MORNING AND EVENING DOSES OF LONG ACTING INSULIN BY ONE
HALF.
On the day before the procedure,
 DO NOT TAKE ANY DIABETES PILLS.
 REDUCE YOUR MORNING AND EVENING DOSES OF LONG ACTING INSULIN BY ONE
HALF.
On the day of the procedure,
 DO NOT TAKE ANY DIABETES PILLS
 DO NOT TAKE ANY LONG ACTING INSULIN
 DO NOT TAKE ANY SHORT ACTING INSULIN UNLESS YOU ARE USING A SLIDING SCALE.
Hard candy or clear soft drinks are ok if your blood sugars are too low.
Coumadin, Plavix, Effient and other anticoagulants:
If you have been instructed by your gastroenterologist to discontinue your anticoagulant, please
ask the physician who prescribed your medication how to take it before and after your
procedure. Please do not assume that you can safely follow the same medication adjustments
that have been made for your previous procedures. If you cannot contact your physician, call us at
least 7 days before your exam.
CONTINUE TO TAKE YOUR OTHER PRESCRIBED MEDICATIONS (such as heart or blood pressure
medications) AS USUAL. If you have any questions about your medications, please contact the
prescribing physician.
5 DAYS PRIOR:__________
Go to your pharmacy (if you have not already done so) to purchase your supplies
 Prescribed bowel preparation
 One 10 ounce bottle of magnesium citrate - clear in color
 One 238 gram bottle of Miralax
 64oz Gatorade (not red or purple)
3 DAYS PRIOR:__________
Begin a low fiber diet.
Examples of foods that ARE allowed on a low fiber diet include:
 White bread or rolls without seeds
 White rice and plain white pasta such as egg noodles or macaroni
 Saltine crackers
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Refined cereals such as cream of wheat
Pancakes or waffles made from white refined flour
Most canned or cooked fruits without skins, seeds or membranes
Fruit and vegetable juice with little or no pulp, fruit flavored drinks and flavored waters
Canned or well cooked vegetables without seeds, hulls or skins such as carrots, mashed
potatoes, tomatoes that are peeled and seed free
Meat, poultry and fish
Eggs
Tofu
Creamy peanut butter
Milk and foods made from milk, such as yogurt, pudding, ice cream, cheeses and sour cream
Butter, margarine, oils and salad dressings without seeds
Desserts with no whole grains, seeds, nuts, raisins or coconut
Examples of foods NOT allowed on a low fiber diet include:
 Whole wheat or whole grain breads, cereals and pasta
 Brown or wild rice and other whole grains such as oats, kasha, barley, quinoa
 Dried fruits
 Raw fruit, including those with seeds, skin or membranes, such as berries
 Raw or undercooked vegetables
 Corn
 Dried beans, peas and lentils
 Seeds and nuts, and any foods containing them
 Coconut
 Popcorn
Approximately two hours after your evening meal, drink 10 ounces of magnesium citrate followed
by 8-10 ounces of water. Chilling or drinking over ice may improve the taste. You may begin to have
bowel movements in 30 minutes to 3 hours. Later that evening, drink two additional glasses of water to
help prevent dehydration.
Begin a Clear liquid diet.
2 DAYS PRIOR:__________
Continue clear liquid diet. NO SOLID OR SOFT FOODS.
Mix the 64oz Gatorade with the 238 gram Miralax and drink throughout the day.
Clear liquid diet examples: As a rule, if you can see through it, you can drink it
Water
Strained fruit juice (no pulp)
Broth or bouillon
Ginger ale
Lemon sorbet
Crystal Light
Ice popsicles
Lemon-lime soda (No dark soda like Pepsi or Coke)
Sports drink (Gatorade or similar)
Plain Jell-O with no added fruit or toppings
Tea
Black coffee
ALCOHOL AND RED OR PURPLE COLORED LIQUIDS ARE NOT ALLOWED.
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1 DAY PRIOR:__________
Continue clear liquid diet. Drink at least 64 ounces (about 2 liters) of clear fluids throughout the day.
If preferred, you may mix the prep solution now by filling the container to the FILL mark with lukewarm
water, then cover and shake to dissolve and refrigerate. The solution should be used within 24 hours
after mixing.
AT 7:00 PM THE EVENING BEFORE THE PROCEDURE:
If you have not already mixed the prep solution, fill the container to the FILL mark with lukewarm water.
Cover and shake to dissolve. You may pour the solution over ice before drinking if you desire.
Drink one 8 ounce glass every 10-15 minutes until half of the solution is gone. Make sure that you
refrigerate the remaining solution, as this will be used later.
NOTE: Individual responses to laxatives do vary. This prep should cause multiple bowel movements
and often works within 30 minutes, but may take up to 3 hours.
Procedure Day:
Five hours prior to your arrival, drink one 8 ounce glass of the remaining solution every 10-15
minutes until it is gone. You may continue to drink water or clear liquids after completing the bowel prep.
*** YOU MUST STOP DRINKING CLEAR LIQUIDS
2 HOURS PRIOR TO YOUR ARRIVAL TIME ***
You may take your routine medications, with the exception of diabetes medications or
anticoagulants (please refer to page 2 for specific information) with a small sip of water.
You may brush your teeth and shower prior to leaving home.
DO NOT wear jewelry or bring any valuables.
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