Download Colonoscopy instructions for 4 Liter PEG Solution with magnesium

Procedure Locations:

The Vancouver Clinic
Ambulatory Surgery Center
700 NE 87th Ave Suite 320
Vancouver, WA 98664

Legacy Salmon Creek Hospital
2211 NE 139th St.
Vancouver, WA 98686
(2nd floor, Surgery Patient Check-in)

Peacehealth SW Medical Center
400 NE Mother Joseph Place
Vancouver, WA 98664
(5th Street entrance, Short Stay Unit)
Patient Name:_________________________
Appointment Date:_____________________
Arrival Time:__________________________
Provider:______________________________
Please call our office at (360) 397-3805 with any questions
Colonoscopy instructions for 4 Liter PEG Solution with magnesium
citrate (Trilyte, Golyte, Colyte, PEG 3350)
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 kit packaging.
Prior to and during the procedure you will receive sedation (unless you request otherwise)
through and 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 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 arrange for an adult to drive you home from your procedure (you will not be
able to drive for 24 hours after your 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.
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 the 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 pick up your supplies:
 Prescribed bowel preparation kit
 One 10 ounce bottle of magnesium citrate (clear in color)- this is over the counter

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
 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
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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
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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, skins or membranes, such as berries
 Corn
 Dried beans, peas and lentils
 Seeds and nuts, and any food containing them
 Coconut
 Popcorn
2 DAYS PRIOR:__________
Continue low fiber diet.
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.
1 DAY PRIOR:__________
Before 10:00 am you may eat a low fiber breakfast.
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 10:00 am, begin a clear liquid diet. NO SOLID OR SOFT FOODS. Drink at least 64
ounces (about 2 liters) of clear liquids throughout the day.
Clear liquid diet examples: As a rule, if you can see through it, you can drink it.
Water
Ice popsicles
Strained fruit juice (no pulp)
Lemon-lime soda
Broth or bouillon
Sports drink (Gatorade or similar)
Ginger ale
Plain Jell-O with no added fruit or toppings
Lemon Sorbet
Tea
Crystal Light
Black coffee
ALCOHOL AND RED OR PURPLE COLORED LIQUIDS ARE NOT ALLOWED!
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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, then cover and shake to dissolve
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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