Download colonoscopy preparation instructions

COLONOSCOPY PREPARATION INSTRUCTIONS
MIRALAX WITH GATORADE SPLIT PREP
The preparation for your colonoscopy is the most challenging part of your procedure. A thorough
cleansing of the colon is essential to having a complete, successful examination. Please follow these
instructions closely. Improper cleansing may result in rescheduling!
ITEMS NEEDED:
Purchase from pharmacy: (2) two Dulcolax (Bisacodyl) 5mg oral tablets (Laxative)
Purchase from pharmacy: (1) one 238 gram bottle of Miralax (no prescription needed)
Purchase (1) one 64 oz bottle of Gatorade (No Red Flavors) or may also use 64 oz of Crystal Light
FIVE DAYS BEFORE YOUR PROCEDURE: ________________________________
 If you are taking Coumadin (warfarin), Plavix or other blood thinners, contact us for instructions.
You may remain on aspirin unless otherwise instructed.
 Do not skip any doses of blood pressure medicine
 Stop taking iron.
 Read and familiarize yourself with the preparation instructions.
 Please call us with any questions.
TWO DAYS BEFORE YOUR PROCEDURE: ________________________________
 Make arrangements for your driver. Due to sedation that you will be given, you MUST have someone to drive
you to and from your appointment. If you do not have a driver, your procedure will not be done. All
drivers must report in with the patient.
 Eat a well-balanced diet, please avoid nuts, seeds, popcorn, raw fruits, raw vegetables and salads.
THE DAY BEFORE YOUR PROCEDURE: __________________________________
 In a.m., mix the 238 gram bottle of Miralax powder into the 64 oz bottle of Gatorade.
 Chill in the refrigerator until time to begin prep. (Shake the solution until Miralax is dissolved).
 Eat a regular breakfast. Begin a clear liquid diet for lunch and dinner. Drink as much as possible throughout
the day.
 A Clear liquid diet may include: water, soft drinks, coffee or tea without cream, Jello, non-pulpy juice
(orange, apple, white grape, white cranberry), popsicles, broth and bouillon.
 Do not drink any RED colored beverages or eat RED Jello. No Dairy Products.
 2:00 pm - Take two (2) Dulcolax 5mg oral tablets with water.
 4:00 pm - Begin drinking the Miralax prep. Drink 8 oz. every 15-30 minutes until one half (½) of the
solution is gone. Continue to drink clear liquids. If you become nauseated
during the ingestion of the Miralax prep, stop the prep for 45 minutes then resume.
THE DAY OF YOUR EXAM: _____________________________________________.
 5 hours prior to your procedure time, drink the remaining half of the Miralax prep, 8oz every 15-30 minutes
Example:
7:00 am procedure: Begin 2nd half of prep at 2:00am
2:30 pm procedure: Begin 2nd half of prep at 9:30am
All liquid must be consumed 4 hrs prior to procedure.
PRESCRIPTION MEDICATIONS:
 Insulin users: take ½ of your insulin the morning of your procedure. Do not take oral diabetic medicine.
 Take all oral medications 4 hours prior to your procedure. Inhalers and nebulizers may be used up to the time
of your procedure.
 Do not skip any doses of blood pressure medicine.
Please leave all jewelry and valuables at home. We do not provide a secure area for these items.
______________________
APPOINTMENT DATE
__________________________ _________________________
APPOINTMENT TIME
ARRIVAL TIME
If you have any changes in your medical history between the day of scheduling and the appointment
date, please contact our office and if you have any questions or should you need to reschedule this
procedure, please call 336-760-4340 Option 4. WE REQUIRE A 48 HOUR (BUSINESS DAY) NOTICE IF
THERE IS A NEED FOR CHANGE OR CANCELLATION OF YOUR PROCEDURE.
OVERVIEW: MIRALAX PREP AFTER 10:00 AM
5 DAYS BEFORE
YOUR
PROCEDURE
 Purchase your
Miralax, Dulcolax
(laxative) and
Gatorade.
Contact us for
specific instructions
if you are taking
Coumadin(warfarin)
Plavix, or other
blood thinners.
Stop taking iron.
2 DAYS
BEFORE
YOUR
PROCEDURE
Confirm your
transportation.
Avoid nuts,
seeds, popcorn,
raw fruits and
vegetables, and
salads.
1 DAY BEFORE
YOUR PROCEDURE
THE DAY OF
YOUR
PROCEDURE
Mix Miralax and
Gatorade. Shake well and
chill.
Eat a regular breakfast.
Drink remaining ½
of Miralax prep 5
hours prior to
procedure time.
12:00 noon: Begin with
a clear liquid diet
2:00 pm: take two (2)
Dulcolax tablets
4:00 pm: drink only ½
of Miralax prep. (8 oz
every 15-30 min.)
No solid foods.
Piedmont Endoscopy Center, Inc.
1901 S Hawthorne Road, Suite 308
Winston-Salem, NC 27103
336-760-4340 (Option 4)
www.piedmontgispecialists.com
May have clear
liquids up until 4
hours before
procedure.