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Microsoft word - dulc mir split feb 2013.docx

PREPARING FOR YOUR COLONOSCOPY

Purchase the fol owing OVER THE COUNTER products for your bowel prep:
• Dulcolax Laxative Tablets (buy box of 10). NOT the suppositories! • Miralax Laxative Powder 238 gm bottle
7 DAYS BEFORE YOUR PROCEDURE:
Do NOT take aspirin or anti-inflammatory medications such as Advil, Aleve, Excedrin, Ibuprofen, Motrin,
Nuprin, etc. unless otherwise directed by your physician.
• You may take Tylenol or Acetaminophen if necessary.
• Do NOT eat any seeds, nuts or whole grain breads for 7 days before your procedure.

ON THE DAY BEFORE YOUR COLONOSCOPY:
Drink only clear liquids all day.
Do NOT eat any solid food or dairy products.
• You can have any of the fol owing as long as they are NOT RED OR PURPLE colored.
-Clear juices without pulp: apple, white grape, lemonade, white cranberry
-Water, clear soda (Sprite, cola, ginger-ale), Gatorade, Powerade, Jell-O (no fruit), ice popsicles -Hot or cold coffee or tea (without milk or non-dairy creamer). Any type of sweetener is ok. -For meals, please drink clear broth or bouil on ( chicken, beef, or vegetable) • At 5 PM take four (4) Dulcolax oral laxative tablets with an 8 ounce glass of water
• A total of EIGHT 8 ounce glasses of Miralax should be prepared – one capful (17 grams) in each glass.
Use 8 oz of any of the clear liquids mentioned above to mix in the glass with the Miralax.
If your procedure is scheduled BEFORE 10:30 AM:
-At 7 PM drink one 8 oz glass with 1 capful of Miralax every 30 minutes, for a total of FOUR glasses.
-At 10 PM drink one 8 oz glass with 1 capful of Miralax every 30 minutes, for FOUR more glasses.
Do not have anything to eat or drink, not even water after 2:00 AM (day of procedure).
If your procedure is scheduled AT 10:30 AM or LATER:
-At 7PM drink one 8 oz glass with 1 capful of Miralax every 30 minutes, for a total of FOUR glasses.
-At 5AM drink one 8 oz glass with 1 capful of Miralax every 30 minutes, for FOUR more glasses.
Do not have anything to eat or drink, not even water after 7:00 AM (day of procedure).
Please CHECK as you complete:
_____Glass #1
_____Glass #5
_____Glass #2
_____Glass #6
_____Glass #3
_____Glass #7
_____Glass #4
_____Glass #8
OVERà
YOUR PROCEDURE IS SCHEDULED AT:
Princeton Endoscopy Center, LLC, First Floor
University Medical Center at Princeton-Plainsboro
Princeton Plaza, 731 Alexander Rd, Princeton
Medical Arts Pavilion, 5 Plainsboro Road, 2nd Fl.
Tel: 609-452-1111
Plainsboro, NJ 08536
Parking & Entrance are at the rear of the building
609-853-7500

ON THE DAY OF THE PROCEDURE:
• Be sure to bring your insurance card and PHOTO ID
• Bring a referral for the facility, if your insurance plan requires one
• Someone MUST drive you to and from your appointment as you wil be receiving sedation which impairs your ability
• You may take a taxi ONLY if you are accompanied by an escort over the age of 18. The taxi driver is NOT an
• DO NOT drive for the entire day
NO gum, NO mints, NO cough drops within 6 hours of your arrival time.
• Please brush your teeth the morning of the procedure: rinse and spit.
• Do NOT wear your contact lenses on the morning of the procedure.

Please take all of your usual medication upon awakening with a small sip of water, except for
medications you were specifically told to stop.


If you are diabetic:

_____Obtain specific insulin instructions for the day of the prep and the day of the procedure from your primary _____Do not take your oral diabetic medications the morning of the procedure. You wil receive specific
instructions about when to take it when you are discharged from the Endoscopy Facility.
If you take Coumadin, Plavix, Pradaxa, Xarelto or Aspirin:
_____You should not take Coumadin for ______ days before the procedure unless you are otherwise instructed.
_____You should not take Plavix for ______days before the procedure unless you are otherwise instructed.
_____You should not take Pradaxa for ______days before the procedure unless you are otherwise instructed.
_____You should not take Xarelto for ______days before the procedure unless you are otherwise instructed.
_____You should continue to take your aspirin unless otherwise instructed.
_____You can take your asthma medication AND please bring your asthma medication to your procedure.
The procedure general y takes about 40 minutes, but you should plan on being present for about 1 ½- 2 hours.
Nurse’s Notes: ________________________________________________________________ ____________________________________________________________________________________ ______________________________________________________________________

Source: http://www.princetongi.com/PDFs/Mar11_2013/2013%20Colonoscopy%20Inst.pdf

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