Colonoscopy instructions

Greg S. Cohen, MD
Office Address (DO NOT go here for the procedure):
GI Lab Address (go here for the procedure):
676 North Saint Clair Street, Suite 1525
675 N Saint Clair Street, Galter Bldg, 4th Floor
Chicago, IL 60611 312-695-4452
Suite 4-104
Chicago, IL 60611 312-926-2425

Outpatient Colonoscopy Instructions – HalfLytely Prep
Your procedure is scheduled for _______________, __________________ .
Please arrive at _______am/pm in order to register prior to the exam.
Plan to spend 3 hours in the GI Lab from start to finish.

Diagnosis: ___________________________________________________________________________
Please read carefully all the instructions TODAY and at least one week before your procedure and
follow the instructions exactly. Failure to do so may result in the need to reschedule your procedure. If
you have questions please call 312-695-4452 Monday – Friday, 8:00 am – 4:00 pm. After hours, we can
be reached at 312-649-2535. If you need to cancel, you must call with at least 48 hours notice in
order to avoid a “no show” fee.

ABOUT THE COLONOSCOPY
This procedure is an endoscopic examination of the colon by a physician. A thin, flexible tube with a
video camera at the tip is used to examine the colon. If necessary, a small piece of tissue (biopsy) can be
removed for further examination under a microscope. If a polyp is found, it can generally be removed
during the procedure. You will be given an intravenous line (I.V.) in the holding area. Immediately before
the procedure begins you will receive I.V. medication for sedation. The test will take approximately 30
minutes to complete. You will be returned to the recovery area where you will be monitored for at least
one hour after the procedure. Every effort will be made to keep your appointment at the scheduled time,
but in medicine, unexpected delays and emergencies may occur and your wait time may be prolonged. We
give each patient the attention needed for his or her procedure.
• You may not drive, operate machinery, make important decisions, or return to work for the
remainder of the day following your procedure. You may resume normal activities the next day unless the doctor states otherwise. You must have a responsible adult to accompany you home after the procedure. This person must
pick you up in the GI Lab. If you have another Doctor’s appointment or any other testing at
Northwestern Memorial Hospital after your GI Lab procedure, a responsible adult must escort you
out of the GI Lab and to your appointment.
You may not walk, take a taxi, or any public transportation home unless you are accompanied by a
responsible adult.
If our staff cannot confirm that you have made safe plans for discharge after your procedure, your procedure will be cancelled. If you will need assistance getting home after your GI Lab procedure, you can arrange a ride home
with Illinois Medi Car through Superior Ambulance Company by calling 312-926-5988. If you have
made Illinois Medi Car arrangements for your discharge home, please inform the GI Lab staff on the
day of your procedure.
If you are required to pre-certify your procedure with your insurance company, please make
certain that you have done so in advance. If your insurance company requires you to have a
referral for your procedure, please bring it with you on the day of your procedure. If you have
Medicare, an Advance Beneficiary Notice (ABN) will be presented to you. This form acknowledges
that Medicare may deny payment for the colonoscopy which could cause you to become responsible
for the cost of the procedure. Please contact Medicare directly with further questions 800-633-
4227.
REGARDING MEDICATION

If you are affected by any of the conditions listed below, please follow these instructions carefully.
Check with your physician regarding your dose of insulin and other diabetic medications needed the day before and the day of your procedure. Inform your Diabetes
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 the morning of your procedure. Heart Valve Replacement
Prophylactic antibiotics are no longer recommended for GI procedures according or History of Endocarditis
to the guidelines published by the American Heart Association in 2007. Blood Thinners:
Ask the physician who prescribed your medicine how to take it before and after Coumadin, Plavix,
your procedure. If you cannot contact your physician, call us several days Pradaxa, Xarelto, Eliquis,
before your exam. If you take Coumadin, you may need a blood test two Brilanta, Effient, Lovenox
It is desirable that iron supplements be held for five days prior Iron Supplements

RISKS OF COLONOSCOPY
Although colonoscopy is a safe test, there are inherent risks with all medical procedures. These risks
include, but are not limited to: 1) Risk of anesthesia reactions including cardiopulmonary complications.
2) Bleeding. 3) Perforation or puncture of the colon – a rare complication that occurs once in every
several thousand procedures. 4) Possibility of an incomplete exam in 1-2% of patients. 5) Possibility of
missed or incompletely removed polyps. Although colonoscopy is the best test for detection and removal
of polyps, it is not perfect. It is possible for polyps to be missed.
ONE WEEK BEFORE YOUR COLONOSCOPY
For best outcome, avoid eating foods that contain seeds, nuts, hulls, berries, or kernels (such as popcorn, poppy seeds, tomatoes, cucumbers, etc.). However, this instruction is not critical. TWO DAYS BEFORE YOUR COLONOSCOPY
If you are constipated (i.e. bowel movements every 2-3 days or longer), it is recommended that you drink
10 ounces of Magnesium Citrate laxative two days before the colonoscopy so that the preparation on the
day before the colonoscopy is easier and more effective. Magnesium Citrate is available without a
prescription at any pharmacy. If you have kidney problems or are on dialysis, do not take Magnesium
Citrate.

HALFLYTELY PREPARATION INSTRUCTIONS:
DAY BEFORE YOUR COLONOSCOPY
1. Today you may not eat any solid foods. You are to drink only CLEAR LIQUIDS all day long.
Clear Liquids include: water, coffee or tea without milk, strained fruit juices without pulp (apple, white grape, cranberry, etc.), carbonated beverages or soda pop, clear broth or bouillon. You may have plain Jello or Popsicles except for any red in color. You may have clear hard candy. If you are diabetic, please follow your usual dietary restrictions with regard to the liquids listed above. a. Drink one 8 ounce serving of clear liquids EVERY HOUR from the time you rise until you b. Between 4 p.m. and 6 p.m. (as early as possible) take 1 bisocodyl delayed-release tablet with water (this is included in the HalfLytely kit). Do NOT chew or crush the bisacodyl tablet. Do not take the bisacodyl tablet within 1 hour of taking an antacid. You will likely need to go to the bathroom within 1-3 hours of taking the bisocodyl delayed-release tablet. c. If you are scheduled for a morning colonoscopy: Between 8 p.m. and 10 p.m.
(approximately 2 hours after taking the bisacodyl tablet) begin to drink HalfLytely, 8
ounces every 15-20 minutes until the entire 2 liters are consumed. Then drink two 8 ounce
glasses of any clear liquid.
If you are scheduled for an afternoon colonoscopy: Between 8 p.m. and 10 p.m.
(approximately 2 hours after taking the bisacodyl tablet) drink four 8 ounce glasses of
HalfLytely, 1 glass every 15-20 minutes, followed by two 8 ounce glasses of any clear
liquid. On the morning of your colonoscopy, about 5-6 hours before the procedure, drink
four more 8 ounce glasses of HalfLytely, 1 glass every 15-20 minutes, followed by two 8
ounce glasses of any clear liquid.
d. In order to perform a successful colonoscopy, the colon must be cleaned of fecal material. This is accomplished using this preparation and will stimulate your colon to purge itself, and result in many trips to the bathroom. You will probably start to have a bowel movement within 1 to 2 hours of taking the laxative. The laxative may cause rapid elimination of stool. 2. Do not eat or drink anything after Midnight.
If your test is scheduled for the afternoon, you may have clear liquids up to 3 hours before the test. WHAT TO EXPECT ON THE DAY OF YOUR COLONOSCOPY
• You may brush your teeth, but do not swallow any water. • You may take your usual medications with small sips of water. If you use inhalers, prescription eye drops or nasal sprays, you may take them as you would normally and then bring them with you. • Please bring your completed GI LAB PATIENT QUESTIONNAIRE and MEDICATION LIST with
you (see the last 3 pages of these instructions). • If you have a colostomy or ileostomy, please bring an extra set of stoma supplies (flange, pouch, etc.) so that your stoma pouch can be replaced following the procedure. • Wear comfortable clothing that is easy to remove and leave jewelry and any other valuables at
home. Your belongings will be stored in a locked coat check room for the duration of your procedure.
• Please limit your visitors to 1 or 2 friends or family members. Visitors are not allowed into the GI Lab with you or into the recovery room. Please speak with one of the GI Lab staff members if you have a special circumstance or request. • Parking is available at the Huron/St. Clair Garage for a $10.00 rate with a validated ticket for 0-7 hours, 7-24 hours is $24.00. Remember to bring your parking ticket with you for validation. • Report to the GI Lab on the 4th Floor of the Galter Pavilion, suite 4-104 to check in at the registration desk at the arrival time scheduled by your Doctor’s office: • You will be required to show a photo ID, verify insurance information, address, phone number, and e- • You will be assigned a case number with which your friend or family member will be able to track
whether you are still waiting for your procedure, in the procedure room, or in the recovery room. • If you are concerned that you have been waiting too long after you have checked in, please speak to the front desk staff or a GI Lab staff member. • You will be brought into the GI Lab where a nurse will review your medical history, current medication list, and that you have taken your preparation appropriately. You will be asked to put on a hospital gown. An intravenous line (IV) will be started for your sedation during the procedure. You may be waiting in a gowned waiting room prior to your procedure with other patients.
There are many doctors that perform procedures in the GI Lab and many patients that are
having a variety of procedures. If you have any concerns about a delay or your exact
procedure time, please speak with one of the GI Lab staff members.
• During the procedure, your heart rate, blood pressure and oxygen level will be monitored. • You will be required to sign a consent form with the doctor prior to your procedure. • When your procedure is done, you will remain in the recovery room for at least 1 hour.
• You may still experience effects from the sedation, such as being tired and forgetful, for a few hours
• The recovery room nurse will review what you should expect to feel for the remainder of the day. If you had a colonoscopy, this includes feeling some gas pain. If you have had an upper endoscopy, you may have a sore throat. • After the procedure, you will receive preliminary results and follow-up instructions. • When you leave the GI Lab, please remember to take all of your belongings and your discharge • About 3 days after your procedure, you will receive a patient satisfaction form via e-mail. Please complete this, as your feedback is valuable to our operation. Please let us know if you will require special assistance while you are in the GI Lab for your
procedure. This includes having difficulty with starting IV’s, requiring a language interpreter,
requiring assistance with walking, changing clothing, or any other special request
please contact the GI LAB Clinical Coordinator at 312-926-7614.
GI LAB PATIENT QUESTIONNAIRE
Refer to Reminder below before completing this form. Thank you for choosing Northwestern Memorial
Hospital for your GI Lab procedure. Please fill out this form and bring it with you the day of the
procedure. Please answer each question. This allows us to provide you with the best possible care.
(Please Print)
Patient Name:
Date of Birth:
Date of Procedure:
Primary Care Physician: Name
Fax Number
Phone Number
Procedure & Related Information: (*): procedure normally requires sedation
Endoscopic Ultrasound/Fine Needle Aspiration* When was the last time you ate solid food? Date When was the last time you drank liquid? Date If your test required a bowel preparation, what preparation did you take? On the day of your procedure, will you have any of the following: (Please circle) Dentures, Removable Bridgework, Glasses, Hearing Aide, Walker, Cane, Wheelchair, Prosthetics, Other Who will be waiting for you during the procedure and/or taking you home afterwards? Reminder: Per NMH Policy, if you are having any type or amount of sedation or anesthesia you must have a
responsible adult to accompany you home after the procedure. This person must pick you up in the GI Lab. If you
have another doctor’s appointment or any other testing at Northwestern Memorial Hospital after your GI Lab
procedure, a responsible adult must escort you out off the GI Lab and to your appointment. You may not walk, take a
taxi or any public transportation home unless your are accompanied by a responsible adult. If our staff cannot confirm
that you have made safe plans for discharge after your procedure, your procedure will be cancelled. If you will need
assistance getting home after your GI Lab procedure, you can arrange a ride home with Illinois Medi Car through
Superior Ambulance Company by calling 312.926.5988. Illinois Medi Car Hours of Operation are
Monday-Friday: 7:00 am - 7:00 pm. Illinois Medi Car Rates are $30 for the first 10 miles, as a flat rate. Beyond 10
miles, $3.00 per mile will be charged in addition to the $30. You are not expected to pay on the day of service. You
will be billed at a later time. Any questions or concerns about a bill from Illinois Medi Car can be directed to Celeste
Basom at 630.854.1364. If you have made Illinois Medi Car arrangements for your discharge home, please inform
the GI Lab staff on the day of the procedure.
Prescribed Anticoagulants, Blood Thinners Insulin or pills to control your blood sugar Please fill out the PATIENT MEDICATION LIST and bring it with you the day of your procedure.
Please rate your pain - 0(no pain) to 10(worst pain) Have you or has anyone in your family ever reactions to the medications given to you during any Allergies (such as drug, food, latex) Please list Have you experienced a fall in the last 12 months? Have you ever fainted, felt dizzy or nauseous after having your blood drawn or an IV started? Diabetes: If yes, do you take insulin or pills? Did you take your blood sugar the day of your procedure? High blood pressure: Is your blood pressure controlled by medication? Do you take antibiotics prior to medical or dental procedures? Antibiotic and dose Heart pacemaker, implanted cardiac defibrillator Lung disease: (such as Asthma, Emphysema) Neurological Problems: (such as Seizures) Gastrointestinal Disease or Symptoms: (such as Reflux, Crohn’s Disease, Ulcerative Colitis) Liver Disease: (such as cirrhosis, hepatitis) Are you pregnant - When was your first day of your last Menstrual Cycle? Other: (such as arthritis, blood disorders, infectious diseases) Do you follow a special diet for medical reasons? (For example, gluten free) Have you visited a GI Lab in the past? If so, please list the procedure(s) you have had and the year it took place: Patient
Signature:
Signature of
Admitting Nurse:
GI LABORATORY
At-Home Medications List
Dear Patient, Please complete the Allergies and Medication sections. A staff member will review this list with you if there are any questions. If you have questions about medications NOT prescribed during today's visit, please contact your primary care physician.
ALLERGIES:
None (check the box if you do not have any allergies) Reaction
Reaction
MEDICATIONS: None (check the box if you do not take any medications, vitamins, herbals, etc)
STRENGTH
FREQUENCY
LAST DOSE
Physician:
DOSE FORM
Please check if
prescribing
additions or changes to
medications
Staff:
If checked, refer to
Instructions below. If
not checked, file list
Do not write below this line - Hospital Staff ONLY INSTRUCTIONS:
Staff: If, during this visit, the patient was prescribed a new medication for a chronic disease/condition or a change was made to the
at-home medication regimen for a chronic disease/condition, complete the patient instructions portion below, instruct the patient
regarding additions and/or changes, and provide the patient with a photocopy of this document. After completion, check box below,
and file.
Medication instructions were reviewed with the patient. The patient received a photocopy of this medication list.
Patient: START/RE-START taking this at-home medication(s):
Start taking this Date, if any, you should stop
Patient: STOP taking this at-home medication:
STOP taking this Medication at this Strength, Dose/Dose Form, and Frequency:
STOP taking this Medication on:

Source: http://www.cohengastro.com/PDFs/Patient_Instructions___Colonoscopy__HalfLytely_Prep_.pdf