Prep(s)aring For A Colonoscopy

Preparing a patient for a test involves instructing them with specific teaching points plus not just listening, but hearing the patient's questions in order to ensure the best results. There are many steps leading up to a colonoscopy that can prevent a repeat test due to an inadequate prep. These steps can get confusing, so this is where nurses can guide patients in navigating the do's and don'ts.

Because it's not a simple, "stay NPO after midnight" instructions, we will go over tips for the days preceding the colonoscopy, the different preps, special indications for diabetics and renal patients, and some important things to remember post colonoscopy.

Tips

Having a clean colon can literally save a person's life because if there is stool left, it can adhere to the wall of the colon or pool in a puddle, covering a sessile polyp, or other disease process. Sessile polyps are flat and are more likely to become cancerous than polyps on a stalk. Usually the doctor will repeat the colonoscopy soon enough to catch it, but some patients put it off not realizing the dangers.

Dr. Robert Bresalier is quoted in the article, " Ensure success with colonoscopy prep," " If the prep isn't done right, and your colon isn't completely clean, the danger is we won't see important, potentially cancer-causing polyps."

It seems like everyone has advice about how best to get ready for a colonoscopy, but there are some diet suggestions that are proven to help. According to the article, "Preparing for a colonoscopy" by The Family Health Guide, begin several days before the test date to eat low fiber foods. Stay away from whole grains, seeds, dried fruit, nuts, and vegetables. Good things to eat are; soup, chicken, fish, white rice, pasta, eggs, with plenty of fluids.

More specifically, one week prior have patients stop fiber supplements like Citrucel or Metamucil. If they take iron pills, they need to be stopped as well as NSAID's such as Aleve, naprosyn, and ibuprofen. Most doctors will allow continued use of aspirin, especially if patients have a history of a stroke or heart attack, but anticoagulants such as plavix and coumadin and over the counter herbs and vitamins like vitamin E, should be discontinued. Patients need to check with their cardiologists regarding their anticoagulant therapy before scheduling a colonoscopy.

Depending on the doctor's request, some patients are told to be on clear liquids the day before the prep, which is two days before the actual test, or just the day of the prep. It is important to reinforce what clear liquids are, such as broth, sprite, coffee (no milk), jello, and frozen popsicles.

Follow Your Instructions

Instruct patients to read over all instructions several days before their colonoscopy, and again the day before the prep to make sure nothing is forgotten. A must for patient's comfort is wet wipes and butt balm. Their bottom will be sore, so using these items from the beginning will decrease irritation.

The previous articles, “To Colonoscopy or Not to Colonoscopy” and “Diseases of the Colon: A Case for Getting a Colonoscopy” explained the importance of getting a colonoscopy and diseases of the colon. This article will complete the thread, tying it up by talking about how important it is to follow the doctor’s instructions in colon cleansing and how nurses can be patient advocates to ensure their success.

According to "The Gourmet Colon Prep" by Carol Rees Parish, R.D., M.S., the following colon preps are the most common.

• NuLytely (GoLytely) - powder miralax (PEG-3350) in 3-4 liters with flavors available. This prep requires clear liquid diet the day before the procedure.
• Half-Lytely - Miralax (in 2 liters) along with bisacodyl delayed release (4 tablets) with clear liquids the day of the prep.
• Colyte - Miralax in 3-4 liters with flavors available. No solid food allowed after light lunch then prep begins between 4 and 6 pm.
• Moviprep - Miralax in 2 liters with 1 liter of additional clear liquid. A small dinner of yogurt or clear soup one hour before the prep begins the night before the test.
• Fleet Phospho-soda - Monobasic sodium phosphate monohydrate, comes in a 45ml bottle or 75ml prep kit. A total of 72 oz prep after a low residue lunch followed by prep and clear liquids starting at 2pm the day before procedure. Extra fluids strongly encouraged.
• Lo-So Prep - Magnesium carbonate, citric acid, potassium citrate, and bisacodyl tablets. The powder is mixed in 8 oz of water along with 4 tablets, and one suppository. Not much is available about further recommendations such as diet and fluids.
• OsmoPrep - Sodium Phosphate monobasic - 32 (thirty-two) tablets with 64 oz. clear liquids minimum.
• Suprep - Sodium sulfate, potassium sulfate, and magnesium sulfate. Some doctors will have patients on a clear liquid diet two days before, then depending on the doctor's order, one dose of 6 oz mixed with water to make 16oz. The second dose is the same day or the next morning both doses followed by 2 16 oz. water.

Tips to Make the Prep More Palatable

No red or purple colored drinks or frozen items! The reason for this is that the red/purple dye will look like blood because the dye remains in the colonic fluids. Chilling the prep is recommended along with drinking it quickly through a straw. Rinsing the mouth helps to remove the taste of the prep and/or suck on hard candy. Remember nothing after midnight, even gum or hard candy will generate bile production and increase the chance of aspiration or cancellation of the procedure.

Special Considerations

Diabetic patients should check their sugar levels frequently, and choose sugar free clear liquids.

Kidney patients must take special precautions, avoiding preps with sodium phosphate. Sodium phosphate crystals can deposit in the kidneys, causing damage, impairing tissue along with electrolyte imbalances. NuLytely or GoLytely are safe alternatives for renal impaired patients.

Post Colonoscopy

Most patients go back to normal diet and medications post procedure. If there were biopsies taken, the doctor will call the results to them, or discuss the pathology on the follow up visit in the office. Patients usually receive written discharge instructions and pictures along with a verbal result from the doctor immediately post procedure. The patient should not drive, operate any machinery, or make any legal decisions for about 24 hours, and it is recommended to have someone stay with them during this recovery period.

Conclusion

It has been established that a screening colonoscopy can save a person's life. Making up your mind to go ahead and schedule one is the first hurdle. We as nurses should be an example and get ours when appropriate, plus it gives us insight into what the patient goes through.

Educating the patient on the benefits of a colonoscopy and the importance of following the prep instructions can make a huge difference in their success.

**If you are a floor nurse and the patient is not taking the prep as prescribed or they are not having the expected results - call the doctor. There are steps that can be taken to "move" things along or delay the procedure until the patient is compliant in finishing the prep. This saves everyone a lot of phone calls and an incomplete colonoscopy due to inadequate prep.

Helping one patient at a time get through the rough days of colon cleansing is how to make the largest impact. You will learn from them and they will learn from you, taking that knowledge to the next patient and friend or family member.

This concludes the articles regarding colonoscopies, thank you for reading all three of them and happy prepping!

References

Espat, Adelina, & Cordeiro, Brittany. "Ensure success with colonoscopy prep." Focused on Health, March 2014. MDAnderson Cancer Center. 6 June, 2015. Web.

Parrish, Carol Rees, R.D., M.S. "The Gourmet Colon Prep." Nutrition Issues in Gastroenterology, Series #56. Practical Gastroenterology, Nov. 2007. 6 June, 2015. Web.

White, Martin R., M.D. "Gatorade/Miralax Prep For Colonoscopy." Medical Clinic of Houston, L.L.P. 6 June, 2015. Web.

To read the other articles in this series go to:

To Colonoscopy or Not to Colonoscopy

Diseases of the Colon: A Case for Getting a Colonoscopy