Elliot Health System is a non-profit organization serving your healthcare needs since 1890.

Gastroenterology


Preparing for your colonoscopy

NULYTELY


Having a colonoscopy can be daunting, but with a little preparation and some knowledge the procedure is easier to handle. That’s what this brief guide is about. It’s broken into sections so you can refer to them as you need them. The sections are:

  1. General checklist of things to do in the weeks before your procedure
  2. Colonoscopy bowel preparation materials
  3. 7 days before the colonoscopy
  4. 2 days before the colonoscopy
  5. The day before your colonoscopy
  6. The day of your colonoscopy

We’re also here to help, so please call Elliot Gastroenterology at (603) 314-6900 with any questions or concerns.


Please note:
If you are having a colonoscopy AND an EGD, these instructions are inclusive of the EGD prep.

We require a one week notice for all procedure cancellations. Please call 603-314-6904 in the event that you need to cancel or reschedule your procedure.

Please be aware that you may be contacted by the procedural department the day of your appointment to adjust your arrival time.


Section 1

General checklist of things to do in the weeks before your procedure:

Check these things at least 2 weeks before the appointment.

  • Check your Insurance benefits and make sure you are aware of your coverage. Contact customer service with your insurance company. Be sure to ask what is covered under insurance plan, and what isn’t.
  • Diabetic patients – Make sure you have contacted your managing or prescribing doctor for medication instructions.
  • If you are on prescription blood thinning medications – you must contact your managing or prescribing doctor for instructions. If your managing or prescribing doctor is at New Hampshire Cardiovascular Consultants, you will be contacted by a nurse from their office approximately 2 weeks before your procedure with instructions.

You will be sedated.
You will receive intravenous sedation during your procedure. You will be monitored throughout the entire procedure. The medications used during the procedure, although relatively short acting, have subtle, prolonged effects on your reaction and judgment time, thought processes, and wakefulness. Because of this you will need a responsible adult to drive you home from your appointment.

If you have children or are the primary caregiver for a family member:
Arrangements should be made for all-day childcare, or dependent care. While the sedation you will receive during your procedure is mild, it can have an effect on the decisions you make after the procedure is done. If possible, bring in someone to help, even if you don’t think you will need it.

What to bring to the appointment. Getting the items from this list together now, and understanding some of the basic requirements, will save time and make things easier on the day of your procedure:

  • Bring your Insurance card
  • Bring your photo Identification
  • Bring a list of all medications and dosages, and allergies to medications
  • Bring a list of conditions that may make you sensitive to sedation.
  • Please wear glasses; DO NOT wear contacts.
  • Leave all jewelry at home, including body piercings.
  • It is okay to brush your teeth and wear dentures.
  • Please allow for two to four (2 to 4) hours at the facility *Please be aware unexpected delays may occur*
  • Do NOT make any important decisions for the entire day of your procedure.
  • Please have a responsible adult stay with you after your procedure. You should not be left unattended.

We fully expect you will be able to return to your normal activities the day after your procedure. This includes driving and going to work.

What to know about your Insurance Coverage
Please know your insurance guidelines and check your insurance benefits. If your insurance requires a Primary Care Provider (PCP) authorization (insurance referral), please be sure our office has received this before your procedure to prevent any unnecessary out-of-pocket expenses for you. Also, not all insurance policies cover screening colonoscopies. For instance, if you are less than 50 years old and/or have Preferred Provider Organization (PPO) insurance, this procedure may not be covered. Every insurance plan is different; please contact customer service for your insurance plan to check your benefit coverage.

You may be scheduled for a screening colonoscopy (covered by most insurance as a preventative procedure). If polyps are found, some insurances will process the procedure as diagnostic (subject to deductible). Please be aware of your insurance coverage.


Section 2

Colonoscopy bowel preparation with Nulytely:

Nulytely (pronounced “new-lightly”) is a prescription bowel preparation. Your Nulytely prescription will be called into your pharmacy approximately one week prior to your scheduled procedure date.

You may use the flavor packets that come with your prescription, or you may purchase Crystal Light powder for flavoring. You may use a flavor that is yellow, orange, or green. You may not use flavors that are red, blue, or purple.

You will also need to buy the following a few days before the procedure.

No prescription is necessary, and these can be purchased at most pharmacies.

It is acceptable to purchase the generic equivalent:

  • Dulcolax tablets, 5 milligrams (mg). You will need 6 tablets. This is the laxative tablet. DO NOT get the suppository or the stool softener.



Section 3

7 days before the colonoscopy:

  • Stop Iron supplements and multivitamins that contain iron, Vitamin E, or fish oil.
  • Do not take supplements in gummy form.
  • Stop any fiber supplements such as Metamucil, Benefiber or Citrucel. Check with your managing provider for alternatives.
  • If you are diabetic, call your managing or prescribing doctor to determine how your diabetes medicine should be taken the day of the procedure.
  • If you are on prescription blood thinning medications, you must call your managing or prescribing doctor and have a plan for these medications. These medications include Coumadin, Warfarin, Plavix, Xarelto, Pradaxa, Effient, or any equivalent.
  • If your cardiologist is part of New Hampshire Cardiovascular Consultants, you will be contacted by a nurse from their office approximately 2 weeks prior to your appointment with instructions on how to come off this medication.

You should receive a call from a nurse a few days before your procedure to review your health history and answer any questions you may have. This will help streamline the admission process the day of your procedure. Elliot Hospital pre-op phone number: 663-3193. Elliot One day Surgical Center (ASC) pre-op phone number: 663-5921 and 663-5968.

If you develop a fever, rash, cough or flu-like symptoms in the days leading up to your procedure, please notify our office immediately.


Section 4

2 days before the colonoscopy:

  • REVIEW colonoscopy bowel preparation instructions.
  • Arrange and confirm your transportation to and from your appointment. You CANNOT drive yourself home after your procedure because of the sedating medications.
    Begin low-residue and low-fiber diet. Low -residue foods will be pushed quickly through the colon, leaving little behind.

    Foods you can eat:
    Turkey (without skin)
    Fish
    Chicken (without skin)
    Eggs
    White rice
    White bread
    Crackers
    Plain yogurt
    Pasta (no red sauce)
    Potato without skin
    Gelatin
    Broth
    Bouillon
    Bananas
    Any liquid without red, blue, or purple dye in it.

    Foods you can't eat:
    Fresh or dried fruit (exception of fresh banana)
    Cooked and Raw vegetables (all)
    Raisins
    Nuts (all)
    Seeds (all)
    Red meat
    Popcorn
    Beans
    Gum, mints or hard candy

  • If a food item is not on the allowed list, you should not eat it.

  • At 5:00 PM: Take 2 of the Dulcolax tablets with 8 ounces of water. This could cause you to have a bowel movement within 6 hours.


Section 5

The day before your colonoscopy:
Drink ONLY clear liquids throughout the entire day - DO NOT EAT SOLID FOOD TODAY.

Drink at least 8 glasses of water or clear liquids today, in addition to your Nulytely solution.

It is important to drink a lot of fluids the day before the procedure. The preparation can be dehydrating. The more you drink, the better you will feel. You may have clear liquids up until 3 hours prior to your procedure time.

Allowed: Clear liquid is any liquid that you can see through. This includes water, clear broth or bouillon, black coffee or black tea (sugar is ok to add). Gatorade, PowerAde or vitamin water that is clear, yellow, orange or green are all OK. Lemonade, carbonated soft drinks (no dark soda such as Coca-Cola, Pepsi, etc.), apple juice, white grape juice, white cranberry juice are all OK. Jell-O and popsicles are allowed if they are yellow, green or orange colored.

Avoid: All solid foods after 8am, milk and milk products, any drink or food with RED, BLUE, or PURPLE dye. These items are NOT allowed. Don’t drink a lot of coffee and tea they dehydrate you. Avoid alcohol as well, it dehydrates you.

Today you must do the following:

  • In the morning, add water up to the fill line of your Nulytely bottle.
  • Add the flavor packet that came with your Nulytely bottle, or you may add powdered Crystal Light (NO red, blue, or purple flavors).
  • Stir or shake the bottle until the powder is completely dissolved.
  • Refrigerate the Nulytely bottle. You will be drinking this later today.
  • At 1 p.m. take 2 Dulcolax tablets with an 8 oz. glass of water.
  • At 3 p.m. take 2 more Dulcolax tablets with an 8 oz. glass of water.
  • At 5 p.m. Begin drinking the Nulytely solution. You should drink half of the solution tonight within a 2- to 3-hour time period. Drink one glass every 10 to 15 minutes. Drink each glass quickly, rather than drinking small amounts continuously.
  • Refrigerate the remaining half of the solution. You will finish drinking this tomorrow morning.

Everyone reacts to laxatives differently. You may feel bloated, nauseated, or have stomach cramping while drinking the solution. This is temporary and will improve once you start having bowel movements. If you feel ill, stop drinking for 30 minutes and then resume drinking at a slower rate. Walking around between drinking each glass can help with bloating. Bowel movements usually start within 2 hours of starting to drink the liquids, but may take longer.


Section 6

The day of your colonoscopy:

  • No broth the day of your procedure. Clear liquids are fine up until 3 hours before your procedure time.
  • 5 hours prior to your procedure time, shake up the remaining half of the Nulytely solution.
  • Begin to drink the remaining solution. Finish drinking the bottle within 2 hours.
  • 3 hours prior to your procedure time, you may take only these medications with a small sip of water:
    • Daily narcotic
    • Anti-anxiety
    • Blood pressure/cardiac medication
    • Seizure medication
    • Asthma inhalers
  • After taking your medications, nothing by mouth, EVEN WATER, 3 hours before your procedure time or else your procedure WILL be cancelled!

If you continue to pass thick, brown liquid or solid bowel movements, please call our office early in the day to discuss if you are adequately prepared. The best results should include passing only clear yellow liquid.

Please call Elliot Gastroenterology at (603) 314-6900 with any questions!