Colonoscopy bowel preparation Instructions for Senna tablets and two sachets of Citrafleet

Colonoscopy bowel preparation Instructions for Senna tablets and two sachets of Citrafleet image

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Colonoscopy bowel preparation Instructions for Senna tablets and two sachets of Citrafleet

Introduction
You have been given this leaflet so that you can prepare for your colonoscopy. To be able to get a clear view of the lining of your bowel it is very important that you follow the bowel preparation and dietary advice below to clear out your bowel before the procedure.

Bowel preparation
A pack of Senna tablets and two sachets of Citrafleet® are enclosed. This comes with instructions inside the packaging, but you must follow our instructions below. Our instructions have been designed by our consultants to provide the best results so that we can carry out your colonoscopy successfully.

Seven days before your colonoscopy

Iron tablets:

  • If you are taking you must stop taking these 7 days before the procedure. You will be able to start taking them again once the procedure is done. This includes any multivitamin tablets or preparations bought over the counter.
  • Please bring a list of any medications you are taking and any medication you may need to take after your procedure.
  • Please avoid seeded bread products for one week before your procedure.
  • You should not eat red jelly for one week before your procedure as this may colour the lining of your bowel.

Five nights before your colonoscopy

Please take 2 tablets of Senna each evening for 5 days*, with day 5 being the same day as the first dose of Citrafleet®

*The remaining tablets in the pack of senna can be returned to the local community pharmacy for safe disposal, if not used on another occasion.

Five days before your colonoscopy

Blood thinning medication:

  • If you are taking blood thinning drugs, these can cause a risk of excessive bleeding when we perform your camera test or take any tissue samples. Please be aware that if we find any pathology during your test and this requires additional intervention, then you will be advised at the time of your test how best to manage your medications. Please follow these instructions:

Warfarin

  • If you are taking Warfarin, please continue to take your normal medication but please ensure that your INR level is below 3. This needs to be checked two days prior to the day of your procedure. Please don’t stop taking this unless you have been advised directly to stop.

Phenindione, Rivaroxaban, Apixaban, Dabigatran, Prasugrel, Ticagrelor or Clopidogrel

  • Please do not take any of these drugs on the morning of your procedure, unless you have been given specific instructions otherwise;
  • Stop taking any medicines for diarrhoea i.e. Lomotil, Loperamide, codeine phosphate etc.
  • Bowel Cancer Screening – The Specialist Screening Practitioner will provide you with clear instructions about your medication and when to stop these. Please follow these instructions as they are specific for your procedure.

If you have diabetes, please see pages 7-8 of this leaflet.

Two days before your colonoscopy

Food and drink

  • Try to drink two litres of clear fluids (eight – ten glasses) per day until the day of the procedure. Examples of clear fluids are black tea, herbal teas, black coffee, fruit squash, water, meat extract drinks (e.g. Bovril or Oxo) and clear soups (without bits in)

Eat only food from the following list:

  • Boiled or steamed white fish (not fried)
  • Chicken (no skins)
  • Eggs
  • Cheese
  • White bread, pitta. Chapattis made with white flour
  • Plain muffins
  • Butter or margarine,
  • white rice or pasta
  • Clear soups (no bits)
  • Rich tea biscuits
  • Potatoes and pumpkin (no skins)
  • Cauliflower/asparagus tips only
  • Tofu
  • Natural yoghurts
  • Plain cottage cheese
  • Tinned peaches/pineapple
  • Plain sponge cakes
  • Plain ice cream (any flavour – no fruit or nut pieces)
  • Salt, pepper, sugar, sweeteners, honey, marmite

Do not eat:

  • Any high fibre foods:
  • Seeded or brown bread
  • Red meat
  • Pink fish (e.g. salmon)
  • Brown or wild rice
  • Brown pasta
  • Raw fruit or vegetables (except those listed above)
  • Cereals
  • Salads
  • Mushrooms
  • Nuts/seeds/pips
  • Sweetcorn
  • Pickles or chutneys

For a morning procedure please follow below:

The day before your colonoscopy
Have a good breakfast and light lunch of foods taken from the permitted list above until 12noon.

  • From 12noon do not eat any solid food until after your examination but drink plenty of clear fluids from the list provided.
  • At 4pm dissolve the contents of one sachet of Citrafleet® in approximately 150mls of cold water and stir for two to three minutes before drinking. Do not worry if the solution becomes warm or hot – allow it to cool a little before drinking. After a period of ten minutes following the administration of each reconstituted sachet, it is recommended to drink approximately 1.5-2 litres of a variety of clear fluids at a rate of approximately 250-400 ml per hour.
  • At 9pm Take the second sachet of Citrafleet®. Mix the sachet as before.
  • You must continue to drink plenty of clear fluids from the list given up to two hours before your appointment, then stop drinking until after the test.

PLEASE DO NOT DRINK ALCOHOL ON THE DAYS YOU TAKE THE CITRAFLEET®

The solution will cause you to pass watery stools so you should stay near a toilet.

Take your usual medication (unless you have been advised to stop it) at least one hour before or after you take the bowel preparation. If you are taking the oral contraceptive pill you should take other precautions for one week after the test.

For an afternoon appointment please follow below:

The day before your colonoscopy
For your meals the day before procedure choose only foods from the permitted list above until 4pm.

  • From 4pm do not eat any solid food until after your examination but drink plenty of clear fluids from the list provided.
  • At 7pm dissolve the contents of one packet of Citrafleet® in approximately 150mls of cold water and stir for two to three minutes before drinking. Do not worry if the solution becomes warm or hot – allow it to cool a little before drinking. After a period of ten minutes following the administration of each reconstituted sachet, it is recommended to drink approximately 1.5-2 litres of a variety of clear fluids at a rate of approximately 250-400 ml per hour.
  • During the rest of the evening, drink at least one and a half litres of water

PLEASE DO NOT DRINK ALCOHOL ON THE DAYS YOU TAKE THE CITRAFLEET®

The solution will cause you to pass watery stools so you should stay near a toilet.

The morning of your colonoscopy
Do not eat any solid food until after the examination.

  • Take the second sachet of Citrafleet® At 9.00am. Mix the sachet as before.

You must continue to drink plenty of clear fluids from the list given up to two hours before your appointment, then stop drinking until after the test.

Take your usual medication (unless you have been advised to stop it) at least one hour before or after you take the bowel preparation. If you are taking the oral contraceptive pill you should take other precautions for one week after the test.

Are there any side effects?

  • Please expect to have frequent bowel actions and eventually diarrhoea starting within three hours of taking the first dose of bowel preparation medicine. We would strongly advise that you stay within easy reach of a toilet once you start taking the preparation medicine. If you need to, please use a barrier cream such as Zinc and Castor oil or Sudocrem®, on your bottom to prevent soreness.
  • If you do not drink enough fluids you may get dehydrated, feel dizzy, faint or get a headache.
  • Some stomach cramping is normal.
  • If you vomit up the preparation medicine at any time, or you have any other concerns regarding side effects please contact us directly during office hours (8am – 6pm).

Patients with diabetes
If you monitor your blood glucose, please monitor it every 2 hours on the day of your procedure up to admission where it will be checked by a member of the nursing team

Patients with Insulin Treated Diabetes

Basal-bolus regimen (injections 3 or more times a day)
Instructions for the day before the colonoscopy:
Give half the usual rapid acting insulin doses with each meal (e.g. Novorapid®, Humalog®). Continue the usual dose of long acting insulin (e.g. Lantus®) if taken in the morning, but reduce the dose by 20% if taken in the evening. If on a once or twice daily insulin regimen, take half the usual dose of insulin.
The instructions for bowel preparation should be followed. Some of the oral fluids contain glucose e.g. apple juice, Lucozade or squash (not sugar-free).

Instructions for the day of colonoscopy:
Basal-Bolus regimens (Injections 3 or more times a day)

Before the procedure:
For those taking long-acting insulin (e.g. Lantus®, Levemir®) in the morning, reduce the usual dose by 20%. For those taking rapid acting insulin (e.g. Novorapid®, Humalog®) with breakfast, omit this before the test.

After the procedure:
Give the rapid acting insulin with the first meal following the procedure. The usual basal dose of insulin should be given in the evening.

Insulin: Twice daily regimens
Mixed insulin injections twice a day (e.g. Novomix 30®, Humalog Mix 25® or 50®)

Before the procedure: Half the usual morning dose of insulin should be given.

After the procedure: The usual evening dose of insulin should be given.

Insulin: Once daily regimens (Injections once a day, e.g. Insulatard®, Humulin I®)
A 20% reduction of the usual dose of insulin should be given if taken in the morning.
The usual dose should be given if the insulin is taken in the evening.

If there is any doubt or concern, the local diabetes specialist nurse or consultant should be contacted for advice.

If more than one meal is to be missed, or there are two consecutive blood glucose levels above 15mmol/l, an insulin infusion may be needed.

Patients with Diabetes Treated With Tablets and/or a GLP-1 Agonist

The day before the test
The usual diabetes treatment should be omitted.

The instructions for bowel preparation should be followed. Some of the oral fluids contain glucose e.g. apple juice, lucozade or squash (not sugar-free).

The day of the test
The usual diabetes treatment should be omitted in the morning. Fluids (including some that contain glucose) should be drunk. It is recommended that blood glucose is checked every 2 hours from waking until the test.

After the test
Usual diabetes treatment should be resumed.

If there is any doubt or concern, the local Diabetes Specialist Nurse or consultant should be contacted.

Contact Details:
If you have any specific concerns about your procedure, that you feel have not been answered and need explaining, please contact the following:

Alexandra Hospital Redditch

  • Booking Office – 01527 505751
  • Endoscopy Nursing Staff – 01527 512014

Evesham Community Hospital

  • 01386 502443

Kidderminster Hospital

  • Booking Office – 01562 826328
  • Endoscopy Nursing Staff – 01562 513249

Worcestershire Royal Hospital

  • Booking Office – 01905 760856
  • Endoscopy Nursing Staff – 01905 733085

Other Information:
The following internet websites contain information that you may find useful:

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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